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Hello guys. Good evening and welcome to this evening's talk. Uh apologies about the delay in commence in the talk. There was a couple of troubleshooting scenarios to attend to. So I'd like to begin by thanking you all for joining us on this Monday evening for this mind the bleep talk. Um It should be in the region of about three quarters of an hour and we're kindly also joined by the BMA as well. It will fix that the talk and will hand over to me after that for the talk on navigating complaints and investigations. If you have any points at any point that you'd like to comment, please feel free to directly add into the comment box and we we're happy to be interrupted as we go along our presentation. So we hope you have a good evening with us and any questions, please feel free to say. So, I'll hand you over to Dan Cool. Uh So yeah, I'll be, I'll be super quick everybody. Um Obviously there's a lot going on around the BMA at the moment, so maybe not too much new information um for you and I'm sure everybody is watching is is a member, but if anyone's not a member, um you can take advantage of that QR code that I put on the screen. This isn't available um online. So it's just a one off if, if I, if I can get to see you guys. Um So if you use that QR code, you'll get your first month for membership uh free if, if you're not a member at the moment. Um So yeah, so what are we? Um again, I'm, I'm sure everyone knows what, what, what the BMA is at this point. Um You know, time to time, we get confusion with companies like MDU mps. Um So indemnity companies. Um So easiest way to, to remember it is we deal with sort of the nonclinical things and they deal with the, the clinical side of things. So everything's sort of pay related mostly and, and sort of relationships between um yourselves and, and other healthcare professionals. Um That's us and then anything sort of patient related, it's, it's um sort of indemnities side of things, three ways to think about how, how the BMA operates um on a on an individual basis. So things like contract checking, um road checking, um any issues you get into personally locally. So um if, if you guys are sort of a group of say F twos, they are all facing sort of similar issue. Um We can get involved in that sense and then obviously on A L on a national level. Um, what's going on with, with the pay restoration campaigns? Um, so, yeah, so three ways of looking at it. Um, so, yeah, just, uh, just the sort of the frequently asked stuff that we get outside of the, um, outside of pay restoration. Um, I won't go too in detail on that, but I obviously do want to touch on it. Um, the re ballot is ending in two days for, for junior. So if you haven't sent it back yet, then, um that's the, the cut off is, is was uh the 15th, so we probably won't get it, but I'm sure everyone's sent it back already. Um You've probably seen as well. There's been an offer to consultants, another offer. So an improved one. the consultants only just rejected the last offer. Um 51%. No to 49%. Yes. So this will probably be the first domino um to, to fall. Um I think the, the consultant, the, the the thinking is the consultants would accept this deal. So that would be the consultants done. Um And obviously you've got junior doctors and S SAS doctors still um completely different fights. II know. Um and a and a lot more sort of um wanted. Um But yeah, but, but it's, it's good news that it's sort of um things are going in the right direction, at least in terms of consultants. Um So yeah, so just a little bit outside of outside of the pay stuff. Um, these sort of questions you can come to. So it's, it's just good to remember that. Uh, we, your first off call, um, if there's, if you've got any issues and you're not sure how to do it, obviously hr can be quite um off putting or, or not really get back to you when you, um, when you email. Um, so if you get in touch with us, we have contacts and we, and we know who to speak to and we have people on the ground at every trust contract checking. I'm sure you use this. Um, it's not the time of the year, I'm sure not, not many of you have got contracts recently, but you can check it speculatively throughout the year anyway. Um, last year, 25% of the contracts we checked, didn't comply with the national models. Um, for better, for worse, we negotiate the contracts um, with the government. So we know what should be in them. There's no reason for them to be wrong. Um, 25% of those that, that we checked were wrong. Um I'm not saying that it's done on purpose but things can be slipped in when they shouldn't be. Um, so it's very naughty. So, um, if you just want to send in any time speculatively, we can check it if you've already signed it and you've been working on it for a long time. Don't worry. Um, we can still get it rectified. Um, if you're, if you're owed any pay, um, we get back millions and millions of pounds, um, for, for doctors over, over the years. Um, so yeah, so just, just if, if you've got a moment, you can forward on your PDF to us and we'll check it and get back to you within five working days. Road checking is a bit more standard. Um, you can check that um on our, on our checking tool online. Um And then yeah, a few more resources. BMA library is, is moving fully online now. So obviously we used to have um BMA House where people go and sort of study and stuff if you're London based. Um but yeah, with, with COVID, um a lot of stuff moved online now. It's basically completely gone online, which is good for, for the, the, the majority of the country anyway, because you can access everything you need instantly. Um clinical key if you've not used it before, it's a point of care to lots of er, procedure videos and whatnot on there. So it's good to have a play around with. Um We also run a series of webinars as well throughout the year. Um You can watch those back on, on, on repeat if you, if you don't want to catch them live. Um So yes, there's a few written there. B MJ learning. So you've got full access to B MJ learning as part of BMA membership and if you, you sh you would be getting all your BM Js through the post. Um I'm sure everyone's got their address details up to date, especially with what's been going on the ballot. Um worth mentioning that you can turn off to B MJ. So you just need to give us a quick phone call, er drop us a quick email support at bma.org dot UK and just say yeah, I'd rather just read them on the app cos you can just read them on there anyway. Um Not sure how, how, how much the supply is everyone watching. Um but we've got a specialty application, uh specialty, specialty explorer tool, sorry. Um It's basically a psychometric test which takes about 20 minutes to complete. It asks all sorts of work life balance questions and then at the end, it will give you um a detailed report of all the top two specialties according to the answers you and um and it often throws up things that you, you may not have thought about. So it's worth doing it sort of different times um for throughout your career. Um So when it comes to choosing your specialty, you've got, you've got a pretty um good, good er judgment with, with the aid of, with the aid of specialty explorer. Um We've got a really good wellbeing er service. So this is open 24 7 and it's available to everybody regardless of whether you a member or not. Um And the unique thing about this is you have the choice of either speaking to a counselor or a peer support doctor and obviously any, any conversations we have are completely confidential of the trust. Um And, and obviously nothing is nothing shared. So, um you can just speak to us directly. That's it. Um I won't take any more time. Thanks for listening to my little bit and I'll hand you back now. Um Yeah, it like I said at the start, if you, if, if you're not a member and you want to take advantage of that offer, then then go for it. Um get your first membership free. So that counts if you're joining for the first time or, or rejoining. Cool. Thanks for listening to me. Um And yeah, I'm, I'm, I'm around. If you wanna message me any questions, I think we're having trouble hearing you again. There you go. Hopefully you should have the presentation on, on the presentation and slide is, is a slide, sorry of fine and sound is fine now as well. Amazing. Thanks for your help, doc. Um So thank you again um for coming and joining us for this talk today. Um So my name is Gagan De, I'm a foundation doctor in the West Midlands and this has been brought together in collaboration with the. So I appreciate all, all of you uh giving your time this evening and what we'll be going through is essentially a quality improvement project that's been led um in the West Midlands, but the purpose is to enroll it nationally. Um, and it's title navigating through complaints and investigations in the NHS we're working in, uh in an environment where there's a lot of pressures amongst staff and having recently graduated from medical school. It's something that we really didn't touch on in medical school. But I think it's a very important topic given that we're working in such pressure, especially in a post pandemic environment with all the challenges that arise in the workplace, just as a brief disclaimer before we begin. So this is a presentation that has been developed by myself and one of my colleagues and it's been uh been over by the mind, the be team as well. And the purpose today is just to give you an overview of um what to expect and how to best navigate through problems should you encounter them? And I guess always the best approach is trying to avoid problems before they arise. Um But we encourage you to go ahead and consider your trust policies in any, in any going. Um This is the plan of what we'll cover. So we'll start by looking at good medical practice guidelines. We'll then go over the proceedings of complaints and investigations and what these might entail and the challenges associated around them. But I guess most importantly will be towards the end, which is the resources and support that are available for anyone that might be in difficulty while they work in the health service. So we're just gonna begin with good medical practice guidelines. So the EMC is our regulator in the UK and the NHS and the GMC, the council um produces guidelines in terms of how we should practice and how best standards of care would be of practice. And these guidelines are regularly updated and they actually been a very recent update in January of 2024 essentially breaking down guidelines into four key domains. Domain one being, knowledge, skills, and development, ensuring that we're practicing competently and we're practicing and keeping our skills up to date. Domain two is largely encompassed around patients, partnerships and communication. There's our interaction with um the public and the patients that we care for. Effective communication is very important and having good sound communication is helps to alleviate a lot of problems in the long term as well. Domain three is tailored around our relationship with colleagues as well as the culture and safety and ethos that we value within our health system. And finally, domain four is around trust and professionalism. So these are the four broad domains that GMC, the Good Medical Council um General Medical Council actually advocate for and they publish a number of guidelines within these domains. So now we'll touch on what the importance is of complaints and investigations. Ultimately, any sort of of um investigation presenting is not um individual based, it's ultimately trying to identify problems which might be in, in terms of a systemic issue. So highlighting complaints, especially if there's problems and issues that are in patterns or recurrence, it might suggest scope for areas of that of patient care that can actually be improved. And ultimately, the thought of any com the issue or any complaint handling is quality improvement. Ultimately, we are working in a profession where we are hoping to best care for our patients. And should there be anything that might risk um bringing adverse outcomes for patients then that needs to be certainly looked into? And ultimately, we need to create an open culture, one that encourages uh building effective trust and honesty and transparency in all our communications, both amongst colleagues, but also more widely uh thinking of our relationship with our patients, other professionals as well as the public. Ultimately, we are in a lifelong learning profession and professional development and tailoring towards the ethos of professional development is very important and any sort of complaints or investigation proceeding just helps with our bettering our own best practice equally, ultimately bettering the care for our patients. So next slide, we're just gonna go over a couple of examples of systemic inquiries that have been highlighted recently in the UK. And so the first one we have on the screen now is something called the Mid Staffordshire report. So this is actually published quite recently and it's something that we study quite a lot in medical school to essentially outline that within Mid Staffordshire NHS Foundation Trust at the time of this public inquiry that was published by Robert Francis. Um there was actually er concerns highlighted with the practice at the hospital in terms of how patients were being cared for and the ethos that um there wasn't enough sufficient transparency in terms of when issues arose. And ultimately, this created a, a risky situation whereby patient safety could be at risk of being compromised if this is not tackled, this is something that's public the and now published into the public domain. And there's an executive summary which highlights the issues around that and what learning points were taken to actually better the practice, not only at midst staff but also nationally and internationally. The next one we have here is something called thalidomide, which was a drug used in, in the 19 100s for pregnancy. It was essentially a pill for morning sickness, but, and there were a lot of complications that were coming out of it. One in particular was having birth defects in, in Children, I guess if this was something that was ignored or not looked into, this would be an ongoing problem. So ultimately, both of these inquiries and both of these reports essentially highlight the importance of bringing to light any systemic issues that may need to be addressed in terms of keeping patients safe cos that's why we are ultimately in this profession. Thirdly, we've got another very big um example here, which was essentially an article published into the lancet um to do with the Mmr vaccine. Um So there was a correlation that was suggested that the Mmr vaccine might have a, a link to autism. And unfortunately, there was um limitations in terms of the data that was being presented. And the inadvertent consequence was the actual uptake of the Mmr vaccine, both in the UK, but also internationally was much produced. And this led to severe outbreaks of measles, mumps and rubella. But the problem was, and the reason why it's been retracted is that we found that the data wasn't as robust as initially thought it was a very small cohort and there was questions into the legitimacy of the data. So again, any sort of literature and any sort of the research has a lot of scope in terms of changing practice for the better. But there also needs to be a lot of caution in terms of ensuring that all the practice changes are being brought out in an evidence based manner and that's not being misused. Lastly, we have another example, which is again, very recent in the UK, which is to do with the contaminated blood scandal. It's something that arose in the late 19 100s and early 2000 and it was essentially to do with samples of blood that was being supplied in hospitals um that had not not been tested or not found to be positive for hepatitis and HIV. However, unfortunately, there was a problem whereby some of these samples were actually contaminated and these um infectious processes weren't picked up. So again, that creates a lot of problems. So here, all four examples highlight the importance of systemic inquiries. Ultimately, they highlight and bring to light mistakes that have happened in practice and we need to learn how to learn from these mistakes and move forward to ensure that they're not repeated. I guess these are a lot of examples within the public domain, quite large enquiries. But there will also be specific professional enquiries that can also be accessed in the public domain as well. The next thing we move on to is the types of complaints that might be encountered in practice. I guess complaints can be broadly divided into those that are patient raised and those that are internal patient raised complaints can include uh stuff like uh to do with standards of care and patient safety. In addition to staffing levels and resource constraints that might be apparent in practice. Now, common complaint tends to be regarding waiting times um especially in a post pandemic environment where there's a lot of pressure on the on the health service as a whole. There's also some element of complaint that is related to privacy and confidentiality, confidentiality and maintaining a good confidential practice is a very fundamental pillar of the medical profession and it's important that this is looked after and tailored for appropriately. Another source has often been um cared towards the end of life and particularly there have been issues related to palliative care as well. In addition to patient raise complaints, complaints can also take the form of internal complaints. And these can sometimes be due to communication uh misjudgments as well as relationships between employers and employees and ultimately also professional conduct as well. Ultimately, we have a duty and a professional duty to ensure that our conduct justifies the trust that patients and the public pace in our profession. And anything that may be seen to potentially undermine, that is something that probably needs to be looked into just to improve practice going forward. So ultimately, it is part of a training and development and learning experience and every opportunity should be taken to learn from any shortcomings that may arise in practice. The next thing we'll move on to is actually the process of how complaints are handled. Um Again, we've highlighted that this might be an individual level issue. It could be a systemic issue that's arising at a trust level. So ultimately, it's important that the initial um concern is actually filed and there's an initial response and acknowledgement to see has been received. This is can vary depending on who's the receiver of that complaint. And ultimately, that comes down to how uh what the implications and why the implications might be of the issue that's arising. So it could be something that's very local in terms of a, er, supporting supervisor group or ultimately, it could also be a trust level or a GMC level issue as well. Um, I guess there needs to be a robust system in terms of looking at and investigating the issue that's been raised and equally um having succinct to learning points to come out of that in terms of what outcome should arise in terms of next steps and in certain circumstances. And hopefully, most of the complaint issues should be resolved with um sufficient local and uh trust level resolution. But there might be the need in some cases to essentially escalate matters if there's a greater risk to the trust in the public profession or a risk to patient safety. Ultimately, as we've touched on, and the theme of today is highlighting that there might be issues that arise within a systemic or individual practice, but ultimately, that forms as part of governance and learning to essentially improve our practice going forward as we've already touched on, there's different levels and hierarchy of where uh concerns can be investigated. And the earliest pillar of those can be at a local level um which is often within supervising groups or responsible people within the hospital or the place of work um involved in that in that conduct um should be required to be escalated, it can be escalated up to a trust level and ultimately should it warrant. It can also go to the regulator tribunal services as well. In very rare instances, there can be issues that need to be investigated more legally. Um but these are not as common, I guess there's a number of challenges and barriers to how complaints can be investigated. Um One big one that's listed first and foremost is resource constraints in a sense where it's a very pressured system already. And there's no, not really a centralized database for analyzing complaints and ultimately those that are responsible for managing issues are also often uh clinically responsible as well. So it creates challenges in terms of balancing and triaging their responsibility. There's also the case that a lot of these cases are quite complex and they often involve multiple parties or involve quite complex medical circumstances or multifaceted issues. And this creates a delay in terms of the time that's required to investigate them properly and equally with due diligence to make sure that any um outstanding areas or any concerns are addressed appropriately. Ultimately, there is a duty of candor to those parties that are directly involved and that forms the pillar of information sharing, sharing with the appropriate people involved, but also respecting the confidentiality of those individuals involved or the trust involved. I guess what's very important to recognize is that a lot of um complaints proceedings also bring a lot of emotional challenge as there's often the very delicate need for handling these cases as they can be quite motive both for the patient but also for the health er, members of staff or the team or the trust that is involved. Um Overall, there is a requirement for any sort of er issue that's being looked into being investigated to comply with regulatory standards and those will be standards as defined by NHS frameworks, but also as a regulator as well. The General Medical Council, I guess there's always room for improvement in terms of how um issues can be looked into. And ultimately, I think first and foremost, there needs to be quite strong training programs to ensure that has a appropriate exposure to um the issues that may arise in someone's practice, but equally providing sufficient training to reduce and mitigate the risk of this occurring. I guess that's a very um pillar ethos that we're advocating here for today. And that's why we're doing this webinar cos ultimately graduating from medical school. It's, it's not something that's really looked upon um or considered too widely, but I think that there's a basic training demand which today has highlighted and all of the national surveys we've enrolled have highlighted. So there's probably the scope to incorporate more of training into medical education and also foundation program of education. Ultimately, the ethos for um quality improvement, um any sort of complaint procedure as we've discussed should be tailored around in improving patient safety and there should be a RCA assessment otherwise known as a root cause analysis to try and decipher why an issue might have but equally to try the risk of it happening in the future. Ultimately, this this is all very heavy and it carries an emotional toll on the people involved, both in terms of the patient that could be potentially involved, members of staff and the trust board that's involved. So ultimately, there needs to be adequate emotional support and empathetic case handling. And I think these are three areas that need to be looked into more for any sort of uh investigation issue. Ultimately, there's a requirement for support and there are a number of support services available on this slide. And the next slide are probably the most take home messages. So this one summarize begins to summarize it. And the next one will share a lot of relevant resources. So there will be local support services available at the trust level. So within the NHS as part of any foundation program, uh trainees should be assigned to an educational supervisor and clinical supervisor as well as a school director and a responsible officer that is overlooking all of their pastoral sport and their clinical progression within their career. But equally when they're mainly the requirement for additional support, these are also the people that should be there to support. There's also peer support networks amongst our colleagues that are, are big advocates for that as well and equally access to professional support and well being services such as pastoral support. Um We're very grateful to have a talk from the BMA um and mini introduction at the start. And that's also a very important professional organization as they've touched on that offer 24 hour support and you don't have to be a member of the BMA for that. Ultimately, it's also advocated that any um one working within the medical profession is also represented by a defense union. And there are a number of medical defense organizations that are available. They can also be in very rare cases, a requirement for legal representation. And ultimately, there are policies and guidelines for people to refer to. So I think this, this slide is very important. It's probably one of the slides that if you were today, this is the slide I would advocate for um any sort of procedure of complaints and investigation can be quite challenging. It carries a lot of emotional burden in the sense where they can be quite prolonged and equally, we all enter this profession in a very caring way and no one intends to cause issues that might arise in practice. Uh Ultimately, we need to learn to better care for ourselves, to better care for our patients and with any sort of issue of learning or professional development, that's the take home. Ultimately, we are working very difficult profession that but it brings much reward as well. But we need to first learn to care for ourselves before we care for our patients. So this is a very nice graphic that has actually been produced by one of my colleagues that's linked below as well. Um It's a very nice catic that begins to illustrate the number of support services that can be available to support our own mental health as doctors. And this is something that can affect any doctor. So it's very important that we have a, a toolkit to treat ourselves and begin to care for ourselves before we care for our patients. And there's a nice QR code there that I'll encourage you all to scan as well or links to a couple of NHS pages that provide a lot of support services available and even after to talk today, and we'll welcome any sort of discussion and you're happy to email myself or um comment down to mind the bleep and we can more happily, more than happily have a chat. Um So what I'd recommend is that you kindly uh scan the QR code and bookmark it onto your phones or devices as well. Cos ultimately, this is a very important slide. So just to wrap up, there's a couple of key learning points that um we aim to address during this talk. So number one, it's understanding the standards of good medical practice as um outlined by the General Medical Council, the GMC. Um It's the culture of actively learning from any sort of complaints or investigation proceeding and creating a culture for open feedback and continuous improvement, the ethos should be of quality improvement and any sort of issue that might arise in practice should be tailored around um quality improvement. There are a couple of challenges that can arise in barriers that occur to any sort of investigative process. But ultimately, you need to learn to essentially improve the way that investigation proceedings are carried out in a way that's empathetic and heartfelt for those involved as it can be quite an emotive area to discuss. So that was the presentation. She's got a feedback form um with a QR link that's on the screen now. Um What I'll do at the end of the uh talk as well when I stop screen sharing is just put a QR link onto the comment section as well. So thank you for attending to talk. And after today, once you've completed the feedback forms, um you get a copy of a certificate as well. Um Just to confirm your attendance to the talk and it's something nice to put into your portfolios. So I'll leave that QR code on for about 10 more seconds and we'll go back to the resources page and should you have any questions? We're happy to welcome those as well. Thank you. So if you have any questions, please feel free to pop them on our chat. So perfect. If there's no questions, thank you for taking the time to attend the talk this evening, we hope that's been useful and this will form part of a series of talks that we do in mind the bleep and we hope in the near future to also collaborate with some defense organizations to give you um a spectrum and a series of talks as well. So sincerely hope that's been useful and thank you for taking the time this evening to attend the talk. I'll remain on the line for a couple more minutes just in case there's any questions. But otherwise, please have a good evening. Thank you. So thank you. Just see that there's a question in the, in the poll. And so the question is, how does one go around the medical error? So I guess that's, that's an important, that's an important question to address. And I guess beginning to go around any sort of um issue that might be arising within any sort of medical practice begins with honesty and transparency in a sense where you've already taken the first step to realize that there might be an error that's arisen uh within one's practice. And ultimately, what needs to happen is um work environment should be quite supportive to bring to that, that issue to light. So if there is a meta query and you've spotted it and you've already done step one, you've realized that something potentially might have gone wrong, that could potentially compromise patients care. And equally, it's, it's probably very important just to begin to reflect on that and, and begin to write a reflection in terms of what's the issue that's arose and what are the learnings from it equally? I think it's very important that that's also appropriately escalated to the relevant people involved. A lot of the time there will be an educational supervisor or clinical supervisor that should be looking after um looking after your pastoral support. But if it's on a ward based setting, it's probably very important to discuss it with your senior colleague. Whether that be one of the registrars or the consultant, probably bring it to their light and they'll be very appreciative of the fact that you've brought this issue to them. Um At that point, you can have a um balanced discussion in terms of what needs to happen next and what the appropriate learnings are cos equally if there is a medical error where by um a mistake has happened to related to other patients care, um We carry an very important duty of candor to be very transparent about what's happened. So be transparency in terms of extending it out to your team, but also extending it out to your patient as well so that they know exactly what's happened, what steps have been taken to reduce the risk of any further harm or if there's any reversal, if there's a treatment error or a drug error, that's prescription error that's occurred. But could he, how do we learn from this? And how do we mitigate the risk of this being repeated in the future. So I think taking these uh step wise approach is very important. So that would be along the lines of speaking and escalating it to your appropriate senior, whether that be a registrar or a consultant. Um Coming on a balance of decisions in terms of what the appropriate next steps are. And then number three, discussing it with the patient because there's a fundamental duty of candor to be transparent about any issue. That's the worries. Ultimately, after that step, number four can be right to reflection. So I hope that's begun to answer your question. And I guess, should there be any difficulty that's arising from a medical error or there's a bit of controversy in terms of what the next step should be? I think it's probably appropriate to escalate it to and more senior members of the hospital or the trust at that point and equally seek guidance from your defense union. Should it be appropriate prior to taking any next steps? So I hope that answers that question. Perfect. Thank you. If there's any more questions, feel free to pop them on the chat. Oh, yeah, love it. So it doesn't look like there's any further questions to address today. So we hope that this talk has been useful. It's been brought to you by mind the bleep and we hope that it's been very informative and advises you on next steps and gives you some food for thought on this Monday evening. Um So please have a lovely evening. Thank you for tuning in us and we can uh look to work towards a future series of talks going forwards as well. So thank you. Um Thanks for attending and have a good evening. Take care.