Making practice safer

Sessional GP and Clinical Lead, EQUIP (Education and Quality in Primary Care) Dr Kamilla Porter shares her highlights from Medical Protection’s eighth annual General Practice Conference

Your membership offers access to a wide range of risk management resources and support. This includes workshops, online learning and a library of publications, booklets and case studies

Filtering the deluge of invitations to medical courses and events that pour into my inbox can be a challenge. Having attended a Medical Protection General Practice Conference a couple of years ago, when I saw the flyer for this year's event, I signed up straight away.

The theme of this year's conference was Making Practice Safe, which, at a time of profound pressure on general practice intertwined with rising patient demand and expectation, is more important than ever before.

Managing difficult interactions

I found the first session delivered by GP and MPS facilitator Dr Vanessa Perrott really interesting. A difficult consultation can be especially stressful; however, I found Dr Perrott's encouragement to view a perplexing interaction in a much broader way than simply a two-way exchange between the clinician and the patient very helpful.

She suggested that the perception of the "difficult patient" stems from staff rather than simply an intrinsic characteristic of that individual. For example, the body language of the receptionist that the patient sees when booking in, or the tense or disinterested expression of the clinician, can have a profound impact on that person's response and behaviour. 

Furthermore, she outlined how difficult interactions are often the product of multiple factors: navigating the healthcare system, the illness, the doctor and the patient. Simply acknowledging that the strong emotions some patients evoke can potentially sabotage a consultation is an important first step in preventing a tricky situation from escalating.

After recognising a difficulty, Dr Perrott recommended considering why it has arisen and to utilise support skills, such as active listening, empathy and reframing the apparent problem; and balance these strategies with trying to identify the nub of the problem and set clear boundaries. To finally manage the difficulty she shared the AID approach: acknowledge, inform and discuss a way forward. 

Human factors

Guy Hirst, retired Chief Instructor from British Airways Training, delivered a great session; he stressed that a no-blame culture is crucial to reducing risk and pointed out that human behaviour is such that once a skill has been learnt, 95% of the time we step into an automatic mode versus a conscious one.

The danger zone results when the automatic system approach overrides the conscious systems. He presented a convincing argument for the value of good communication within the practice with daily briefings amongst staff, protected time to deal with repeat prescriptions and effective handovers by clinicians.

Safe prescribing

The conference offered the opportunity to attend workshops and share stories and learning with your colleagues. I attended a workshop on safer prescribing in primary care: we were encouraged to think about high-risk situations where errors could arise. Delegates put forward many examples and there were interactive discussions, not just about individual strategies to reduce errors, but also using technological, organisational and systematic approaches. The P.R.E.S.C.R.I.B.E.R checklist was an aide memoire I had not encountered before and I have already started sharing it with trainees.

Personal reflections

The day ended with a deeply moving presentation delivered by Dr Michael Blackmore, in which he shared his own experience of stress, mental health, addiction, recovery and resilience in the NHS. His personal account of a doctor descending into the darkness of depression and drug dependence made for uncomfortable listening at times, but his determination and courage to turn around his life was an inspirational human tale.

He reminded us all that doctors can succumb to the same scourges that bring about the downfall of so many in our society – and admitting that there is a problem and asking for help can be so much harder as a professional. His emergence from the sick doctor to carer for vulnerable patients was testimony not only to his own resilience, but also the concern and assistance he received from his colleagues and professional bodies.

A nod to next year

The day was an opportunity to take time out from daily practice and glean new information, while refreshing old skills that are not routinely covered post-qualification. As a GP trying to keep afloat in the modern age, I left the conference feeling better protected and equipped to meet the many challenging risks I face in primary care.

Back to all GP articles

Please note: Medical Protection does not maintain this article and therefore the advice given may be incorrect or out of date, and may not constitute a definitive or complete statement of the legal, regulatory and/or clinical environment. MPS accepts no responsibility for the accuracy or completeness of the advice given, in particular where the legal, regulatory and/or clinical environment has changed. Articles are not intended to constitute advice in any specific situation, and if you are a member you should contact Medical Protection for tailored advice. All implied warranties and conditions are excluded, to the maximum extent permitted by law.