Out and about
GP partner and trainer Dr Ashok Kelshiker reports from the annual MPS General Practice Conference – Keeping Safe, Back to Basics, held in London and Manchester
I was lucky enough to attend the MPS GP conference in mid June, which was hosted at the magnificent King’s Fund building in London. It was my first MPS conference and I decided to attend after dealing with some challenging cases in the practice in the last year. The common themes were vulnerable patients where gaps in services caused problems and where patient and carer expectations were difficult to meet. I came hoping for some solutions to help me “manage the impossible”.
Dr Richard Stacey set the scene beautifully with likening general practice to the view from the top of a ski slope – an exhilarating place to be, but with inherent dangers to negotiate. He insightfully stated that GPs were still highly trusted, but that the trust was more fragile and needed to be nurtured. For me, trust was the core theme that ran through the entire day. “maintaining trust” (Domain 4) in the Good Medical Practice framework for appraisal and revalidation. perform well throughout their careers. For me there was a “moment of Kairos” when I came to appreciate why there is a whole section on
Niall Dickson from the GMC made the case for revalidation. He reminded us that revalidation should help to push up standards and also to spot the underperforming doctor early enough to be able to offer remediation. The public needed to trust that doctors would continue to
Baroness Finlay was inspirational and her statement that “how people die remains in the memory of the living” was a simple truth. Her main message was to argue against changing the law to allow assisted dying. She felt that our patients trusted us to help ensure their wellbeing and this was at odds with any involvement in their active demise. “What can we do to improve today?” was perhaps a good beginning even in the most difficult of situations. As a GP it was also a reminder that we have a role in entering the debate on important policy issues, such as assisted dying.
The most memorable talk for me was provided by Dr Mark Dinwoodie. He spoke on difficult patient encounters. He skilfully demonstrated that each of us have our own unique set of clinical encounters that can challenge us. He also showed that there are techniques that can be learnt to increase our effectiveness in such situations. A simple technique was to depersonalise the difficult situation and consider the “difficult encounter” rather than the “difficult patient”. This reduces the negative emotions that such situations can generate and make us feel more empowered. I also liked the reminder to us to “HALT” when we are feeling “hungry, angry, late or tired” as these are doctor factors that can lead to error.
Dr Adam Morris reminded us of the challenges of balancing our primary care role with our commissioning role – a very topical issue. He captured the sense that we are at a watershed moment in primary care. The trust that our patients have in us could be challenged by more explicit rationing where we are seen as the agents of rationing. I wished I could have attended the break-out workshop on this issue but the others on prescribing, confidentiality and handling complaints were equally relevant.
The afternoon sessions on vulnerable patients and on the anatomy of a claim were both excellent. Caroline Bennett from the MPS legal team confirmed what was most evident in the whole day – that MPS are here to support us in a personal way at times of difficulty. There was a recognition of the huge personal toll a complaint can have.
The biggest achievement of the day for me was opening my eyes to the huge educational potential there is to “keep safe” and look after ourselves, which will allow us to better care for our patients.
I hope next year’s conference can develop the theme of managing the tensions between our patient advocacy role and our gatekeeper role within CCGs. “I know GPs have to reduce referrals” is a comment I hear more often in the consulting room. A little more on the issues related to safeguarding children would also be welcome. Finally, I would love to hear more on practical tips to manage difficult patient encounters – perhaps a break-out session would be a good format for this.
Thank you to MPS for a great conference. I came away feeling that managing all our diverse challenges was not impossible.
Read a full summary of the GP Conference report >>