Return to Our Comments 6th October,2003 The smallest cog in the wheel?..............the GP It is arguable that the smallest cog in the patient's personal health care plan is the General Practitioner. Like all 'small cogs' in any system, these cogs may be small, but are absolutely vital to the workings of the whole system. Failure on the part of a 'small cog' can cause a complete seizure of the the whole system.  Failure of a GP to function adequately can have a dire effect on the health care consequences of any patient as many of our members have discovered ( see  'Your Comments: " Nothing has changed....nothing has changed....) The GP is the first point of call for most medical care, and if he/she gets it wrong by mis-diagnosis or wrong prescription etc., and if these errors cause very serious damage, then the patient is in real trouble. The patient usually tries to see another GP at the practice or will try to move to other practices. However, the GP who has made the serious error can usually rely on all his colleague GPs not to let him/her down, and they will 'sing to the same tune' or they will simply refuse to see or take on their list an iatrogenic patient. Patients have reported that they have been told that they can only see their normal GP. Others have reported that although they manage to change to another GP practice, after about 70 days they are then struck off and have to try another practice. They become the 'wandering patient' who can find no one to look after them. Other patients have recorded that GPs  to whom they have moved become so distressed because they are unable to obtain genuine specialist care for them, that they literally beg the patient to go else where, some GPs are in tears and explain how powerless they are. GPs who inadvertently cause a  serious Adverse Medical  Incident, can  rely, not only  on their fellow GPs to 'cover-up' for them, but they can usually rely on  consultants to do the same. Once consultants have become involved with a 'cover-up' then the patient is in even more trouble and at great risk. It will not matter how many consultants to whom  the damaged patient is referred, they will not got the truth, nor will they receive genuine medical care and further more they are probably very likely to get 'crap' letters written to go in their Medical File that will further frustrate them in obtaining the medical care to which they have a right. If the consultants refuse to 'play ball' - there is absolutely  nothing that the GP can do! This is why it is futile and even irresponsible for civil servants at the D.o.H. to tell a patient that their health care is the responsibility of the GP, when a a victim of a medical error reports that they are unable to obtain specialist care What should GPs do who discover that a fellow GP as caused serious damage to a patient - or consultants are refusing to give genuine speicalsit care,  they should, of course, report the matter to their professional regulatory body, the GMC. What Does the GMC 'Good Medical Practice Guide' say? Maintaining Trust: 22.If a patient under your care has suffered harm, through misdaventure or for any other reason, you should act immediately to put matters right, if that is possible. You must explain fully and promptly to the patient what  has happened and the likey long-and short- term effects. [ How often does thsi happen? Unfortunately by this time the patient has become a potential litigant which is why SIN has been advocating a Victim's Compensation Fund - see publication: " Balancing the Scales"] Conduct or performance of colleagues: 26You must protect patients from risk of harm posed by another doctor's or other health care professional's conduct, performance or health, including problems arising from alcohol or others substance abuse. The safety of patients must come first at all times. 27. If you have grounds to believe that a doctor or other healthcare professional may be putting patients at risk, you must give an honest exlanation of your concerns to an appropriate person from the employing authority [Do you think they will be pleased to hear it? They will simply see legal liablility and money for compensation - they will not wish the truth to be given to the patient - and that means genuine medical care]. If ......you remain concerned about the safety of patients, you should inform the relvant regulatory body ( GMC or NMC) Has anyone heard of a GP reporting a consultant to the GMC? We all know what is likely to happen to such a GP, don't we? He would most likely be ostracised by his other colleagues for  'breaking ranks' - after all who would then be safe if such behaviour became common place?- and in particular he could well be ostracised by other consultants. This could result in  him having difficulty in obtaining genuine specialist care for his other patients. Remember it is estiomated that 34,000 patients die needlessly and 45,000 are seriously and permanently damaged every year in our NHS. Remember that 55% of medical errors are misdiagnoses! How many patients get to hear the truth? How many errors are covered up? Mr Alan Milburn, former Sec. State for Health admitted ".....mistakes are hidden and  cover-ups can occur" ( D.o.H website 10th July 2001) On the other hand, if the GP maintained his/her professional allegiance, it is more likely that his /her career will prosper. He/she would be given access to prestigious committees, and perhaps obtain promotion or gain work on lucrative hospital clinics. Certainly if he/she broke ranks and spoke out on behalf of the iatrogenic patient, he /she would not receive any accolades from his/her colleagues. The setting up of the Primary Care Trusts, where several GP Practices amalgamate together under the Trust, will surely make it more difficult for a damaged patient to move to an impartial GP and so get the truth about their condition? This is why SIN advocates that  it should be a statutory offence not to report an Adverse Medical Incident (AMI) if a health professional has caused it, or has witnessed it, or anyone who has become aware that such an incident has occurred. The aim is to find out the cause of the AMI, to help the health professional involved and most important of all to ensure the the damaged patient receives the specialist care to which they have a right. Who has an ethical argument against this? Would anyone condone a person who caused  a car accident that seriously damaged or killed a passenger or  pedestrian, and any witness of this event - to say nothing - to turn a blind eye? read SIN's recent publication: " The case for the Removal of Anonymity in the Recording of Adverse Medical Incidents ( AMIs in the Interest of Patient Safety"