The deaths of a number patients in the community led to fatal accident enquiries,(FAI’s) during which a number of community physicians were cross-examined about their practice abilities and patient care. These enquiries are similar to those of the Coroners’ Courts in England and Wales.
The clear message that came out of the FAI’s was, the communications between hospital specialists and the community physicians was totally unfit for purpose. The term ‘woefully inadequate’ would have been too gentle a criticism of the virtual blank wall between hospital knowledge and the absolute patient requirements for effective care in the community. The standard discharge from hospital letter that followed a patient’s movements, was inadequate and it relied, in the majority of cases, on someone handing this outline letter to a GP practice reception. G.P’s had difficulties contacting specialists and obtaining information. It was a sorry state of affairs.
Sadly, the patients who died had special medical needs or rare conditions understood in some depth by specialists and not by general practitioners. Some of the consultants would have been based in the regional hospital and others would have been out of region. They offered follow-up out-patient services in the regional hospital. This system still pertains. GP’s started to tell patients with special needs that the hospitals, sometimes hundreds of miles away, had to continue their care, they, the GP’s could not. Since the FAI’s and the GP ‘work to rule’, there have been practice changes. There has been a major overhaul of information technology and consultants are more readily accessible to the G.P’s, BUT, only within region.
The General Practitioners can now obtain reports of consultations and diagnoses, also the medical care required, all at the press of a computer button. This arrangement does rely on the individual uploading the information and doing it promptly at the hospital end. Blips occur, though in my limited experience, they have been rectified relatively quickly, once noticed.
Likewise, and this relies on good practice pertaining within hospitals, essential community G.P. practice information about a patient can be accessed through the I.T network, for example, about drugs intolerances.
It is a big improvement on what happened in the past and the technology can work. The I.T. systems seem to be up to the job. The weaknesses though, are obvious, the system is not infallible, but then nothing is. The access to information is dependent on timely recording onto the computer systems; it is dependent on hospital staff seeking community information and also checking on in-patient medical history, all being good medical practice.
One of the largest weaknesses is that the sharing of vital information is limited to the hospitals and community medical practices based in the regional health authority. A major communications gap exists, fraught with old dangers because a range of specialist expertise is based outside the health authority.
The regional I.T. system is, to a large extent, doing what it was set up to perform, to share important health care patient information, so community health care professionals in theory, can provide appropriate care in the community. I say in theory, because the other major weakness lies in what resources are available to continue supporting specialised care requirements in the community.