Being a Good Clinical Lead

The General Medical Council (GMC), in its document “Good Medical Practice 2024 ,"¹ explains the individual responsibility of doctors in their professional work. It provides a framework for high standards in the patient-doctor relationship and is an important part of the appraisal and revalidation process. The GMCguidance  states relating to Clinical leadership: “You must provide necessary and timely information to those you manage so they can carry out their roles effectively. You should also pass on any relevant information to senior managers and make sure that arrangements are in place for relevant information to be passed on to the team promptly. You must be satisfied that systems are in place to communicate information about patient care.”

Healthcare is provided by multi-disciplinary teams and it is important that Orthopaedic Surgeons fully understand their roles and responsibilities. Consultants must be involved in providing Clinical Leadership at different levels. The consultant retains the responsibility of ensuring that the patient under their care gets safe and effective treatment. Clinical leadership starts with each individual practice and is not confined to designated leadership roles of Trauma or Elective Clinical Leads, Clinical Director or Medical Director in their respective Trusts or increasingly at a National level. 

We expect all providers of care for musculoskeletal disorders to meet the BOA’s Six Guiding Principles for Trauma and Orthopaedic Surgery²:

• The right patient should receive the right treatment at the right time in the right place³
• Investigations should only be undertaken if needed. They should be based on good evidence and should not replace a considered and informed clinical assessment⁴
• The choice of surgical intervention should be appropriate to the condition of the patient and to its severity
• Patients, rather than clinicians or commissioners, should be able to choose their treatment for a non-urgent disorder, having been provided with information on a variety of alternatives from multiple sources including a choice of no treatment
• Each treatment must be accompanied by:
  • A  good evidence base
  • An assessment of its expected duration and magnitude of benefit
  • A  risk assessment
  • A clear definition of the required inpatient and outpatient care
  • Any treatment alternatives including no active treatment to be discussed
• Any chances, including those in service delivery, must:
  • Improve the quality of care
  • Be effective
  • Be capable of independent assessment
  • Be good value for money
  • Are subject to audit and monitoring where needed

The current Good Medical Practice¹ defines this and states that we must all "Make the care of your patient your first concern" and also advises medical staff how to address any deficiencies in the following paragraphs from Domain 2:

“You must take prompt action if you think that patient safety, dignity or comfort is or may be seriously compromised.

a)    If a patient is not receiving basic care to meet their needs, you must immediately tell someone who is in a position to act straight away.

b)    If patients are at risk because of inadequate premises, equipment or other resources, policies or systems, you should put the matter right if that is possible. You must raise your concern in line with our guidance and your workplace policy. You should also make a record of the steps you have taken.
c)    If you have concerns that a colleague may not be fit to practise and may be putting patients at risk, you must ask for advice from a colleague,escalate your concerns to clinical lead/CD and Medical Director via the appropriate local Medical workforce panel, your defense body or us. If you are still concerned you must report this, in line with our guidance and your workplace policy, and make a record of the steps you have taken"

It is a matter of course that problems do occur in the practice of Orthopaedics and Trauma; these may be highlighted by clinical audit, MDT meetings, a critical incident report, complaints or litigation. Constructive mechanisms based on Education and Training with appropriate Continuing Professional Development and Personal Development Plans, formed during Appraisal, will resolve most concerns. All surgeons have a duty to ensure the safety of patients and to report unsafe systems, infrastructure or staff.

All Orthopaedic Surgeons must fully understand their accountability in these matters within their Trust. They should also be fully aware of the Trust’s clinical governance and disciplinary procedures, and the roles of Case Investigator and Mediator. Trusts do have local Policies and Procedures for dealing with most issues and Orthopaedic Surgeons should make themselves aware of these Standards of Practice.

Most organisations now utilize the principles of MHPS⁵ to deal with issues of professional misconduct. Particular issues with Surgeons performance, conduct and behaviours nowadays are escalated via the Trusts Senior medical workforce panel.

If these systems are insufficient you must bring your concerns to the attention of the British Orthopaedic Association or the Royal College of Surgeons.

However, external input may be requested in exceptional circumstances and, acting in support of The Royal College of Surgeons of England’s ‘Invited Review’ mechanism, the BOA has committed itself to providing advice to Trusts in such a situation. Assessors assisting Trusts in resolving issues under local procedures are Consultant colleagues who act as ‘honest brokers’. The Trust should have an indemnity policy to cover the assessors acting in such a role.
 

References

^{1. https://www.gmc-uk.org/-/media/documents/good-medical-practice-2024---english-102607294.pdf}

^{2. [Insert]}

^{3. https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.boa.ac.uk%2Fstatic%2F024bc0a3-7c12-4433-b52d6e81bc30ea35%2FGIRFT-Further-Faster-Handbook-January-2024.pdf&psig=AOvVaw3ZDHbZsQcHanPUbQcnx4g-&ust=1726223708769000&source=images&cd=vfe&opi=89978449&ved=0CAcQr5oMahcKEwiA9JrJmr2IAxUAAAAAHQAAAAAQBA}

^{4. https://www.bmj.com/content/350/bmj.h2308}

^{5. https://resolution.nhs.uk/ppa-training/understanding-and-using-mhps-effectively/}