A key survey provided evidence that in a substantial minority of hospitals, patients are dying due to lack of care, with one in every seven GPs reporting a local hospital department as ‘dangerously sub-standard’.

The survey, conducted by Pulse and entitled ‘Practical Commissioning’, attracted a response rate of about 167 from 500 GPs who stated they believed a patient had received dangerously poor care at their local hospital in the last year.

About 10% of GPs state that one of their patients had died in the previous year probably because of substandard hospital care, such as poor emergency treatment, complaints over missed diagnoses, and dangerously early discharge.

Last year, a third of GPs reported concerns to their local hospital, some in writing to clinical standards teams, yet less than half of the GPs felt confident that their concerns would be acted upon.

Accumulatively, 64% of GPs rated hospitals’ clinical care as ‘good’ or ‘very good’, yet only 38% applied the same rating for communication and personal care, and only 44% for speed and efficiency, with problems reported, such as substandard nursing care for elderly patients, delays to follow-up appointments, and patients discharged so prematurely that GPs could ‘no longer rely upon in-patient care being complete’.

Even though about 78% of GPs reported they would recommend their local hospital to patients, only 20% said they had warned patients in confidence about the hospital’s care in the last year, and 21% would not entrust their family into the hospital’s care.

15% of GPs reported that entire hospital departments were ‘dangerously sub-standard’, of which A&E departments were reported most often.

An Oxford GP, who prefers to remain anonymous, reported that their practice reported more than three ‘serious’ missed diagnoses by the gynecological department at the John Radcliffe Hospital, one of which was ovarian cancer.

The GP stated:

“I think the patient with cancer has died. We wrote a letter. All we wanted was something back saying ‘let’s look at this’. Instead we got a five-sentence reply saying ‘under NICE guidelines we did nothing negligent’.”

In reply, an Oxford University Hospitals NHS Trust spokesperson declared:

“The trust is confident about our services, but not complacent. If a GP feels our care falls short, we would urge them to raise this.”

A Glasgow GP, Dr. Peter Livingstone, reported that he had raised concerns over ‘dangerous’ premature discharge:

“A patient had been admitted on Saturday and discharged on Sunday. A chest X-ray had found left broncho pneumonia. When I saw him he was unresponsive, his pulse was running too fast, he had a fever and his blood pressure was down. They turned him out thinking a nursing home would look after him. That is substandard care – I worry he may have died.”

An East Midlands GP said an elderly patient died due to substandard care:

“He fell out of bed and fractured his hip. It wasn’t picked up, complications set in and he died. The patients who don’t do very well are the elderly.”

Another GP in Romford, south London, stated that his practice now re-referred a quarter of patients because his local hospital discharges patients on ‘target driven, not clinical’ criteria. He said:

“I have written to the chief executive to say if I had my way I would not refer a single patient to her institution.”

Barking, Havering and Redbridge University Hospitals NHS Trust declared: “We take GPs’ concerns very seriously and are working with our clinical forum on a quality improvement program,” whilst The Department of Health stated: “Unsafe care will not be tolerated. We are developing patient safety measures which will show the outcomes of care.”

The Editor of Pulse, Richard Hoey, concluded:

“The recent summing-up of the Mid Staffs public inquiry was clear that “key features of the trust’s failure were replicated to a significant degree more broadly across the NHS” and that the tendency within the DH to view Mid Staffs as an isolated example is dangerous. Our survey results demonstrate that in a significant minority of NHS hospitals, GPs have Mid Staffs-like concerns over the quality and safety of care – in particular over poor standards of personal care, and A&E departments that at times are plain dangerous. The results shouldn’t detract from the very good quality of care in most NHS hospitals, but they suggest the minority which are bad and unsafe is larger than the Government might like to admit.”

Written by Petra Rattue