AUDIO RECORDING OF THE CONSULTATIONS (November 2018)
Dr Beerstecher started the audio recordings in 2014 after an inspection by the National Clinical Assessment Service (NCAS). See Audio recordings of consultations in the BMJ [sorry for the typo in the title].
For a part of the investigation NCAS had taken medical records of 30 patients and then Dr Beerstecher was questioned by a panel of three, with questions like "what were you thinking when you prescribed the cream to patient X at 09.56am on the 3rd or May 2012?", "Did you ask patient Y about suicide thoughts at 11.23am on 14 June 2013?".
Another part of the investigation was 'observed practice', where two other doctors would sit in the consulting room for two days making notes about the consultations. Afterwards Dr Beerstecher wrote to the NCAS whether one of the doctors had dementia or was hard of hearing, as his account of a consultation was incorrect. NCAS stood by their report and findings and Dr Beerstecher had to ask the patient to come back in, this time making an audio recording to prove to NCAS that their account was factually incorrect. It opened the eyes of Dr Beerstecher to the dishonesty of some inspections, maintaining the criticism of Dr Beerstecher instead of apologising and correcting the faulty information.
More inspections were already instigated in 2014, this time by the General Medical Council and Dr Beerstecher realised inaccuracies and misinformation could only be countered by evidence. As a single person, whilst under questioning or conducting a consultation at the same time, how could you write everything that is being said, and would this be credible against the word of several inspectors?
A lot of doctors are fearful of recording the consultations because the recording might show that the level of care has been inadequate, or that the doctor has been disrespectful. Currently GPs are funded to provide 10-minute appointments and there is only so much that can be done. Is that time better spent on talking, looking and explaining, or on typing up all the details instead of just the important parts?
During 2015, 2016 and 2017 NHS England continued to criticise Dr Beerstecher for recording the consultations, even though most (99%) of you thinking it is a good idea. NHS England continued to question if consent was obtained for each and every consultation, despite the GMC already reporting to NHS England in 2015:
"The assessors confirmed from Dr Beerstecher that the audio recordings are consented to, both by a notice in the waiting room and verbally in the consultation. They are stored on individual compact disks (CDs) for each patient, and kept securely with the patient's Lloyd George envelope.
They are passed on with this if the patient moves practice, and patients can access the whole record, including the recording, if they wish to do so.
All this is acceptable in line with GMC principles."
Despite the 2015 GMC inspection, NHS England reported Dr Beerstecher to the General Medical Council (GMC) in November 2016, after the CQC had issued the report "inadequate" rating for making recordings of the CQC inspection in 2016 and of meetings with NHS England.
Audio recordings of the CQC inspection (link to the next page) disproved many assertions in the CQC report of 2016. The same happened two years previous in 2014, when NCAS issued their report, the audio recordings of their inspection showed their report had hundreds of inaccuracies and ascribed numerous confabulated statements to Dr Beerstecher, all of them putting Dr Beerstecher in a bad light, instead of 50% like you would expect if they were just genuine mistakes.
The consent issue for patient encounters was checked again in 2016 by the CQC, who inspected three years early on instigation of NHS England, again all was found in order.
Yet NHS England insisted in another inspection in September 2017, again with an inspector listening to the recordings of the consultations and again finding no fault with what is happening.
It is unclear why this innovative solution to the impossible target to type everything that happens is not welcomed by NHS England, why would you object to having complete and accurate records?
Dr Beerstecher believes he has found the ideal combination, brief and clear written entries, backed up by an audio file with literally everything.
As one of the first of a minority of practices we have given patients access to all electronic records, including the typed ones. Would a practice that has something to hide offer patients access to everything in the electronic records?
It seems to be a problem for the authorities as Dr Beerstecher has received threats from the legal departments of the CQC, NCAS, and the CCG in relation to making recordings. The GMC, NCAS and NHS England have forbidden audio recordings of the viva exams, interviews and inspections.
You would have to question why all these organisations are so fearful of having their actions recorded? Why is NHS England so opposed to the consultations being recorded? If Dr Beerstecher is doing such a bad job, then all the evidence is in the recordings, and it would make it much easier to get rid of him.
Nonetheless these organisations and many GP practices, the out of hours doctors, the 111 service, the ambulance service and many more have no problem making audio recordings of your calls or interviews without your approval, without warning you on outgoing calls, and without keeping the files save with your records to access if you wanted them in future.