AUDIO RECORDING OF THE CONSULTATIONS (November 2017 update)
Dr Beerstecher started the audio recordings in 2014 after an inspection by the National Clinical Assessment Service (NCAS). See Audio recordings of consultations [sorry for the typo in the title]. It was a result of the report and the investigation. 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 inspectors and as more inspections were already instigated this is where Dr Beerstecher realised dishonesty could only be countered by evidence. The NCAS and other inspectors would simply say their account is correct as they were taking notes at the time.
A lot of doctors are fearful of recording the consultations because the recording could 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?
NHS England had referred Dr Beerstecher to the General Medical Council (GMC) in November 2016, after the CQC had issued the report "inadequate" rating.
Audio recordings of the CQC inspection (link to the next page) disproved many assertions in the CQC report. The same happened in 2014, when NCAS issued their report, the audio recordings of their inspection also showed their report had hundreds of "inaccuracies".
There was another inspection of the practice the following year, now by the General Medical Council in 2015. Two doctors also sat in with the consultations for two days and their report found that as far as recording the consultations is concerned:
"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."
Dr Beerstecher received threats from the legal departments of the CQC, NCAS, the CCG. 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.
Re: The minutes of the meeting of the NHS on the right.
To allay any fears and allegations Dr Beerstecher agreed for his work to be reviewed on a weekly basis since 2015. Dr Hall was initially appointed by the NHS to do this.
It is not true to say "no independent evidence regarding record quality since 2015"
Dr Hall did not find any problems, and was sacked without notice one Friday afternoon in 2016. The NHS never sent an explanation to him.
Since then Dr Beerstecher agreed with the GMC that his work has been reviewed every two weeks by Dr Shum, and has been thinking about the value of all the typing for hundreds of hours. The proposals of how the records were going to be reviewed was agreed by the NHS in April 2016. More requirements were added afterwards in a meeting, see the audio file on the right. The suggestions were also incorporated, see the excel file on the right.
Another review of records was carried out by Dr Reed for the NHS in 2016. Dr Cochrane-Dyet has seen some of the patient records in 2016. The NHS sent a secret report to the CQC, and the CQC also questioned the recordings (audio evidence is on the right).
The work on typed records was reviewed at the annual appraisal all GPs have to undergo, in November 2016, by the independent appraiser, Dr Moore.
Still NHS England insisted on appointing another inspector, Dr Wilson, who reviewed the records in September 2017. His report was not shared, only the decision from NHS England to "close the case".
Dr Beerstecher would like to publish the reports of NCAS, the GMC and the NHS, but they all contain confidential information about patients. It is therefore not possible for Dr Beerstecher to defend himself publicly against the allegations.
What you can see in the minutes of the PDLP meeting and also on the tapes, and repeated in NHS reports is that doctors can apparently read through thousands of entries and hundreds of hospital letters, then see the patient and then type up everything that happened, all in the space of 10 minutes.
Now, if you don't believe that, if you believe that at the most a doctor may at best glance at the summary, then all the individual entries would be irrelevant, as they can never be used during the consultation. The ones that can be filtered on the computer may be of use if they are short enough, there is always a balance between clarity and brevity in the real world. That is why 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 or has neglected the records offer patients access to everything in the electronic records?