July 15th 2020

Clinical Diagnosis Complaints 2019/20

What do people complain about and why has this increased this year?

A 40% year-on-year increase in complaints relating to concerns regarding misdiagnosis in this year’s annual report could, at first reading, give significant cause for concern. However, on closer inspection the story behind the headline is quite different and is a timely reminder of us all to take time to properly understand situations before rushing to judgement.

The first point we need to acknowledge is that the OCCS team categorises complaints based on the primary concern raised by the consumer. Whether that initial concern is ultimately the substantive issue may not always be the case.

Despite the increase in activity in this area only 0.4% of OCCS cases each year will result in referral to the Fitness to Practise team at the GOC. This is down from 2.4% last year-the reasons for this will be explored later.

The table below shows the categorisation of concerns managed by the OCCS this year. Retinal detachment concerns were most prevalent closely followed by ARMD and cataract. The nature of concerns relating to these three conditions are very varied – with detachment and ARMD concerns often coalescing around the need to be reassured that the condition had not been missed previously.

Cataract complaints often revolve around the need for assurance regarding referral criteria and assurance regarding the prognosis. If, on initial review, it is clear that the case is not ‘mediatable’ we will define it as out of our remit and steer accordingly. When a complainant is seeking damages or ‘compensation’ this would need to be steered to independent legal advice regarding the validity of their claim.

We are seeing a noticeable increase in ARMD concerns many of which are able to be addressed by the OCCS, however, we have, along with The Macular Society and Birmingham Optical Ltd, developed new CET material on how we can all better manage these scenarios to avoid escalation.

Condition  Refer to practice with advice Out of remit  Advice only  Resolved on mediation  Still live   
Cataract 3 2 4 1 10
Glaucoma 3 3
Retinal detachment  5 3 5 1 14
ARMD  3 1 8 12
Misc  4 3 3 1 1 12
MECS/EOS  1 1 2
19 6 12 13 3 53

At a time when our regulator appears to be drawing fire on a number of fronts it may be timely to acknowledge the excellent initiative instigated by the GOC in 2018 to implement a triage and Acceptance Criteria function.

This significant development has been the catalyst to a significant reduction in referrals into the GOC and enables us to manage complaints through a more flexible mediated approach.

The policy also enables the GOC to refer cases out to us where a flexible and proportionate mediated resolution may be more appropriate. This has been the breakthrough allowing the profession to step change its approach to such complaints and has ultimately been the primary driver of the increase in misdiagnosis complaints at the OCCS with a commensurate reduction in unnecessary complaints sitting in the GOC.

This is illustrated by the data that Keith Watts of the Fitness to Practise team presented to Council in May 2020

2015-16  2016-17  2017-18  2018-19  2019-20
GOC registrants  29,162 29,136 29,883 30,097 31,368
New referrals  343 425 495 453 342
Investigations opened  223 293 262 269 155
Referrals to the FTPC  66 59 57 37 58
Erased from the GOC register 10 3 5 9 13

This data shows how Triage and Acceptance Criteria have reduced investigations being opened from 269 to 155. The fact that similar levels of sanctions are being taken should reassure that those cases that need to stay in the system are doing so and the process is effectively eliminating the low level concerns that can move across to mediation.

The collateral benefits of this move are evident in that we have been able to reduce the volume of referrals from OCCS to GOC from 2.4% of cases to just 0.4%. Moreover, we are confident we will see a decrease in the average timelines to process FtP cases in the future – watch this space!

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