The Pharmaceutical Journal Vol 267 No 7171 p595-597
27 October 2001

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  Community pharmacy
  Travel medicine
  Clinical governance
  The Society

Letters to the Editor

Clinical governance

Possibility of misuse

From Mr P. Walton, MRPharmS

Among other things, clinical governance represents a system to prevent errors, a laudable aim that I believe is never going to succeed fully. Alongside clinical governance, we need a system that deals with error when it happens, even where systems of governance have been implemented. Using the tenets of governance all sources of error should be corrected. This, however, is an impossible dream: foolproof systems would be costly and almost impossible to achieve.

Assuming that I am correct with the statements above, and we continue to experience failures in the system, pharmacists, technicians and others in the frame for blame need to be confident that they are not suddenly going to lose their livelihood, or a significant portion of their expected income.

So what happens when errors occur? Some factors will be due to the pharmacist, to technicians and to other staff. Other factors will almost certainly be down to the employer. Employers will contact their insurers for advice.

What should employees do in this situation? They must obviously give the employer some information about the error. If the error is serious, however, all statements should be given under the supervision of a solicitor.

It has to be borne in mind that the employer could well be in the frame for prosecution as well, and that they might ask questions to mitigate their own blame or to avoid their own prosecution or an appearance before the Statutory Committee. It may be difficult for lower paid employees to afford to get legal advice immediately, or indeed they may fear that if they do not co-operate fully with their employer they could lose their job, status and promotion prospects.

In the case of a major error, offering independent legal advice at the time when prosecution proceedings have commenced should be deemed to be too late, and wholly unacceptable.

The fear factor may well encourage employees to follow a course of action suggested by the employer, even though this may not be the most appropriate course of action for them.

There may well be times where the employer sees it is politically prudent to keep staff from working, or the trauma of the consequences of the error may well keep the member of staff off work with stress.

What redress does an employee have in this these situations, especially if there are major system failures that are down to others?

We hear of the no-blame culture, which has been proven to be a myth. In any prosecution all the parties involved are likely to do their utmost to protect themselves. The politically strongest are likely to come off relatively unscathed whereas those at the bottom of the heap are more likely to be the scapegoats for the error. What we really need is a noble-aim culture where each party fully admits to their own error. Bearing in mind potential costs I doubt whether this will happen.

It is quite possible that clinical governance could be misused as a tool against employees, to protect employers, and to do little to improve patient safety.

Perhaps all employees should seek to clarify their own position with their employers and/or their insurers, and the Royal Pharmaceutical Society should give guidance on the issues.

Philip Walton
Manchester

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