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Sonia Panchal – End of life care

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Rheumatology specialist registrar, Sonia Panchal, 33, took a break from her training programme to become a leadership fellow. She sees the CQC specialist advisor role as a way to empower doctors in training – as well as make vital changes for patients.

"The CQC specialist advisor role first appeared on my radar in 2013, when I was on the National Medical Director's Clinical Fellow Scheme in London.

Other fellows already involved in inspections mentioned their experiences and it seemed appealing as well as relevant to what I was doing.

I'd taken the fellowship having grown frustrated at how hard it seemed to push through hierarchical barriers to make changes in my role as rheumatology specialist registrar at University Hospitals of Leicester NHS Trust.

I now work for a local education and training board, Health Education East Midlands, as part of a team designing and implementing a post-graduate leadership programme for doctors in training.

One objective of my role is to empower doctors in training to make decisions despite the top-down approach and hierarchical attitude that exists. Working as a specialist advisor, which is about valuing everyone as part of a team to work together and create change for patients, fits well with this ethos.

Inspecting end of life care

My work schedule means I've only been able to do one hospital inspection so far, in March 2014.

I was part of the end of life care team assessing how end of life care was done at the trust. Having had a lot of experience of patients in their final months, weeks and days as a medical registrar, this was a good fit.

Our inspection tasks included making sure that if a patient had a DNR (Do Not Resuscitate) form, it been discussed with their family and was properly documented. It also covered checking controlled drugs books were up to date and talking to patients to ensure they knew who was responsible for them.

Highlighting the importance of documentation

My CQC work has made me understand how important it is to have things in a certain way. One of those issues is documentation.

As clinicians, we're used to documenting all manner of things every day. But inspections hammer home the importance of why we document clearly. The minute there's a break in the link it can cause issues. For example, during the inspection I spotted a DNR form that hadn't been reviewed when someone went home from hospital.

That patient had to be re-admitted at a later date, and staff didn't know whether the form was still valid. If they did need resuscitating, it wouldn't be immediately clear if that was the patient's wishes or not. This would potentially waste vital minutes and cause anxiety for staff as well as loved ones.

Empowering trainees to encourage change

During the course of my work for Health Education East Midlands I often encourage trainees to become specialist advisors too.

Trainees tend to work in a hierarchical system, yet I believe that improvement or change needn't only come from the top down. Even as a doctor in training you can influence how things move forward. If trainees are encouraged to speak out and feel empowered then things can improve vastly.

Noticing information on the ground

There's another good reason for using doctors in training as CQC specialist advisors: the information they pick up every day. Rotation patterns mean trainees are transient within trusts so frequently notice things more senior staff often don't – whether that's nuggets of information, niggling problems or even great solutions.

If they're involved in CQC inspections, they can look out for those things too. People don't necessarily ask trainees for their views on what's happening in trusts, but they're an underused resource.

Creating good medical leaders of the future

Becoming a specialist advisor is a way to empower a trainee to speak out and talk about care or processes that may not be right. Or, equally, to take things that work well back to their trust and have the confidence to present these to more senior staff while feeling their opinion is valid.

After all, doctors in training are future medical leaders so we need to do all we can to empower them."

Last updated:
29 May 2017


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