Medica Group
Action Taken
Medica have edited their Medica Alerts policy to include a potential new diagnosis of TB as a reason to raise an urgent notification to referrers, and this has been circulated to all reporters. They will also work with clients to enact the Academy of Royal College/RCR Alerts guidelines 2022. (AI summary)
View full response
Dear Miss Persaud
Thank you for your email dated 19/5/23 and the enclosed Regulation 28 Report (attached as reference).
Since the inquest Medica have edited the Medica Alerts policy to include a potential new diagnosis of TB as a reason to raise an urgent notification to referrers. The alert and the report should advise the referrer that a change of treatment may be required.
This new policy has been circulated to all reporters and a communication from me has highlighted the findings of the inquest to all reporters.
Medica will work with Clients to enact the Academy of Royal College/RCR Alerts guidelines 2022 as Clients wish to/are able to integrate the process locally. I note the Academy of Royal Colleges advice that ‘open TB’ should receive a Critical Alert. This is not a process in place in any NHS Trust to my knowledge at this time. Medica will raise Urgent Findings until Clients adjust their internal processes.
I would like to respond to the following areas of the Regulation 28 Report:
Section 5. The CXR was reported in a way that raised the possibility of atypical pneumonia. At the time of reporting the CXR the reporter had no knowledge of the additional information available in the court, there were no red flag symptoms for TB given in the clinical request and the CXR findings could have been caused by a number of pathogens including TB and COVID amongst others including fungi and less common bacteria. Therefore, the Xray was reported in what I would consider a standard way. Section 5. At the time of the CXR in question, I would consider Akash to have been under the care of his GP. My comment regarding a clinical team was meant to indicate primary, secondary and tertiary care if there is an element of active management/follow up. IRMER 2017 regulations place onus on the referrer to read and act appropriately on imaging reports of studies they have initiated. Section 5. There is an agreed Medica Alerts policy and an agreed Medica/Barts Alerts policy in place now and at the time of the reporting of the CXR. This did not overtly specify a need to alert TB.
Thank you for your email dated 19/5/23 and the enclosed Regulation 28 Report (attached as reference).
Since the inquest Medica have edited the Medica Alerts policy to include a potential new diagnosis of TB as a reason to raise an urgent notification to referrers. The alert and the report should advise the referrer that a change of treatment may be required.
This new policy has been circulated to all reporters and a communication from me has highlighted the findings of the inquest to all reporters.
Medica will work with Clients to enact the Academy of Royal College/RCR Alerts guidelines 2022 as Clients wish to/are able to integrate the process locally. I note the Academy of Royal Colleges advice that ‘open TB’ should receive a Critical Alert. This is not a process in place in any NHS Trust to my knowledge at this time. Medica will raise Urgent Findings until Clients adjust their internal processes.
I would like to respond to the following areas of the Regulation 28 Report:
Section 5. The CXR was reported in a way that raised the possibility of atypical pneumonia. At the time of reporting the CXR the reporter had no knowledge of the additional information available in the court, there were no red flag symptoms for TB given in the clinical request and the CXR findings could have been caused by a number of pathogens including TB and COVID amongst others including fungi and less common bacteria. Therefore, the Xray was reported in what I would consider a standard way. Section 5. At the time of the CXR in question, I would consider Akash to have been under the care of his GP. My comment regarding a clinical team was meant to indicate primary, secondary and tertiary care if there is an element of active management/follow up. IRMER 2017 regulations place onus on the referrer to read and act appropriately on imaging reports of studies they have initiated. Section 5. There is an agreed Medica Alerts policy and an agreed Medica/Barts Alerts policy in place now and at the time of the reporting of the CXR. This did not overtly specify a need to alert TB.