GS Medical Group is an independent medical organisation providing medico legal services in the UK. GS Medical Group has a strong interest in medical education.
GS Medical Group takes its name from the Medical Director and Founder, Dr G Spoto, FRCPsych MA FAcad MEd a Consultant Psychiatrist andMedical Educator with over 30 years experience in the NHS and the Independent Sector Dr G Spoto is a Member of The Medico legal Society of London. He is an Expert Witness and was asMedical Member of the 1st Tier Tribunal (Mental Health) between 1995 - 2021.
Medicolegal Education and Services are a neglected area of practice and the role and function of the Expert Witness is poorly understood.
The issue is nowhere more problematic than in Psychiatry where recourse to litigation is often necessary, not always as a last resort.
GS Medical Group are passionate about the medicolegal interface and are fully committed to seeking and supporting new talent in this exciting area of practice
There have been major advances in the provision of psychiatric services and education during the last 50 years ( Ikkos and Bours ,2021 ) resulting in significant changes of practice. However, with regard to medicolegal education, the ambition to go forward has not been quite the same. Medicolegal services including education are to this day a neglected area of practice.
It is clear that isolation from mainstream medicine has excluded the medicolegal system from developments of practice which are now common place elsewhere in medicine, with serious detrimental implications both for a safe delivery of justice and patient care.
Bizarrely, training in the medicolegal system appears to be largely aimed at experienced Consultants and experts with an established medicolegal practice rather than trainees.
Furthermore, teaching and learning in the medicolegal system is to this day still very much classroom based, a most unsuitable way of teaching and learning for the clinical settings (De Cossart and Fish ,2005) including medicolegal.
GS Medical Group aims to ditch outdated practice from the medicolegal system and indeed GS Medical Group was created precisely with the intention of making excellent medicolegal education, including Supervision and Mentoring available to the more inexperienced Consultants and higher trainees, rather than the usual suspects as it is the case now.
A small scale investigation carried out by the Group based on standard curricular practice ( Fish and Cole 2005 ) shows existing Medicolegal Education to be based on outdated principles and values or none at all
For example the idea still held to this day in the medicolegal system that doctors in training do not need any education ( medicolegally speaking ) because they are unlikely ever to act as Expert Witness as they lack the required experience is false
First of all it is clear that a trainee’s experience to diagnose and treat Mental Disorder which is known as Section 12 Approval is certified by the Secretary of State , the role of a Section 12 Approved Doctor regardless of status being enshrined in the Mental health Act 1983 ( +)
However it is also clearly the case that doctors in training subject to certain conditions can make excellent Expert Witnesses, as already demonstrated in many cases and in several jurisdictions. Yet bizarrely training is to this day not provided to trainees but only available to experienced Consultants and Experts with an established practice (+)(+),in other words the trainers .
Secondly, all training is to this day except perhaps in the Forensic settings ,essentially based on classroom work , a practice that was abandoned many years ago is no longer supported in postgraduate medical education (+) (+)(*) By contrast access to supervision is lacking
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the role of a Section 12 Approved Doctor is a quasi-Judicial role .The role allows a doctor including doctors in training to conduct Mental Health Act Assessments and subject to certain criteria detain patients in a psychiatric unit, thereby instantly depriving people of their liberties
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(+)(+) most training organisations in the UK subscribe to the view that Doctors in training are not suitable experts and this is today also the very strong views of the Reporting Agencies in cases of Personal Injury or Negligence.
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(+)(+)(+) the place where learners engage for the first time in supervised practice away from the classroom is called a “Practicum “ , a safe place where practice rather than the Lecture takes learning forwardThe term “Practicum” was originally introduced in undergraduate education , as a place where the real world of professional practice is simulated
In the training of Surgeons ( De Cossart and Fish , 2005 ) the clinical setting has been equated to a “ Practicum”. However the concept of a “ Practicum “ in the medicolegal system is unknown
The principle underpinning all didactic teaching is of course that Knowledge is “ transmitted “ a view which is no longer accepted in postgraduate medical education
(+)(+)(+) and was successfully challenged by the Constructivist School ( Vigotsky 1978 ) , the prevailing view in postgraduate medical education being today that knowledge is never transmitted from a teacher to the learner as it were by “ osmosis “, but is always constructed by the learner (+).
Unlike other Training Organisations GS Medical Group take the view that didactic teaching is unsuitable for the medicolegal system and categorically reject educational practice based on classroom work which they believe to be outdated and entirely unsuitable for the clinical settings, including medicolegal (+)(+) .
Instead they seek to introduce new ways of teaching and learning based on the constructive model of education including Supervision and Mentoring
GS Medical Group are also of the view contrary to the prevailing opinion and are firmly of the view that subject to certain conditions and provided they are adequately trained and suitably supervised not only doctors in training can make excellent expert witnesses but also that doctors in training what they call “ Junior Experts” should regularly act as Expert Witnesses in most jurisdictions .
Indeed GS Medical Group are entirely of the opinion that provided they are suitably trained and adequately supervised “ junior experts “ rather than experienced Consultants should be the expert of choice in most legal proceedings except in the most complex cases. ( Spoto 2020 )
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(+) New ways of teaching and learning were first introduced by KSS Deanery in 2007 in the South East Region ( KSS Deanery 2007 ) and are now common place in postgraduate medical education. However this new model has never been applied previously to the Medicolegal system
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(+)(+)The original model which hails back to Vigotsky’s idea of “ scaffolding “ ( Vigotsky 1978 ) demands complete abstinence from any kind of classroom work and any attempts by either the learner or the Teacher to go back to the lecture is regarded as “ reverting to type “ and forcefully resisted In medicine of course the discredited view of the infant as a “ tabula rasa “ has now completely lost any traction
The Group has several charitable aims.
Mentoring is automatically provided under GS Medical Group and is a unique benefit of membership. The provision is unlimited. Any Member of the Group engaging in supervised practice may be a Mentor.
Mentorship is provided in the form of a professional conversation and is available by telephone, in person or video link. Mentorship is entirely confidential and available by private arrangement.
Supervision is available to members of GS Medical Group and a unique benefit of membership. Supervision is entirely based on the member's own practice as an Expert and entails for the first time in the UK the supervision of "real " cases under instruction. Supervision is only available to experts prior to the evidence being submitted.
Supervision applies to the three main criteria of practice.
· Preparation;
· Examination of the Case;
· The medicolegal report
GS Medical Group requires at least three supervised cases as a condition of ongoing membership. Supervision is available by private arrangement either in person or via video link. Opportunities for observed practice may also be available.
Occasionally cases where the instructions may be initially with a Supervisor may also be available to be used as a supervised case, if appropriate in relation to the complexity of the case and provided they are of educational value and subject to the explicit consent of the parties
Supervision Is defined by GS Medical as an educational activity which is unrelated to coaching and is entirely discretionary. The responsibility for providing medical evidence regardless of the supervision they receive as part of their training including all the opinions and conclusions that the Experts reach or are reached by the Expert, rests always with the Experts themselves.
A library has been set up by GS Medical Group for the purpose of collecting medicolegal reports by members of the Group, originally the Founder’s own and other teaching materials.
The reports, which are entirely anonymised, are uploaded to the library only for teaching purposes and are subject to copyright. Access is only available to members.
Members of GS Medical Group have access to an online Forum where information about medicolegal education and services may be exchanged.
The Forum is intended to enhance the learning experience available to members of GS Medical Group and also provides opportunities for networking. The Forum’s content is regularly monitored.
GS Medical Group requires learners to reflect on their practice as it is standard practice in Postgraduate Medical Education ( De Cossart and Fish 2005 ) and Learners are expected to keep a Learner's Journal (Moon 2002). Reflections are entirely the learner's choice and are confidential to the learner.
Learners are also encouraged to reflect on “ Critical Incidents “ events of educational value in the life of the learner .Critical incidents need not be untoward incidents and may not be necessarily clinical.
Membership of GS Medical Group is granted subject to a successful application. This entails completing an online application form and interview with a supervisor. Membership is for 1 year initially but up to 3 years or longer. Membership may be revoked whenever necessary.
Services with GS Medical Group, subject to registration, are open to the following:
Consultant Psychiatrist with a substantive post either in the NHS or the private sector, or equivalent academic position;
Higher Psychiatric Trainees (ST's) in a substantive training scheme or holders of an equivalent academic or research post in their final year or approaching CST qualification.
No previous medicolegal experience or qualification is required to join GS Medical Group however applicants must hold the MRCPsych and Section 12 approval (1983) and/all AC approval as appropriate are mandatory. Attendance at a suitable medicolegal course is also necessary.
Consultant Psychiatrist who are members of the Group are able to engage in case-based discussions (CBD’s) as they apply to medicolegal practice CBD's are part of quality improvement and a condition of appraisal under GMC rules.
Consultant Psychiatrist who are members of GS Medical Group are able to engage in CBD's as a benefit of their membership. Members of GS Medical Group are expected to engage in at least 2 medicolegal CBD's a year.
Consultant Psychiatrists who are members of Gs Medical Group are expected to be in Good Standing with the Royal College of Psychiatrists in terms of their Continuing Professional Development ( CPD ).
Services provided by GS Medical Group including Supervision and Mentoring or any time spent in the library or the Forum attracts suitable CPD points subject to approval by the Peer Group.
The literature is silent on the subject of medicolegal education, possibly because of lack of familiarity with Action Research (Elliott 1991).
One study ( Spoto 2018 ) where opportunities for medicolegal practice were included in the job description (JD) of Higher Psychiatric Trainees in a large rotational scheme in the South East Region shows the new scheme to have been very successful.
The scheme was very popular with trainees and indeed Upon being appointed as a Consultant a number of trainees were also found in the study to have developed their own medicolegal practice, some even becoming Medical Members of the 1st Tier Tribunal (Mental Health).
The original study treated by GS Medical Group as a Pilot Study provides the evidence base for the medicolegal services and education provided by GS Medical Group
As a service provider, GS Medical Group specialises in the area of Personal Injury, Clinical Negligence and Employment Law, in relation to patients of working age. Family Law in relation to parenting and Immigration are also areas of interest, and evidence is provided regularly both in relation to Claimants or the Defendant.
GS Medical Group has a further interest in the area of Mental Capacity including capacity to engage in litigation and in certain aspects of crime, including Fitness to Plead or stand trial, and provides services in such areas.
GS Medical Group accepts instructions under Legal Aid and on a pro bono basis.
Experts with an established practice may temporarily join GS Medical Group as Visiting Members subject to registration as part of the Group's "guesting" system.
Membership where Guests enjoy the same level of service provision is only granted for a limited period upon a successful Application,
Supervision "on demand" is available under the scheme and Guests may also engage in medicolegal CBD's as required.
De Cossart L and Fish D (2005) "Cultivating a Thinking Surgeon. New perspectives on clinical teaching learning and assessment".
TFM Publishing Ltd.
De Cossart L and Fish D (2007) "Developing the wise doctor. A resource for Trainers and Trainees in MMC". RSM Press Ltd.
Elliott J (1991) "Action Research for educational change".
Open University Press. Buckingham.
Fish D (2013). "Quality mentoring for student teachers. A principled approached to practice".
Routledge.
Fish D and Coles C( 2005 ) “ Medical Education.Developing a Curriculum for Practice”
Open University Pressin association with McGraw Hill
Maidenhead
Hendry R (2019). "More Doctors need to train as Expert Witnesses say MPS ) Expert Witness Magazine.
BMJ,364
Ikkos G & Bouras N (2021) "Mind State and Society. Social History of Society and Mental Health in Britain 1960 - 2010. Cambridge University Press.
KSS Deanery (2007). "Liberating Learning. A practical guide for learners and teachers in postgraduate medical education and the European Working Time Director. The report of the conference of Postgraduate medical deans ad hoc working group on the educational implications of the European Working Time Directive".
KSS Denary
Moon J (2002). "Learning Journals".
Kogan Page.
Schon DA (1987) "Educating the reflective practitioner".
Josey - Bass.
Spoto G (2018) "Medicolegal training for Doctors. Impact on recruitment of Tribunal medical members". Mental Health Tribunal. Spring Journal.
Spoto G ( 2020 ) “ More Doctors to serve as Expert Witness .Says MPS.A short Commentary
Medicolegal Journal 13
Specialist Info
Vigotsky LS (1978). "Mind in society: The development of higher psychological processes". Harvard University Press. Cambridge
Massachusetts.
Wenger D ( 1999) “Communities of Practice: learning , meaningand identity”
Cambridge University Press
Massachuttes
Allen D (2012) "We need it by next Thursday. The joys of writing Psychiatric Reports".
Create Space Independent Publishing Platform.
Rix K (2001). "Expert Psychiatric Evidence".
RCPsych Publications.
GS Medical Group declares no conflict of interest with respect to the research, authorship and publication of the material quoted on this website
GS Medical Group declares no conflict of interest with respect to the research, authorship and publication of the material quoted on this website
The views and opinions expressed by GS Medical Group as a medical organisation are only the views of GS Medical Group.
The views and opinions of GS Medical Group are not the views and opinions of the Royal College of Psychiatrists, the GMC, the BMA or other professional or training organisations concerned with the medicolegal education and services.
MedicolegalSociety of London. tba
UK Register ofExpert Witnesses. tba
Academy ofExpert Witnesses. tba
MediLaw. tba
Royal Collegeof Psychiatrists. tba
GMC. tba
BMA. tba
GS Medical Group tel no tba
Email tba
Many thanks are due to the following:
C Kelly for editorial support
D Venn for legal advice
M Rubinson for Accountancy advice
Dr G McKay for critical friendship
N Larsen for administrative advice and support
This project is dedicated to the memory of
DrH Rosenfeld FRCPsych
Medicolegal Education.
Action Research.
Supervision.
Mentoring.
Expert Witness.
Junior Expert.
Medical Education
Medicolegal reports
GS Medical Group was founded in 2020 by Dr G Spoto FRCPsych MA FAcadMEd Consultant Psychiatrist with the intention of improving practice in medicolegal education and services
GS Medical Group is a virtual organisation with no physical body, premises or Consulting Rooms.
Members of the Group are expected to make their own arrangements with regard to their medicolegal examination and administration
All educational activities are generally conducted remotely via Zoom. However, members who are based in London subject to capacity may take part in activities in person by private arrangement such as Supervision, Mentoring or Appraisal.
Members of GS Medical Group undergo Appraisal with the Group which is provided by a Supervisor. Mb Members undergo Appraisal on a yearly basis either in person or remotely. Participation in appraisal is mandatory.
GS Medical Group is committed to providing the highest standards of service provision and quality is regularly monitored including fidelity to the group's own model of service provision.
Members are encouraged to research their own practice and also more generally Research into medicolegal education and services is encouraged and regularly undertaken
The services provided by GS Medical Group are GDPR compliant and confidentiality is always maintained including the distribution and a exchange of training materials.
Members of GS Medical Group must have Clinical Indemnity. It is the responsibility of individual members of GS Medical Group to ensure that they have a level of medical indemnity which is appropriate to their practice.
Medicolegal practice in the UK is subject to a duty of care. This rests entirely with the individual service provider on a case by case basis.
GS Medical Group as an organisation does not accept responsibility for any of the services they provide in terms of the duty of care.
Policies and procedures in place to ensure that services are provided in a non-discriminatory manner regardless of gender, age, race or sexual orientation.
GS Medical Group as a medical organisation is run according to its legal requirements in terms of both the reporting structure and governance.
Members of GS Medical Group will have completed 5 supervised cases or engaged with the group for at least 5 years, whichever is the sooner, may become educational supervisors subject to satisfactory appraisal.
Appointments to the role however may also be made by any number of alternative routes whenever is appropriate.
Members of the group who have completed at least 3 supervised cases or engaged with the group for 3 years or longer, whichever is the sooner, are eligible to be mentors for the group subject to satisfactory appraisal.
Members of GS Medical Group may be appointed to the role of course tutor subject to successful appraisal. The role of the course tutor is to support other members through their training, acting as a progress advisor as distinct from a mentor. Tutors are members of the group already acting as supervisors.
Registration and membership ( yearly ) £300
Supervsion (Hourly rate ) £200
CBD ( ½ hourly rate £100
Appraisal (Hourly Rate) £200
Mentorship Free
Library Free
Forum Free
Guesting membership ( yearly ) £300
Supervision on Demand (Hourly Rate) £200
TBA
Application form. TBA
CBD Form. TBA.
Appraisal Form. TBA.
Attendance Certificate. TBA.
Dr G Spoto FRCPsych MA MAcadMEd
Consultant Psychiatrist
Rooms: Wilbraham Place Practice, 9a Wilbraham Place, London, SW1X 9AE
Email: Giuseppe.spoto@ntlworld.com
Registration with GMC: Full (No 241645)
Medical Defence Organisation: MPS (No 112929)
Membership of Royal College of Psychiatrist: (No 6169)
Curriculum Vitae.
I am a Consultant Psychiatrist with over 40 years' experience in General Psychiatry in the UK and abroad and a Fellow of the Royal College of Psychiatrists.
I trained as a Psychiatrist in Milan (Italy) and upon moving to the UK in 1976 I held training posts at the Royal Free Hospital, the Tavistock Clinic and University College Hospital where I was a Senior Registrar and Hon Clinical Lecturer.
Until my retirement from NHS Practice on 11.07.2017, I was a Consultant Psychiatrist with Speciality Responsibility for Psychotherapy with Sussex Partnership NHS Foundation Trust where I was appointed as a Consultant on 01.10.1990.
I joined the Priory Hospital Roehampton for a brief period as a Visiting Consultant on 14.02.2018 and I have been in full time private practice since 01.06.2019.
I am a Member of the Independent Doctors Federation (IDF) where I am a member of the Education Committee. IDF is my Designated Body for Revalidation and Appraisal purposes. My Revalidation date is 29.11.2024.
My research was initially in the field of Psychopharmacology but as early as 1972 I became interested in the relationship between Pharmacotherapy and Psychotherapy, at the time still a completely new area of scientific endeavour. I am published internationally in this area of scientific research.
As a Consultant Psychiatrist in the NHS I maintained clinical responsibility for a defined catchment area in Crawley, West Sussex, whilst retaining responsibilities in Medical Psychotherapy for the Trust over many years.
At Trust level, I was until my retirement a member of the steering group for Personality Disorder Services, a body set up by the Trust to develop policies for this client group including a dedicated Pathway.
I have for many years held senior roles in Medical Education serving the Royal College of Psychiatrists as an Examiner and Scheme Tutor for a large SHO rotation.
Other senior College roles have over the years also included the role of Deputy Regional Advisor for Kent Surrey and Sussex (KSS) and Regional Representative (Community Psychiatry) for KSS.
I hold a Masters Degree in Medical Education and I am a Fellow and Founder Member of the Academy of Medical Educators. I retain accreditation with the GMC as an Educational Supervisor for CT and ST Training in Psychiatry.
My clinical interests are in the care of the seriously mentally ill where I have had leading roles in a number of innovative projects and more recently severe stress related Disorders including complex PTSD.
I am a Medical Member of the 1st Tier Tribunal (Mental Health) where I was appointed in 1995 sitting on average on 120 Tribunals a year in London and the South East.
I have an established medico-legal practice regularly taking instructions as an Expert Witness in cases of Personal Injury, Crime, Clinical Negligence and Immigration work and I am a member of the London Medicolegal Society.
Dr G Spoto
signed
Dr G Spoto. FRCPsych MA FAcad MEd
Consultant Psychiatrist
Date 13.04.22
