Bleak by design

I TIPTOE in the back door of the medical practice just as an anxious patient is telling his GP about a recent trip to hospital with chest pains. The doctor shifts uneasily in his seat as the man reminds him he has sought advice from him on a number of previous occasions for the same issue. The look of mild panic on his face suggests the GP is wondering whether he missed a diagnosis. Should he have referred the patient for specialist help sooner?

It’s a tense scene but rest assured that no patient confidentiality was breached during the writing of this article. The anxious patient, Mr Martin, and his GP Dr Wright are two central characters in the forthcoming sixth episode of MDDUS’ flagship GP drama series Bleak Practice, an online risk learning resource that has proved immensely popular amongst UK medical practices. Exclusively for MDDUS members, each 15-minute instalment focuses on key risk areas in day-to-day clinical practice and is accompanied by a discussion guide that lets teams work through the films in their own practices at their own pace.

SETTING THE SCENE

Filming for this latest drama-packed instalment takes place over two days at a real GP practice in Glasgow while it is closed for the weekend. I arrive just as the scene is finishing another take, being careful not to make any noise that could be picked up by the microphones placed around the consulting room by sound recordist Alan Henry. Director Brendan Smith, of video production company Enterprise Screen, is keeping a close eye on the action alongside producer Gavin Hopkins.

The small consulting room is filled with expensive-looking lighting, cameras, monitors and sound equipment and the actors and crew gingerly step around the coil of wires and tripod legs dotted across the floor. Just outside the doctor’s office is MDDUS risk adviser and Bleak scriptwriter Alan Frame, who carefully listens for any inaccuracies or inconsistencies in dialogue. Senior risk adviser Liz Price also stands quietly in the hallway, overseeing the whole project with the help of team administrator and chief organiser Ann Fitzpatrick.

Ann is well acquainted with Dr Wright, having had the dubious pleasure of dying in episode two as ‘Mrs Hicks’ after the GP failed to check her test results. Indeed, being such a small production with a tight budget (the actors apply their own make-up and supply their own non-medical costumes), many MDDUS staff have served as extras and supporting characters over the years alongside the cast of paid actors. The films are truly a team effort.

BLEAK BEGINNINGS

The idea of producing a filmed drama was first touted around five years ago when Liz Price and her risk education team received increasing numbers of requests from managers for learning resources they could access in their practices, at a time that suited them. Keen to create something engaging and different, it was Alan Frame who first suggested a short scripted drama as an entertaining way of highlighting everyday practice risks.

With the help of risk advisers Cheryl Adams and Dr Gail Gilmartin, a story board, script and discussion guide were drafted. Enterprise Screen was brought on board to take care of filming and post-production and within six months the first episode was ready. The big premiere took place at the MDDUS Practice Managers’ Conference in St Andrews in 2014, where it formed the basis of a varied programme of interactive risk workshops.The feedback was immediately positive and the risk education team have made new episodes every year since.

“We have been delighted at the positive reaction to Bleak Practice which seems to build in popularity each year,” says Liz Price.

“The films offer a real team-building experience and practical learning for practices. It’s also a plus that they can be accessed in different ways. Some teams work through a whole film over the course of an afternoon’s protected learning time (PLT) while others break it down into sections and work through it scene-by-scene.

“Every episode has one main theme with a number of sub-themes so there are a lot of really practical learning points in there. The scenarios are all based on real MDDUS case files so the risks and mistakes are real – they just may not all take place in one practice in one day.”

One important message Liz wants practices to take from Bleak is that risk comes from the entire healthcare team, doctors included.

“Many failures occur as a result of a failure across a multidisciplinary system and our experience shows that doctors are equally prone to making mistakes,” Liz adds. “It is not just the PM or receptionist. That’s why we encourage practices to work through Bleak with their entire team.”

FANBASE

Since its premiere, Bleak has received a steady flow of positive feedback from practice managers. One manager who has worked through the episodes with her team during PLT says: "The staff really enjoyed the presentations. They could laugh at the blatant confidentiality breaches knowing that they would never do such silly things. However, the more subtle and seemingly innocent comments which could cause major issues struck a chord with many and made for interesting post-video discussion. Everyone is looking forward to the next instalment."

Many of Bleak’s main characters have become familiar faces, including Dr Wright. He has featured in numerous episodes, having battled alcoholism and faced accusations of negligence. He is played by actor and former murder mystery business owner Peter Hammond.

But the character who enjoys most recognition is Margo, whose piercing blue eyes and wide range of pained facial expressions has earned the long-suffering receptionist something of a cult following.

She is played by Nicola Clark, a trained actress who had a brush with pop stardom in the 1990s after winning a competition to sing in a girl band managed by former X Factor judge Louis Walsh. While her music career never quite took off, she continues to fit in singing and acting around her day job for Transport Scotland.

As Margo, she will take centre-stage in episode six with her father Mr Martin. I speak to her as she is putting on her receptionist’s uniform and preparing to film her first scene.

“This will be my sixth episode so for me coming to filming is like a big reunion,” says Nicola. “It’s great fun playing Margo. She means well but has a bit of a big mouth. I think a lot of people can relate to her – she shows that sometimes when you go out your way to help someone it can land you in trouble.”

After two busy days of filming, Bleak 6 will spend a few weeks in post-production before a rough draft is released to Liz’s team for approval and a final cut is ready for its big premiere.

• Bleak Practice episode 6 will be available for members under “team training” in the Training & CPD section of mddus.com. Click her to view the trailer for Bleak 6

Joanne Curran is an associate editor of Practice Manager