The NHS said it wants England’s GP surgeries to conduct as many remote consultations as soon as possible - does this affect my indemnity or other medicolegal support?
In the current situation doctors may have to consult with patients remotely more frequently than normal, and advice on this from the appropriate regulatory authorities should be followed.
Although a face-to-face consultation is usually preferred, a remote consultation with their regular doctor may, for the time being, be preferable for some patients.
GPs should inform the patient why, on that particular occasion, they are proceeding with a remote consultation. In making the decision to consult remotely, GPs must balance the risks and benefits in how they consult with their patients and how they advise them. They must also be satisfied that they can adequately and clinically assess the patient remotely.
Regardless of the unique circumstances, we would recommend doctors makes a record of the reasoning behind any decisions made, and the information given to patients, in case it is necessary to explain the approach taken later.
I’m worried my working conditions and environment during this crisis are unsafe - how can I protect my own health, and protect myself from potential errors resulting from these circumstances?
Firstly, employers have a duty of care to all their employees to ensure that the environment is safe to work in. It would be wise to discuss the contingency plans that are in place in your practice now, so that everyone has a clear understanding of the risks that staff may face and the actions and procedures that will be put in place to protect staff.
Your own health is important, and the GMC’s current advice is: ‘'If you know or suspect you are infected, you should follow the current public health advice, including self-isolating'.
If you have pre-existing health conditions that place you at increased risk of infection, you should discuss working arrangements with colleagues and the practice. It may be appropriate to ask another suitably-qualified clinician to take over the care of patients who are suspected to have, or have been diagnosed as having, COVID-19.
Secondly there is a risk that some systems in the healthcare sector will be put under considerable pressure and some may fail to cope or breakdown. If you are worried that patient safety or care may be compromised you should raise your concerns with other clinicians in order to agree the best course of action to ensure the best care for patients.
Doctors should record any concerns in writing, clearly and objectively setting out the reasons for their concerns and the potential impact on patient safety, with examples.
Keep a record of any correspondence or discussions about the problems you have raised and the steps that you have taken to try to remedy matters. If an adverse incident does occur, it can be useful to show that you took action.
Some patients are demanding extra repeat prescriptions, as they want to stockpile, how are these requests best handled?
The government has made reassurances that there are currently no medicine shortages as a result of COVID-19, and that the country is well prepared to deal with impacts of Covid-19 with stockpiles of generic drugs like paracetamol. It would be wise to look out for any further updates on this from the DHSC, the equivalents in Wales, Scotland and Northern Ireland, and the RCGP.
However, many practices will still face requests from patients for extra medication to stockpile ‘just in case’. With an increasing stack of repeat prescriptions waiting to be signed by GPs, it is crucial not to rush this task or be pressured by patients into overprescribing. The practice should have a good repeat-prescribing policy in place and stick to this unless they receive official advice stating otherwise.
While medicine shortages are not anticipated at this time, the policy should include steps to take if patients do face delays obtaining routine medications. If you are worried that inadequate resources could impact on some high-risk patients, for example, in England you should raise those concerns to the local CCG.
Where there are no current concerns, honest and open communication will be key if a patient is insisting that they have extra supply, along with explaining and justifying decisions and actions.
Despite this, some patients will remain angry about not being able to stockpile their prescriptions. The practice’s complaints process should be offered at the consultation should they remain dissatisfied, and conversations should be noted in the patient’s records.
Working outside my competence
I’m concerned that I may be required to undertake duties that are outside of my speciality or expertise to help with the effort to manage COVID-19. What is the advice, and what are the indemnity arrangements?
Firstly, when it comes to indemnity, the assumption is that ‘emergency indemnity’ to enable some healthcare professionals to undertake additional or different duties would be state-backed as it would be NHS-contracted work, specifically to support the government’s plan to manage COVID 19.
However, if a doctor is asked to perform a duty that they would not normally undertake they need to assess whether they feel competent to proceed. This will include considering what is in the best interests of the patient. If they do not feel it is safe to proceed and that to do so would place the patient at greater risk of harm than not undertaking the duty that has been requested, then they should advise whoever has asked them to do so and explain their concerns.
It would be wise to record the details of this deliberation in case it becomes necessary to explain the reasoning behind the decision to act or not to act.
The GMC has issued some advice should the situation escalate, and doctors need to depart from established duties or procedures to care for patients. It has also written to doctors, along with the UK's four chief medical officers, explaining that regulators will take account of temporary changes in practice as a result of a significant COVID-19 epidemic in the UK.
Can I decline if I am asked to work beyond my clinical competence? If so, how?
Doctors should make the care of their patients their first concern. In the current crisis the expectation is that all doctors will do the best they can for their patients in the circumstances in which they find themselves and act in good faith.
Sometimes in a crisis the circumstances may mean that the levels of care which would normally be given are simply not possible.
If however, a doctor believes that they are being asked to work in a way that is placing patients at risk of harm they should raise their concerns by following the workplace policy and the GMC’s guidance, Raising and Acting on Concerns about Patient Safety.
When deciding how to act doctors must consider the best interests of their patients and be prepared to explain and justify their decisions and actions.