Medico-legal: How can practices prepare for a second wave of COVID-19?

MDU medico-legal adviser Dr Kathryn Leask offers practices advice on reviewing their procedures before a potential second wave of the COVID-19 pandemic.

Practices could assess which consultations best lent themselves to being carried out remotely (Photo: sturti/Getty Images)
Practices could assess which consultations best lent themselves to being carried out remotely (Photo: sturti/Getty Images)

GP surgeries had to quickly adapt to changes in practice when the COVID-19 pandemic first hit. Not only was there new guidance to get to grips with, but also new arrangements for managing patient care.

With warnings about the possibility of a second wave of the virus, it is important to reflect on your procedures now to ensure you minimise medico-legal risks and consider what lessons can be learned. Looking at what went well and areas that could be improved will help to prepare for a second wave or a similar situation in the future. Here are some key questions practices can ask themselves in order to do this.

1. Which consultations can continue to be handled safely remotely?

One of the biggest changes of the pandemic has been the use of remote consultations, either by phone or video. Electronic and remote consultations had become more common, even before COVID-19, but the pandemic meant that all consultations began with some form of remote communication and triage.

Many practices, and patients, will have realised the benefits of this and the use of remote consultations is likely to continue. Reflect on your procedures for handling remote consultations, considering any issues that may have arisen. Decide which consultations best lent themselves to being carried out remotely and identify those that could continue to take place by phone or video. Equally, consider those where optimal patient care requires a face-to-face consultation.

2. Do triage staff need further training?

Practices are likely to have dealt with triaging of consultations differently with some using allied healthcare staff such as clinical pharmacists and nurse practitioners. If practice staff were given additional responsibility they may have faced a steep learning curve and reviewing any concerns now can ensure any further training needs can be met.

Were there any particular areas that practice staff carrying out triaging found challenging or which led to concerns being raised by patients? If so, arrange relevant professional development to enhance knowledge and boost confidence levels. Develop the necessary protocols to help in clinical decision making or review those already in place.

3. Were patients able to access face-to-face consultations?

When judging which patients needed to be seen in person, review whether the correct patients were selected.  With hindsight, were there incidences where patients who should have been seen weren’t?

If a patient needed hospital admission but was reluctant or refused, did they understand the seriousness of their condition and the risks they might be running? Was the discussion with the patient well documented, so that you can understand the information provided and reasons for decisions made if required, for example, if a complaint is made later about a delayed diagnosis?

4. Were records updated and were appointment timings about right?

Record keeping is always important and the more detailed a note of a consultation, the better. Was the format of the consultation noted in the records and the limitations of any examinations acknowledged, for example, where the practice was unable to see the patient at a face-to-face appointment?

Triaging appointments and having remote consultations will inevitably have had an impact on the timings of consultations. In some cases this may have made consultations more efficient allowing clinical time to be managed better. Looking back, was the timing of appointments appropriate in terms of appointment length and spacing between appointments?

5. Did shielding advice cause complaints?

Some MDU members received complaints from patients about shielding letters, particularly where a patient felt that they should have received a shielding letter but didn’t.

With hindsight were there any patients who you now believe should have been shielding but weren’t provided with a letter? Could this have been due to incorrect coding in the patient’s records? Bear in mind that even if a patient didn’t fulfil the criteria, practices are able to use their discretion to extend shielding to other patients who may benefit

6. Could we improve communication with care homes?

Looking after patients in care and nursing homes has been a particular challenge during the pandemic. Consider asking for feedback from care home managers in your practice area and reviewing any concerns to help you plan better for these patients. Could communication be improved and if so, how?

7. Were facilities adequate and clean?

If you had a ‘hub’ for patients to be seen in did this provide adequate facilities for you to see people safely and provide appropriate care? For example, there were reports of patients being seen outside practice buildings such as in the practice car park. Were there any issues about infection control or confidentiality and, with more time to prepare, could you improve facilities?

Cleanliness of a practice, whether in the waiting areas or consulting rooms, is always of paramount importance but never more so than during the pandemic. Are there any areas for improvement, such as decluttering rooms or providing alternative waiting areas to allow improved social distancing? Does the practice have a good supply of PPE and cleaning supplies, including hand sanitisers and is there appropriate infection control in place for areas such as patient toilets?

Fully prepare for a second wave

Patients, relatives and carers have continued to raise concerns during the pandemic. During the lockdown, the MDU was notified of almost 500 complaints by members and there will inevitably be further clinical incidents.

Some of these may be outside the practice’s control, for example, delays due to patients not attending hospital when they were advised to because they were fearful about being infected with the coronavirus. There is also a risk of delays in referrals, patients receiving secondary care appointments and routine screening.

We recommend that practices carry out a significant event analysis to highlight areas which may need additional attention to ensure that you are fully prepared should there be a second wave. Your medical defence organisation can provide you with further guidance on doing this.

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