Out-of-hours Services - Vetting UK and overseas doctors

Consortia must ensure out-of-hours providers do full checks and have an induction process. By Dr Donald Law

Dr Law: 'Providers now have greater res­ponsibility for ensuring that all doctors they hire are suitably qualified and experienced'
Dr Law: 'Providers now have greater res­ponsibility for ensuring that all doctors they hire are suitably qualified and experienced'

How big a risk is there that more patients who need a GP to see them out-of-hours may suffer death through drug administration errors?

Following the death of a patient in Cambridgeshire from an opiates overdose at the hands of a doctor from Germany doing an out-of-hours session, this is a question GP consortia cannot answer conclusively.

However, they will certainly consider it when awarding contracts to service providers. And if consortia ensure the providers they contract with undertake all the checks listed here, as well as having robust induction and audit processes, hopefully there will be no more preventable deaths.

PROVIDERS' INDUCTION POLICIES

Must include:

  • Familiarisation with the computerised clinical record system and its use to generate prescriptions.
  • National quality requirements on time limits for triage and face-to-face consultations.
  • Familiarisation with the geographical area covered including the location of primary care centres and local hospitals.
  • The call process, from triage to face-to-face consultation.
  • The role of other staff (call handlers, drivers and receptionists).
  • Referring patients to other services (district nursing, social services) and admitting patients to hospital.
  • Issuing prescriptions and, where necessary, personal dispensing and recording use of stock drugs.

Basic requirements
After the Cambridgeshire death, the process by which out-of-hours providers check doctors working for them was reviewed, although the basic requirements remain essentially the same (see box, below).

CONDITIONS FOR OUT-OF-HOURS DOCTORS

Basic requirements

  • Certificate of current medical indemnity.
  • Certificate of GMC registration.
  • MRCGP, JCPTCP or PMETB or certificate of equivalent experience for European Union (EU) registered doctors.
  • CV and referees (who are contacted and a current reference obtained).
  • Entry on a PCT performer's list.
  • Date of last GP appraisal.
  • Recent cardio-pulmonary resuscitation training and child protection/vulnerable adult training.
  • English language competence at International English Language standard level 7 or higher (where English is not the first language).
  • Evidence of a recent extended Criminal Records Bureau check.

Additional conditions added by some SHAs

  • The English language competence condition must be properly enforced (some PCTs were reluctant to enforce this on EU-registered doctors because of EU freedom-of-work laws).
  • Inclusion on a PCT performers list local to where the service is provided. In most cases, the PCT must be within the SHA area. Some SHAs expect the doctor to live in their area.
  • The provider is satisfied the equivalent experience of EU-registered doctors covers all areas of general practice.
  • The provider has an induction and training policy approved by the PCT commissioning the service.

Extra conditions some SHAs now insist on were added as there was variation in the level of evidence required by individual PCTs. Previously, when a doctor was on one PCT performers list, this was used as permission to work anywhere in the UK.

Some EU doctors 'shopped around' to find PCTs less stringent in applying the requirements of entry to their list.

It seems too that some locum agencies pointed doctors to these PCTs.

While a doctor may have a certificate of equivalent experience in another EU country, this experience may vary markedly from that in the UK. For example, a GP in Italy will not routinely see children as all children are registered at birth with paediatricians who provide treatment until their 16th birthday.

In the UK, greater emphasis is now on assessing the doctor's clinical experience. The areas focused on particularly are:

  • Palliative care and use of drugs in terminal care with particular emphasis on administrating and recording use of controlled drugs.
  • Understanding and reporting significant untoward incidents.
  • Child protection and vulnerable adult policies.
  • Demonstration of clinical knowledge expected from a GP in the UK.

Supervised session
These areas are explored at interview but the clinician must undertake a session supervised by a suitably experienced clinician employed by the provider.

Only if the supervisor is satisfied will they be allowed to undertake further sessions (which are audited using the MRCGP audit toolkit).

Providers now have greater responsibility for ensuring that all doctors they hire are suitably qualified and experienced. They can no longer rely on sub-contractors or agencies to provide this evidence. If they do and problems arise, they will be held accountable.

  • Dr Law is medical adviser on out-of-hours services for the East of England Ambulance NHS Trust in Essex

Dr Donald Law recommends

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