Continuity of care and risk as a locum GP

There are a number of risks when different healthcare professionals are involved in a patient’s care. Continuity of care can be compromised. What are the risks for locum GPs?

Continuity of care often involves seeing the same doctor each time you visit your GP surgery. It is an important part of general practice, where the patient and doctor build a relationship of trust. However, due to staff absences, developments in primary care meaning chosen GPs are not always available, and patients wanting fast access to a GP, locums are often called upon to step in.

Risks and benefits

Being a locum has its benefits, but it also has its risks, because you will more than likely not have worked at a particular GP practice before starting a locum job. It will be an unknown practice you are walking into, seeing unknown patients – your only knowledge of the patients will be what’s in the medical records, which are handed over from another GP.

Locum GPs unfairly take a lot of flak from the media, often being accused of putting patients at risk, and being stigmatised as not being as good as regular GPs. If locums are aware of the risks and what they need to do to mitigate them, then the chances of errors being made can be reduced.

What are the risks?

Keeping comprehensive medical records for every patient is important. They should be detailed enough to allow a colleague to carry on where you left off. In 2013, MPS visited 127 practices in the UK and conducted Clinical Risk Self Assessments (CRSAs). Of those practices, 89.5% had risks associated with record-keeping.

You are responsible for taking steps to manage locum risks. On your first day at a new practice, ask what their handover system is. Remember, handwritten notes can get lost. Practices should have in place protocols for the transfer of relevant information between doctors; however, in case they don’t cover locums in the protocol, you should have your own system in place to ensure adequate clinical handover.

One problem with locuming is the lack of continuity of care and patient follow-up that comes with moving from practice to practice. At the end of your session, ensure safe handover. If you need to pass on information on your last day, make sure you leave it with someone who you trust will pass it on. You need to hand over all outstanding matters.

Main risk areas

There are two main areas of risk for locum handovers – handover to a locum and handover by a locum.

Handover to a locum

  • You might need to take more time to familiarise yourself with clinical records and a patient’s history, since every patient is potentially a new patient.
  • It will take extra time to read the notes, as well as in the actual consultation when gathering the relevant history.
  • Locums will have to rely on good documentation and record-keeping from the GPs and nurses who saw the patient previously. Poor records risk the locum not having all the information required.
  • If in doubt, discuss the patient afterwards with a partner who knows them, to get the relevant patient, family, social background history.

Handover by a locum

Locums must ensure their records are comprehensive, contemporaneous and detailed, since they may not see the patient again.Locums should try to wrap up what they can in the consultation, e.g,, dictate referral letters, arrange outstanding investigations, ensure follow-up is arranged.If arranging tests, ensure there is a follow-up plan for patients to obtain results.

  • Ideally, ask patients to arrange a follow-up appointment with a doctor. If high risk, hand the matter over to a named doctor, and ensure he/she knows that tests are awaited and that the patient will need following up. Ensure you document your management plan.
  • Speak to colleagues and formally hand over any patients of concern.
  • Consider asking the doctor to let you know the outcome for certain patients, to enable you to learn from episodes/support your learning and professional development.

What the GMC says about continuity of care

  • Doctors must contribute to the safe transfer of patients between healthcare providers. Doctors must share all relevant information with colleagues involved in their patients’ care. They must pass on relevant information about a patient’s condition and history when they hand over care as they go off duty, and when they delegate care or refer patients to other health or social care providers.
  • Doctors must make sure the patient is informed about who is responsible for their overall care
  • Patients should be advised whom to contact if they have questions or concerns about their care.

Conclusion

Good record-keeping helps to ensure patients receive the best possible care and, as a locum, it is particularly important because you will not have met the patients before and so will need to be aware of their medical history. It is essential that records are accurate and up-to-date for an effective handover.

Poor record-keeping is a major factor in litigation brought against healthcare professionals. Risk management is all about thinking ahead and having a plan in the event that things go wrong. A patient’s notes are an objective record of the care you provided, should you be faced with a complaint or claim in clinical negligence.

Charlotte Hudson

Writer and editor at MPS. MPS’s educational risk management workshops, ‘Mastering Professional Interactions’ and ‘Medical Records for GPs’ provide further information on the risks to patients and doctors when patient care passes between doctors, and on good record-keeping. They are free as a benefit of membership to MPS members too.

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