Locum GPs may be asked to work in new ways in unfamiliar environments as a result of the Covid-19 crisis. Dr Rachel Birch, medicolegal consultant at Medical Protection, advises on medicolegal dilemmas they may face.
It is no secret that General Practice would not survive without the expertise and availability of GP locums. In this current Covid-19 pandemic, it is likely that the NHS has never needed locum GPs more.
In light of this, locum GPs may have a variety of questions and concerns at this unprecedented and challenging time.
I am worried that my working conditions and environment may be unsafe- how can I protect my own health?
Practices and Covid-19 assessment centres have a duty of care to all their employees, including locum GPs, to ensure that the environment is safe to work in. Before accepting a locum post, you may wish to speak with the practice manager or hospital manager to clarify what is going to be expected of you. For example, will you be assessing patients with suspected Covid-19 remotely or face-to-face? What procedures have been put in place to protect staff?
Your own health is important, and the GMC advises “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, in advance, with your employer.
Remember that it may well be stressful working in the current environment. Ensure that you look after your own mental health and wellbeing and seek the support of colleagues and peers. The BMA wellbeing support service offers counselling to any doctors or medical students and is available 24/7.
I am concerned about the adequacy and supply of Personal Protective Equipment (PPE).
There are well-publicised concerns about potential PPE shortages and the level of PPE required. NHS England have published guidance about the use of PPE when treating patients with suspected Covid-19. This is subject to updates as the situation evolves and locum GPs should familiarise themselves with this guidance.
While healthcare workers will always make patients their paramount concern, their personal safety is important and they must have confidence in the supply and adequacy of their PPE. Before accepting any locum GP position, it would be prudent to firstly ensure that the practice has sufficient PPE for you to use. You may also wish to ask them what their contingency plan would be, should they run out of PPE. For example, what alternative arrangements would they make for the assessment of patients?
Once in practice, if you are concerned that a lack of PPE (or lack of other resources, or inadequate policies or systems) could pose a risk to patients as well as yourself, you should raise your concerns with the practice manager in the first instance, in line with GMC guidance, and keep a note for your records.
I am concerned that I may be asked to undertake duties outside of my expertise.
Before working in an unfamiliar environment, it would be best for locum GPs to go through a process of induction, even if by electronic means, as well as undertaking any training or reading necessary to fulfil that role.
If, as a locum GP, you are asked to perform a duty that you would not normally undertake, regardless of the circumstances, you need to assess whether you have the skills and competency to proceed.
This will include considering what is in the best interests of the patient. If you don’t feel that 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 you should advise whoever has asked you to do so and explain your 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 guidance should the situation escalate, and doctors find themselves being asked to work at the limits of their comfort zone or in some cases beyond. They advise, when deciding the safest and best course of action in such circumstances, doctors should:
- Consider what is within your knowledge and skills, and how your existing skills could be used in a different healthcare setting
- Identify what skills and experience other members of the healthcare team could offer
Be willing to seek professional advice and clinical supervision from colleagues. This may come from a senior, peer or a more junior colleague who is acting within their usual clinical setting or scope of practice
- Seek additional training and guidance as far as you reasonably can in the circumstances.
- This can include preparing for work in a new setting by accessing online or local training to help improve your knowledge and skills in advance
- Make sure you know who go to for support and professional advice.
I have concerns about undertaking remote consultations
Most patients with suspected Covid-19 will be initially assessed remotely, by way of telephone triage. Locum GPs are likely to be asked to take part in such work.
In a remote consultation, you must be satisfied that you can adequately assess the patient remotely, documenting this clearly in the medical records. It is preferable that you have access to the patient’s full medical records, even if the patient is already well known to you. If you cannot access the patient’s medical records, then you should consider whether you can continue to make an adequate assessment by telephone, or whether it is better to ask a colleague who knows the patient to undertake this.
The quality of the telephone line or Skype call must be sufficient, so that you can both communicate effectively.
In many cases it may be that you can assess the patient and offer appropriate advice over the telephone. However, if you feel that you cannot adequately and safely assess the patient, or if you have concerns that they need to be assessed face-to-face, then you should recommend the most appropriate route for the patient to seek medical assistance, in accordance with local public health/government guidance. You should ensure that you are familiar with local protocols and the action to take in emergency situations.
Will I be indemnified for remote consultations during this time?
We understand that in the current situation doctors will have to consult with patients remotely more frequently than normal.
In all remote consultation situations, it is important to ensure you practise in accordance with any applicable laws and regulations around the diagnosis, treatment, prescription and provision of medication to patients – both within the country in which you practise and, if applicable, within the country in which the patient is based at the time of the consultation.
You should inform the patient why, on that particular occasion, you are proceeding with a remote consultation. Regardless of the unique circumstances, we would recommend doctors make 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.
In some cases, travel restrictions have resulted in patients contacting their doctors for a remote consultation from other countries. More information and advice on this and other scenarios can be found on the Medical Protection website.
Will I have to change my indemnity arrangements for increased work due to Covid-19?
It’s best to check with your Medical Defence Organisation (MDO) whether your indemnity arrangements are affected by increased work due to Covid-19.
Locum GPs who are Medical Protection members do not need to update their professional protection during this period to reflect increased work due to Covid-19.
State indemnified GPs are not required to tell us about any increase in their state indemnified workload during this time and we will not charge them any more for their professional protection.
As a mutual organisation, our purpose is to be there for our members in times of difficulty and there has never been a more important time to step in and provide the assistance that doctors need.
If locum GPs have any concerns about the duties they are performing to help manage Covid-19, they should contact their MDO for advice.
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.