Welcome to our section on risk management for GP locums and salaried GPs. The Medical Protection Society has supported the NASGP for over 10 years with help and advice for Sessional GPs around the management of risk, and here you find all those articles.
As you look through them, please feel free to leave your comments at the bottom of any page.
Cancelling sessions through unforeseen circumstances such as illness is just one of those things. Obviously, it shouldn't be undertaken lightly as it can create an inordinate amount of inconvenience for the practice and patients. Wherever possible, if you can help ease the inconvenience by suggesting an alternative, then so much the better - but not always possible considering the precipitating circumstances.
If you make a habit of cancelling in this way, the sad reality is that the practice will think very hard about booking you again.
But cancelling work because of a change in mind, a better offer or to take a holiday is invariably professional suicide. For starters, the GMC's Good Medical Practice has something to say about this, and bad news about a locum cancelling at such short notice would (and does!) spread like wildfire to other practices. Unforeseen circumstances aside, only ever book work that you know you will not have to cancel.
Do you get your own username and password when signing into practice computers? Sick of always being signed in under various combinations of ‘LOCUM1/DRL/LARRYLOCUM’? Perplexed as to how it’s your first time at the practice but looks like you (DRLOCUM) have seen this patient twice already this month? Irritated because you can’t work out who all the other freelance GPs are who’ve already seen this patient? Demoralised for not having the fundamental means for recording auditable medical notes? Struck off for never having officially been enabled to record a consultati…OK, you get the idea.
Secret passwords and usernames are essential to working as a GP – recording contemporaneous medical information in the patient’s notes is a vital part of clinical management; and a medico-legal requirement. And if your password isn’t secret, and call me paranoid, someone else could falsify records in your name. So how come freelance GPs are so rarely given their own? Come on chaps, stand your ground and insist on one! Some of the clinical systems are pretty easy to set up, whereas others aren’t. For example, the procedure for setting up passwords on Microtest can be quite tricky. So we’ve been working with them (and what nice people they are) to make the procedure easier.
@NASGP Huge risk area. I had my name signed to referral letter for a pt I'd never seen. V diff to ensure audit trail in such a setting...
— Dr Catherine Harkin (@buletproofcardi) March 13, 2015
Meanwhile, here is advice provided by Pallant Medical Chambers to shove under the noses of any defaulting practices.
...make it a condition that each practice gives any member working for them a confidential username and password as advised by the General Medical Council, Medical Protection Society2, Department of Health and Good Practice Guidelines for General Practice Electronic Patient Records...
We've asked the 3 leading UK medical defence organisations to let members know what they do for sessional GPs.
Medical Protection Society
MPS is the leading provider of comprehensive professional indemnity and expert advice to doctors, dentists and health professionals around the world. We are a mutual, not-for-profit organisation offering more than 280,000 members help with legal and ethical problems that arise from their professional practice. This includes clinical negligence claims, complaints, medical council inquiries, legal and ethical dilemmas, disciplinary procedures, inquests and fatal-accident inquiries.
Using our wealth of knowledge and experience we have developed a range of education and risk management resources that will assist you in reducing your exposure to complaints and claims. The portfolio available includes publications, conferences, lectures, workshops, E-learning and clinical risk assessments. 97% of members who used MPS say they would recommend us to their colleagues.
Medical Defence Union
The MDU is the UK’s leading medical defence organisation, a not-for-profit organisation wholly dedicated to our members’ interests. Our team is led and staffed by doctors with real-life experience of the pressures and challenges faced in practice.
We offer members expert guidance, personal support and uncompromising defence in addressing medico-legal issues, complaints and claims. Our customised services range from legal assistance, indemnity, training and risk management advice.
As an MDU member you can also benefit from the following:
- 24-hour medico-legal advice and guidance free via our 24-hour helpline (0800 716 646, 24 hours a day, 7 days a week).
- Medico-legal journal and publications. Our highly regarded journal and other publications are free to members and feature real case histories and articles on subjects such as complaints and confidentiality.
- Learning and development support, take advantage of our local medico-legal seminars, specialist training courses and online CPD.
- Member prices for CPD workshops, which are interactive and tailored to small groups.
- MDU online CPD, an online, free easy-to-use resource, which provides an introduction to medical ethics and law and helps you understand the principles and apply them to a variety of day-to-day practice scenarios.
- Free MDU podcasts are available on key medico-legal topics.
Visit themdu.com to find out more, or speak to our membership department on 0800 716 376 (8am to 6pm Monday to Friday, excluding bank holidays).
MDDUS is a mutual organisation that has been providing indemnity, advice and guidance on medico-legal matters to members who encounter professional difficulties for over 100 years.
Membership of MDDUS provides access to:
- Professionally trained medico-legal advisers who are qualified in medicine and are available to speak to you 24 hours a day, 365 days a year
- Medical indemnity against claims of negligence
- Legal representation from solicitors who are recognised as the UK's leading experts in the medico-legal field
- Representation and legal support at General Medical Council (GMC) proceedings
- Help in dealing with complaints
- Assistance with disciplinary matters
- Legal representation and support at coroner's inquests
- Worldwide indemnity for Good Samaritan acts
- A quality, personalised service at a reasonable cost
The MDDUS Risk Management Team have produced a new range of CPD verified online learning and risk management tools. The majority of these resources are exclusively available to members and include video modules, risk checklists, blogs and expert interviews.
For an online quick quote or information about the range of additional benefits of membership visit www.mddus.com
Call our membership team on 0845 270 2038 or email firstname.lastname@example.org
Follow us on Twitter @MDDUS_News
The simple advice here is to try not to get involved in repeat prescribing. This is an area fraught with risk for locums. If you don’t know the patients or their medical histories, this could compromise their care. The last thing you want is a batch of 100 prescriptions to sign off under the pressures of time and record-checking.
Nevertheless, you may be unable to avoid this task if your services are required long-term or in a single-handed practice. In this case, you should agree what will be expected of you regarding repeat prescribing in your terms with the practice in advance.
It is important to clarify
Will you be expected to sign repeat prescriptions?
Does the practice have a protocol for safe repeat prescribing? (Some locums ask for the practice to state in writing that this system is robust and checked regularly.)
What extra time you will need and any supplementary fee for carrying out repeat prescribing work.
When using an unfamiliar electronic prescribing system:
Specific review period or dates should be entered and observed.
Don’t ignore computer warnings of over- or under-use of medication.
Prescriptions should be issued with caution if a review with the patient is overdue. Make sure appropriate arrangements for timely follow up are in place.
Add appropriate computer messages, eg ‘No more methodone until seen’, with the date and your initials.
From a patient safety and risk management perspective, the suggestions below may help.
Familiarise yourself with the practice’s repeat prescribing protocols.
Some medication is unsuitable for repeat prescribing, so a face-to-face consultation would be essential in cases such as night sedation, antidepressants in the suicidal and NSAIDs in the elderly.
Don’t issue a prescription for an item you feel uncomfortable with, eg hypnotics, strong analgesics or anti-depressants.
Refresh your memory on the National Prescribing Centre’s guide – saving time, helping patients: A good practice guide to quality repeat prescribing.