This is an exceptionally difficult and rapidly evolving situation and we wish to offer reassurance that the MDDUS stands ready to assist, advise and support our members.
Doctors should ensure they remain aware of the latest guidance from the relevant government and health departments and follow those guidelines. You should be cognisant of GMC guidance, ensuring that this continues to be followed.
The GMC are clarifying and updating their guidance online, as matters proceed, which can be accessed from their hub:At all times you must make the care of your patients your first concern by prioritising their needs. You should be able to justify your actions, if later called upon to do so.
What if I am asked to work in another area or outside my usual limits of competence e.g. non-acute specialists working in ED or academics working clinically?
As the situation develops, some doctors may be asked to work outside their usual working arrangements, including in other areas of practice. If faced with such a situation, you should consider the particular circumstances and ensure that patients are not exposed to unnecessary risk. It may be that rapid decisions are needed and that these decisions are then reviewed regularly, to ensure that decisions are clinically appropriate and consistent with current guidance (which may also change frequently).
With any such decision, doctors should keep in mind their knowledge and skills and be aware of their own limitations. You should consider what support is available from others in the healthcare team, the need of the individual patient, as well as the whole patient population alongside the wider public health issues. You should also consider steps to minimise risk of transmission and ways to protect your own health. You may wish to also consider innovative ways of using your existing skills if you are asked to work in another area and you should be willing to seek advice and supervision from colleagues.
If you are working in another area, you should do all you can to prepare, such as accessing online or local training and to be aware when and who to contact for advice.
As with all challenging decisions, where possible, canvass the views of your senior colleagues and management to inform your decision. You should document decisions you make, including the rationale.
In an emergency, with no alternatives, you should do your best to provide safe care that benefits the patient. You must ensure patients are not exposed to unnecessary risk and you should tell seniors or management if you think patients are being exposed to avoidable risk.Close
What should I consider when undertaking remote or online consultations, rather than seeing patients face to face?
In this unprecedented emergency situation, you may consider that remote consulting is preferable to face-to-face consultations for certain patients. Such a change to practice needs to be in line with current guidance, clinically appropriate and offer the optimum means of providing care (in the particular circumstances being faced).
Remote consulting is inherently different from traditional consultations and doctors should be aware of the unique challenges. These include considering whether you have sufficient knowledge of the patient’s background/history (if you can’t access their records) and ensuring that you have informed consent from the patient to consult with them in this way (i.e. that they know there are risks, which are accepted). Ensure notes are made and (where possible) placed in the patient’s usual records, communicated to their usual team and that continuity of care and follow-up arrangements are in place.
Communication can be more of a challenge remotely, for example some of the usual natural, non-verbal cues are not available or clearly the ability to physically examine a patient. Practical issues like connection problems or computing issues may also hamper the ability to undertake a full consultation.
Doctors should ensure they assess all information about a particular patient carefully and consider what is clinically appropriate. Another important factor is what arrangements are in place to facilitate safe and timely face-to-face contact, if this is needed?
You can review our published guidance on this topic >remote consulting in the coronavirus outbreak<
You may also want to review other helpful online training in our section on “Training for Returning Doctors”
GMC: Remote consultations
GMC: Good practice in prescribing and managing medicines and devices (2013) . This includes a section on remote prescribing.Close
I have concerns about increased risk of claims, complaints or GMC referrals, if the care provided is not to the usual standard. Will the MDDUS support and defend me in that situation?
MDDUS can offer reassurance to members that you can approach us for advice and guidance at this challenging time. We have confirmation from the GMC that, whilst doctors should continue to follow the GMC’s professional guidance, responding to this pandemic requires flexibility.
The GMC have clarified that these standards can only be applied as far as is practical in the circumstances. The GMC chair, Dame Clare Marx, in a message to doctors on 24 March 2020 has advocated a measured approach to varying standards as the situation demands. She states “responding to this pandemic will require us to do things differently. It will require us to be flexible… any concerns raised about your practice will take into account the extreme circumstances in which you are working.” Dame Marx confirms that, “in this national emergency, that means taking a measured approach to varying standards as the situation demands. In the peak of this outbreak, that could include departing significantly from established procedures.”
As the situation develops, doctors should use the current guidance to inform their decision-making.
The GMC will take account of exceptional circumstances but you do need to be in a position to explain and justify decisions you make, if later called on to do so. It is good practice to document such decisions carefully, including the reasons. This is all the more important in these unusual circumstances and where guidance may not be available that directly applies to the decision you are facing. If you are in doubt about any medicolegal or ethical aspects, please contact MDDUS for advice.
The GMC has made clear, in a Joint Statement with the other statutory regulators of health and care professionals that they recognise the anxiety doctors are feeling about how context is taken into account when concerns are raised about their decisions and actions in very challenging circumstances. They have further added that where a concern is raised about a registered professional, it will always be considered on the specific facts of the case, taking into account the factors relevant to the environment in which the professional is working. They would also take account of any relevant information about resource, guidelines or protocols in place at the time.
Should you face any medicolegal issues, such as a complaint or GMC referral that arise from your clinical actions, members can always turn to MDDUS for advice and support.Close
I have underlying health conditions, how should these be considered? In particular, what effect does my health have on my duty to work versus the right to be protected from infection?
Employers / contracting bodies should be taking all the steps they can to keep staff as safe as they can be. Given this is a rapidly developing situation, difficult decisions may need to be made. If you are worried about your own health, you should discuss your concerns your employer and Occupational Health to assess how best to proceed. It may also be appropriate to discuss your concerns with your own doctor.
If you are concerned that you may have coronavirus / covid-19, you should follow the current public health guidance. You may need to arrange for a suitably qualified colleague to take over the care of your patients.Close
There are reports of shortage of protective equipment: if PPE is not available or not the type expected, what should I do? What if patients need to be seen and there is not the right equipment available to see them safely?All employers / contracting bodies should be taking all the steps they can to keep staff as safe as can be. Given this is a new and rapidly developing situation, difficult decisions may need to be made. Employers also have a responsibility to provide staff with the right information to minimise risk. You should follow the latest applicable guidance if you are in doubt.If you are concerned that you do not have the correct protective equipment, you should raise this with your employer/Trust/Health Board or public health department and work with them to try to resolve the situation as quickly and safely as possible, ensuring patients are cared for. Doctors will be required to make a judgement on a case-by-case basis on how to proceed, based on the urgency of the situation and any alternatives to direct face-to-face contact that are available e.g. online or telephone consultations.You should take the following factors into account:
- whether treatment can be delayed, or provided by another means, such as remotely
- whether additional steps can be taken to minimise the risk of transmission
- whether any doctors are at a higher risk from infection than other colleagues
- what course of action is likely to result in the least harm in the circumstances.
For those wishing advice on use of PPE and beards click here to access additional advice relating to PPE from our partners BTO (Brechin Tindal Oatts).Close
What about colleagues who have tested positive for COVID-19 or who have symptoms? What if there are dangerous staff shortages and they need to come back to work?
All healthcare professionals and members of the clinical team must ensure they follow the latest guidance in relation to their fitness for work. This guidance applies to healthcare workers in the same way as it does to the whole population and must be followed. This includes strict adherence to self-isolation requirements, whether due to your own symptoms or if others in your household have symptoms.
In these difficult times, there may be colleagues who feel pressure to return to work before the guidance allows. If faced with such a situation, where there are limited alternative options, doctors would be expected to consider the particular situation, ensuring they select the best option to protect patient safety, both patients as individuals and the population more widely. Doctors must ensure that all factors have been considered and they have (where possible) obtained agreement from specialist bodies (such as the public health team) and their employer, if intending to take a course of action not covered by the guidelines. The guidance is clear that you must follow self-isolation requirements and if asked to go back to work before this, you must exercise extreme caution and have clear advice (e.g. a directive from occupational health). As with all challenging decisions, particularly in unprecedented situations such as this, doctors must be prepared to justify their decisions, if later called upon to do so.
If you have any concerns about the clinical care that is being provided, you should raise those concerns through the appropriate channels, in line with GMC guidance:Close
What other changes should be made to practice?
Given the situation is rapidly evolving in light of new information, it is vital that processes are put in place to ensure you are kept up to date with the latest guidance. Processes should be reviewed on a regular basis to assess how they are working, ensuring they adhere to the relevant guidance at that time and that changes can be made quickly, if needed.
For example, most healthcare providers will now have processes in place to assess and manage patients with suspected COVID-19, whilst minimising the chances of onward spread. Processes may also have been instigated to rapidly assess even non-acute patients to allow optimisation of limited healthcare resources. It is important to regularly review such emergency measures to ensure they continue to represent the current best means of delivering care. It would be appropriate to keep a record of processes you institute and the reasons for those.
Working remotely: how can I ensure maintaining patient confidentiality?
For those being asked to work remotely, be mindful of your ongoing professional duties and take steps to ensure compliance, as far as possible. For example, a patient’s right to confidentiality remains and all steps should be taken to ensure this is protected. You may wish to consider where you are working and how you can protect the security of data you access.
Consider potential sources of accidental data breaches, such as being overheard, and take steps to mitigate those risks. From a practical perspective, think about the way you are now handling patient and your own personal data; do you need to ensure your telephone number is blocked? What about your phone bills, might patient data appear there and have you protected this data?
If you are in doubt, speak to your Data Protection Officer or contact MDDUS for advice.Close
I am a recently retired doctor and I’m thinking about returning to practice, what do I need to consider?
The GMC has written to 15,000 recently retired doctors (in the past 3 years) to ask if they would consider temporary registration under the GMC’s emergency powers, so they can return to practice. Further information about this is available https://www.gmc-uk.org/registration-and-licensing/temporary-registration
With immediate effect, MDDUS has automatically reinstated membership benefits for all doctors who have retired from membership in the past three years. Review the information about this here: https://www.mddus.com/about-us/media-centre/2020/march/hurdle-to-a-return-to-work-for-retired-members-removed-automaticallyClose
I am a medical student and I want to offer assistance. What do I need to consider?Medical students may also be a source of assistance to the healthcare team. At present, they would be offering voluntary help and should not be carrying out any duties of a doctor. They should only be asked to undertake tasks they are competent to perform and satisfactory supervision should be in place.
Have a look at the latest GMC guidance, including advice in relation to your education:
I am worried about my own physical and mental health, are there any sources of support?
It is vital that you look after your own health. This is an unprecedented situation and your resilience and coping mechanisms are likely to be pushed to the limits. Take time to find the best support for you.
If you are worried that you may have symptoms or Coronavirus / COVID-19 you must follow the current public health guidance. You may need to arrange for a suitably qualified colleague to immediately take-over care of your patient.
A list of support services can be accessed via NHS Practitioner Health at the following link: https://www.practitionerhealth.nhs.uk/covid-19-frontline-wellbeingClose