Delegate with care

Should new government plans for healthcare reform in England come to pass one thing is certain – the GPs affected will be doing a lot more delegating. How else will they find time to run the NHS?

Delegation has been an increasing area of controversy in primary care over the last ten years with the rise of the nurse practitioner and healthcare assistant. In medico-legal terms it is a common area of risk but not due to the overall quality of care offered by nurses and HCAs.

The GMC frames the issue clearly in Good Medical Practice:

"Delegation involves asking a colleague to provide treatment or care on your behalf. Although you will not be accountable for the decisions and actions of those to whom you delegate, you will still be responsible for the overall management of the patient, and accountable for your decision to delegate. When you delegate care or treatment you must be satisfied that the person to whom you delegate has the qualifications, experience, knowledge and skills to provide the care or treatment involved. You must always pass on enough information about the patient and the treatment they need."

Each year MDDUS deals with many cases in which there has been a failure at the interface between GPs/GDPs and practice staff. A typical example would be a nurse asked to syringe a patient’s ear. In one such case a practice nurse carried out the task under a GP’s instruction but neither had ascertained that the patient had previous ear surgery which is an absolute contraindication. Both were named in subsequent legal action although the nurse claimed she was just carrying out the task as ordered.

Here the case hinges on passing information but more often cases are to do with a failure to ensure that staff have appropriate training for carrying out a task such as taking blood. It is the GP’s responsibility to be satisfied that a delegated task is within a staff member’s competence.

Such responsibility can be a two-way street. The Nursing and Midwifery Council states:

"Where another, such as an employer, has the authority to delegate an aspect of care, the employer becomes accountable for that delegation. The nurse or midwife will however continue to carry responsibility to intervene if she feels that the proposed delegation is inappropriate or unsafe."

A similar regulatory principle holds for members of the dental team. The General Dental Council states in Principles of Dental Team Working:

"If you employ, manage or lead a team, you should make sure that all the members of your team understand their roles and responsibilities, including what decisions and actions have and have not been delegated to them…"

"Only carry out a task or a type of treatment if you are sure that you have been trained and are competent to do it.

"Only ask another member of the team to carry out a task or a type of treatment if you are confident that they have been trained and are competent to do it."

It is clear there is a shared responsibility to ensure that all medical or dental treatment is carried out only by appropriate and fully trained staff. But the ultimate responsibility for ensuring this is the case must rest with the employing GP or GDP and it is here that any major liability will certainly be borne.

ADVICE. Ensure your staff are not asked to take on tasks out with their competence or responsibility. Ensure that they are properly trained in any task they are asked to carry out. Keep good records of all staff training as proof of competence.