Safe delegation

IT'S hardly surprising that the current pressures facing the NHS are reflected in an increased number of calls to MDDUS from members concerned about inadequate staffing levels or premises, and the risk to patient safety. A related concern is the growing trend to delegate tasks to more junior members of the healthcare team or to other healthcare practitioners.

Media headlines recently highlighted how ambulance technicians are now regularly sent out to deal with medical emergency calls. This month the RCGP also issued a note of caution regarding the launch of an NHS England campaign encouraging parents to take their children to the pharmacy before seeing a GP. Such reports raise questions for all of us in regard to appropriate delegation – and again these concerns are reflected in calls to our advice line.

Delegation utilised carefully and with due safety is a practical way of enhancing the delivery of care. It is now common and accepted practice that many jobs can be delegated, for example to nurses and HCAs. This is reasonable and sensible, but safeguards must be in place.

The GMC is very clear in Good medical practice that: "When you do not provide your patients’ care yourself, for example when you are off duty, or you delegate the care of a patient to a colleague, you must be satisfied that the person providing care has the appropriate qualifications, skills and experience to provide safe care for the patient".

Similarly the GDC states in its guidance, Standards for the dental team: “As a registered dental professional, you could be held responsible for the actions of any member of your team who does not have to register with the GDC (for example, receptionists, practice managers or laboratory assistants). You should ensure that they are appropriately trained and competent".

The guidance also states: "You can delegate the responsibility for a task but not the accountability. This means that, although you can ask someone to carry out a task for you, you could still be held accountable if something goes wrong.

"You should only delegate or refer to another member of the team if you are confident that they have been trained and are both competent and indemnified to do what you are asking."

Both the medical and dental regulators make it clear that when you delegate care you remain responsible for the patient’s management. Also, in all situations of delegation, clear instructions are essential so that all practitioners know and understand their role.

Most healthcare professionals can practice independently when they have been suitably trained. However with delegation, there is often an additional responsibility to provide adequate supervision. In Leadership and management for all doctors the GMC states: “If you are responsible for supervising staff, whatever your role, you must understand the extent of your supervisory responsibilities, give clear instructions about what is expected and be available to answer questions or provide help when needed. You must support any colleagues you supervise or manage to develop their roles and responsibilities by appropriately delegating tasks and responsibilities.

"You must be satisfied that the staff you supervise have the necessary knowledge, skills and training to carry out their roles."

It is essential that healthcare professionals understand their roles in relation to delegation and supervision and are up to date with guidance from their regulator. This requires vigilance in relation to training and review, with appropriate support networks in place so that help can be accessed if needed. Patient safety is paramount; any system must be practical but also support safe care.

ACTION POINTS

• Check your personal responsibilities in relation to delegation.
• Ensure you are aware of regulators’ guidance.
• Regularly undertake reviews with staff carrying out tasks for you to ensure adequate up-to-date training and competency.