Following the World Health Organisation characterising COVID-19 as a pandemic, pressure on services may result in healthcare staff working outside their usual practice or in unfamiliar surroundings.
Caring for patients in challenging circumstances
The healthcare regulators have issued joint guidance explaining that healthcare professionals are expected to follow key principles in the ongoing situation. It explains this includes, "the need to work cooperatively with colleagues to keep people safe, to practise in line with the best available evidence, to recognise and work within the limits of their competence, and to have appropriate indemnity arrangements relevant to their practice."
The joint guidance explains that in highly challenging circumstances, it may be necessary to depart from established procedures to care for patients. However if a concern is raised, "it will be considered on the specific facts of the case, taking into account the factors relevant to the environment in which the professional is working," and any protocols in place at the time.
A joint statement by the GMC and CMOs acknowledges that while doctors have a duty to recognise and work within their competence, employers 'must bear in mind that clinicians may need to depart, possibly significantly, from established procedures in order to care for patients in the highly challenging but time-bound circumstances of the peak of an epidemic.'
Doctors need to feel confident that they will not be subject to unreasonable criticism by the GMC, or have their registration removed or restricted, because of the difficult decisions they are forced to make, or the standards of care they are able to provide during a pandemic.
In considering any complaint made about a doctor working during a pandemic, the GMC will take into account the resources available to the doctor, the problems of working in unfamiliar areas of practice and the stress and tiredness that may affect judgment or behaviour. The primary requirement for all doctors is to respond responsibly and reasonably to the circumstances they face.
The GMC recognises that difficult decisions may need to be made quickly regarding the safest and best course of action at any given time. It states that doctors should take the following factors into account:
- 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.
The Chief Medical Officers have also issued guidance. GP practices, hospitals, trusts and health boards are responsible for ensuring their staff are supported, while recognising there may be a need for staff to depart from established procedures in order to care for patients. In the event of a lack of personnel and overwhelming demand on services, employers will need to support staff to use their skills under difficult circumstances and outside their usual scope of practice.
If you work in an area outside your usual practice during the coronavirus pandemic, you can get support, advice and assistance from the MDU in the usual way.
Advice for trainees
Trainees may also be asked to work flexibly if the coronavirus pandemic gets worse such as by carrying out alternative tasks or working in different clinical contexts.
A set of principles for trainees has been published by the GMC and the medical education and training bodies in the UK. The principles include that:
- you shouldn't be asked to carry out any activities beyond your level of competence
- you should receive appropriate induction and supervision if you're deployed to a different clinical area
- interruptions to your training should be considered during your annual review of competence progression (ARCP).
Protecting your own health
The GMC has also issued advice about protecting your own health including following the current public health advice, including self-isolating if you know or suspect you are infected.
If you have pre-existing health conditions putting you at increased risk, the GMC says it may be appropriate to ask another suitably qualified clinician to take over the care of patients who have the virus or are suspected of having it.
Medico-legal advice and support
Our expert medico-legal advisers are available from 8am to 6pm, Monday to Friday (and can be contacted around the clock for urgent enquiries) to answer any medico-legal queries about dealing with the ongoing coronavirus situation, or to offer support to members in professional difficulty. You can contact them on 0800 716 646.
This guidance was correct at publication 06/04/2020. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.