Delegation dilemmas

It is my usual practice to ask the junior doctors to obtain the pre-operative consent of patients admitted for elective surgical procedures. However, the most recent F1s have suggested that they consider this delegation may be inappropriate.

A junior doctor with limited or no experience of the procedure to be undertaken may lack adequate understanding of the nature of the operation, including the possible risks and complications, to explain the procedure in appropriate detail to the patient.

We would advise consultants to follow paragraph 45 of the GMC's guidance Good Medical Practice (2013) which states that the delegating doctor must be satisfied that the person to whom the task is delegated must not only have the necessary knowledge and experience but also the qualifications and skills to provide the care or treatment. This is expanded in the GMC explanatory guidance Delegation and referral (2013).

The delegating doctor also has a duty to ensure that the patient has given their consent before the investigation or treatment begins.

Paragraph 26 of the GMC's guidance Consent: Patients and doctors making decisions together (June 2008) elaborates on this duty, and indicates that it is the responsibility of the doctor undertaking the investigation or providing the treatment to discuss it with the patient. The guidance continues by stating that the task may be delegated, provided the person to whom you delegate has the necessary training and experience, complies with the GMC guidance and has sufficient knowledge of the investigation or treatment that is proposed, as well as an understanding of the risks involved.

Paragraph 27 of the GMC's guidance Consent: Patients and doctors making decisions together (June 2008) states that the delegating doctor will however remain responsible for ensuring that the patient has been given sufficient time and information to make an informed decision. The delegating doctor also has a duty to ensure that the patient has given their consent before the investigation or treatment begins Consequently F1 doctors, particularly at the start of their rotations, may not have the necessary knowledge and experience to perform the task of obtaining consent. You may therefore consider it appropriate to complete the process of consent yourself or at least ensure that it is delegated to another sufficiently experienced junior member of your team.