Upskilling practice staff

NHS England's GP Forward View revealed that £45 million over five years would be dedicated to support the costs of practices training reception and clerical staff for additional duties.

These duties include 'signposting' patients to direct them to the most appropriate healthcare professional, and managing clinical correspondence.


  • Involves advising the patient about sources of help and advice most relevant to their needs.
  • Does not involve making a diagnosis or planning treatment.

Correspondence management

  • Involves coding incoming clinical correspondence, taking actions where appropriate – including forwarding to another member of the team, or passing the letter to a GP if a clinical decision is needed.
  • More advanced than basic document processing or coding.

A well-trained administrative team can be invaluable to the efficient running of a practice. If your practice plans to delegate more tasks to non-clinical staff, keep in mind the following medico-legal considerations.

Provide adequate training

Make sure staff are comfortable taking on additional responsibilities and are working within their level of competence.

For example, correspondence management requires staff members to be confident in making decisions about how to code a letter and its contents in the patient record, how to use an approved protocol for deciding which letters are sent to a GP and with how much urgency, and when to ask for help.

  • The GMC expects doctors to be 'satisfied that the staff you supervise have the necessary knowledge, skills and training to carry out their roles'.
  • The CQC expects practices to regularly review the training needs of their staff and maintain a record of all staff training and development.
  • NHS England has outlined details of training for reception and clerical staff under the GP Forward View on its website.


When delegating tasks to a colleague, GPs are still responsible for the overall care and management of patients.

  • The GMC's guidance to delegation and referral states that 'you must be satisfied that the person providing care has the appropriate qualifications, skills and experience to provide safe care for the patient.'
  • A senior doctor within the practice should oversee non-clinical staff taking on enhanced roles.
  • Make sure there are clear procedures in place to guide clerical staff and provide consistency in how tasks are carried out.
  • Provide staff with a way of raising concerns if they are uncomfortable with performing a task.
  • Conduct regular audits to monitor and improve systems and training.


  • GP partners are jointly vicariously liable for the actions of practice staff under their employment.
  • It's important that any staff undertaking enhanced roles within the practice are fully trained, working to up-to-date protocols and closely supervised.
  • Staff should also have access to clinical guidance and support when they need it.

If you're implementing an upskilling system in your practice, contact the MDU to ensure you have the appropriate indemnity. We can also advise on the relevant medico-legal implications.

This guidance was correct at publication 31/10/2018. 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.

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