Coronavirus: medico-legal update

The medico-legal implications for doctors during the coronavirus (COVID-19) outbreak.

The General Medical Council (GMC) has issued guidance explaining how it intends to regulate practice during an outbreak of coronavirus (COVID-19). The guidance covers doctors working outside their usual field of practice, protecting your own health, and temporary registration for certain doctors who may be asked to return to practice, such as those recently retired.

Caring for patients in challenging circumstances

Broader joint guidance has also been issued by the healthcare regulators which explains 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.

Indemnity for retired members

The GMC has granted temporary registration to certain doctors to supplement numbers and provide cover during the emergency. Those granted temporary registration will now extend to doctors who have given up their registration or license to practise in the last six years.

Only doctors with no outstanding fitness to practise investigations or sanctions are being given temporary registration. They are able to opt out of temporary registration at any point, for any reason, explains the GMC. The GMC says doctors in this group wouldn’t be charged to re-join the medical register and wouldn’t need to revalidate during their temporary registration.

We want to reassure retired members returning to practice to help out in an emergency in these circumstances, that we are able to reactivate their membership if they contact us.

Such roles will be indemnified under arrangements put in place by the NHS. However, retired members may need MDU membership for access to the additional medico-legal benefits such as help with complaints or coroners' inquests.

Working outside usual field of practice

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.

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.

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. 

Working outside usual field of practice - 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.

Final year medical students and foundation year one doctors

A joint statement by the UK Health Departments, the General Medical Council, the Medical Schools Council and others explains there will be early provisional registration of final year medical students, once they have graduated and early full registration of suitable foundation year 1 (FY1) doctors.

Key principles in deploying medical students and FY1 doctors are that:

  • it will be for these graduates and doctors to decide if they wish to contribute in this way and opt in
  • the safety of these doctors will be paramount. They should be given induction, provided with full necessary personal protection equipment and the training to use it, appropriately supervised, and not asked to work beyond their competence
  • employers working with medical schools and statutory education bodies will determine how these individuals can best be deployed to support front line colleagues.

If you wish to work as an FY1 doctor, it's essential you have appropriate GMC registration. MDU student membership includes advice and assistance with any medico-legal matters that arise and you do not need to let us know you are doing this work.

Medical students volunteering

The Medical Schools Council (MSC) has set out their expectations on volunteering for employers, medical schools and students.

The GMC explains that, student volunteers 'must be supervised to be safe and act within your competence. You must not be asked to carry out any duties of a doctor.'

Medical student members who choose to volunteer, for example as healthcare assistants do not need to let our membership team know they are doing so. You can also seek our assistance if medico-legal difficulties arise as a result of undertaking this role.

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.

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