Members of the Medical Defense Society will soon see a fresh new look and logo on our website and in our written communications.
Since going live in 2017, Medical Defense Society has steadily grown in size. Now in 2020, we have firmly established our place in the MDO market. Our growth results from our ability to stand out from our competitors, with our individually tailored service to each GP. This is reflected in our new company image.
Our memorable new logo distinguishes us ¬from the rest of the MDOs in the market that use acronyms – Medical Defense Society is a unique service created by GPs for GPs. We are proud to offer a high quality, personalised service led by experts who know the challenges faced by GPs.
Although our look is changing, our operations will be unaffected. We will carry on providing an excellent service to our members as usual.
For 24/7 support contact Medical Defense Society.
Even before COVID-19, plans were in place for GP practices to provide online and video consultations. Yet adoption of digital technologies was slow. The pandemic changed that, dramatically accelerating the shift to remote consultations as practices reduced the risk of infection for staff and patients. Within weeks, under a quarter of consultations were face-to-face.
GP practices now triage and treat patients remotely wherever possible, via telephone, video and online messaging. Fortunately, clinicians report numerous benefits: flexibility for self-isolating staff and patients, reduced waiting times, greater collaboration, increased efficiency and better prioritisation, all improving satisfaction for patients and staff alike.
While the vast majority of GPs are positive about digital-first care, the speed of change may have left many with questions about potential medico-legal pitfalls.
So how should you safeguard patients’ interests and mitigate any risks of delivering remote care?
Is remote consultation in the patient’s best interests?
The General Medical Council (GMC) provides a flowchart to help clinicians decide if it is safe to treat a patient remotely or if a face-to-face consultation is in the best interests of the patient.
If you are confident that clinical need outweighs any concerns, consider the benefits, potential risks and patient preferences for different communication channels. Keep in mind that some patients feel anxious about online or telephone consultations and establish back-up plans in case of technical issues. Ensure that you can follow the law and GMC guidance using the chosen medium.
How does good medical practice apply in digital-first care?
As for all patient consultations, apply GMC’s principles of good medical practice to remote interactions.
Obtain adequate patient consent: Provide information about all the options, tailored so that individual patients can understand it. Allow sufficient time for the patient to digest the information. Check that they have capacity to understand and make decisions.
Ensure patient confidentiality: Establish that you are speaking with the right person. Check that the patient is ready and in a private space. Make sure that you cannot be overheard. Wherever possible in remote consultations, use a secure system approved for clinical use.
Communicate with other doctors to ensure continuity of care: If you are not the patient’s GP, seek the patient’s consent to obtain and send details of their medical history.
Keep accurate notes about remote patient care: Document that the consultation was remote and make adequate record of your decisions. Be prepared to explain and justify decisions if asked.
Is it appropriate to use photographs and video consultations?
Using photographs and video consultations is appropriate if it supports clinical decision making. Indeed, GPs and patients have increasingly used these during the pandemic, especially photographs.
GMC provides ethical guidance. Important points:
• Only ask for images if essential to support clinical decision making
• Use secure systems for storing and transferring images
• Seek informed consent
• Clearly explain why an image or video consultation is needed, and how it will be kept secure.
Is it safe to conduct intimate examinations remotely?
Carefully consider whether intimate examination is clinically necessary. In some cases, it may be more appropriate to examine the patient in person.
If you and the patient decide to proceed with remote examination, follow GMC’s key principles. Ensure you:
• Offer a chaperone wherever possible
• Use caution when requesting and storing intimate images
• Consult relevant laws and consider safeguarding issues for vulnerable people.
What special considerations apply to remote consultations with children and young people?
Safeguarding the health and wellbeing of children and young people is a priority. If intimate images are required for clinical decisions, follow relevant laws and local policies. Seek advice from your medical defence organisation.
The Royal College of Paediatrics and Child Health provides information on safeguarding in remote consultations.
What advice is there for remote prescribing?
Charlie Massey, Chief Executive and Registrar of GMC: “We … support the use of remote prescribing that follows our clear prescribing guidance.”
GPs should be aware of potential risks and follow GMC’s high level principles for good practice in remote consultations and prescribing. Allow adequate time for patients to understand prescribing information.
Practices should ensure that systems are in place to:
• Identify patient behaviour that raises concern, such as attempts to access potentially harmful medicines
• Monitor patients with long-term conditions
Top Tips for remote consultations
For top tips, visit the Royal College of General Practitioners guidance and Roger Neighbour’s Ten Tips for Successful Video Consultations.
NHS England provides resources to help practices implement the triage-first approach and video consultations. The British Medical Association also offers advice on tools for video consultations and home working.
• Follow GMC’s guidance
• Take practical steps to mitigate risks to patient safety
• Check your indemnity cover is adequate for remote consultation activities
For advice about your remote consultation activities, contact Medical Defense Society.
As we emerge from the initial peak of the COVID-19 pandemic, there is a sense in general practice that while it has presented an exceptionally challenging situation, it has provided a unique opportunity to rethink how patient care is delivered.
Recent reports from the British Medical Association (BMA) and Royal College of General Practitioners (RCGP) focus on identifying and capitalising on certain positive changes that have occurred in general practice since the outbreak began.
We look here at some key themes of those reports.
In response to COVID-19 and the need to protect patients and staff, GPs have made remarkable achievements in radically transforming their working practices and environments, almost overnight. They have made use of a temporary relaxation in regulatory burdens and increased flexibility to provide innovative solutions to meet patient needs despite social distancing requirements and the abrupt changes to everyday clinical practice.
Some of these innovations are clearly here to stay…
The rise of digital technology
One of the most extraordinary and fast-paced changes is in the use of digital technology, which has enabled ‘total triage’ by phone or online, and remote consultations for most patients to reduce the risk of COVID-19 infection. According to the latest BMA tracker survey (9 July), the vast majority of GPs want greater use of remote consultations to continue. Potential benefits include flexibility to better support the needs and preferences of individual patients as well as ease-of-access and convenience for many.
At a meeting of the Royal College of Physicians, Health Secretary Matt Hancock said: “From now on, all consultations should be tele-consultations unless there’s a compelling clinical reason not to.”
Yet, face-to-face consultations will remain an essential part of patient care for those with more complex needs. Prof Martin Marshall, chair of RCGP, cautioned: “Remote consultations, whether by telephone or video, won’t be suitable or preferable for everyone.” Besides, many GPs have highlighted technical problems and the need for more investment in resources, training and IT support.
Closer collaboration and ‘virtual huddles’
As well as enabling consultations to continue during lockdown, use of digital technology notably facilitated collaboration and sharing of expertise in general practice. ‘Virtual huddles’ have helped remote-working GPs feel connected. Video-conferencing between practices, or with secondary care and social care teams, has aided communication and improved continuity of care.
Perhaps these changes have contributed to the greater sense of team working that many GPs have reported during the crisis. Ideally, such digitally-enhanced communication will be expanded and developed in the future to improve patient care across organisational boundaries.
Increasing trust, reducing bureaucracy
Over half of GPs surveyed by the BMA reported feeling less burdened by bureaucracy during the COVID-19 crisis, thanks to a temporary relaxation of regulatory processes and contractual requirements. Based on experiences during the pandemic, the BMA calls for a new culture in which GPs are trusted to use their clinical judgement, with greater autonomy supported by light-touch regulation.
Encouragingly, the government has already committed to a review into reducing the bureaucratic burden as part of the 2020 GP contract deal for England. In addition, a revamp of the GP appraisal process is underway, which will focus much more on the wellbeing of doctors and recognise the experiences of COVID-19.
Doctors have been encouraged to return to the workforce during the pandemic, and a streamlined approach has supported this. There are hopes that some GPs who returned may be persuaded to stay, given the right working conditions and a further reduction in the associated administrative requirements.
GPs at the heart of community leadership
General practice has played a key public health role during the pandemic, which is set to continue. GPs have been essential as leaders and decision makers in emergency planning, clinical pathway redesign and supporting community health. They have led initiatives to provide care for vulnerable patients in the community and care homes, address health inequalities, and support patient self-care.
GPs are now at the forefront of managing the long-term care and rehabilitation of patients with ongoing physical and psychological consequences of COVID-19. In addition, many are now caring for patients with other conditions such as cancer or heart disease that presented at a later stage, due to the interruption to normal services during the pandemic.
Many NHS services are yet to return to full capacity, and recovery is expected to take a long time. As decisions are made on how to deliver and prioritise care in the aftermath of COVID-19, whilst still protecting patients and staff from infection, the experience of general practice is vital. The BMA recommends further strengthening the role of GPs as clinical leaders within their communities.
If you need advice about changes to your clinical role resulting from the COVID-19 pandemic response, contact Medical Defense Society.
It is over 100 days since the World Health Organization declared COVID-19 a pandemic on 11 March. Healthcare services have adapted fast and continue to adjust. With UK case numbers falling, lockdown restrictions are being progressively lifted. GPs and other healthcare workers must prepare for increasing demand for routine care alongside possible local flare-ups of COVID-19.
A survey by the British Medical Association (BMA) (18 June) revealed that over half of GPs have little or no confidence in their department being able to manage patient demand as normal services resume. Many are understandably concerned about a second peak of COVID-19.
So how should you ensure safety and wellbeing of staff and patients as normal services restart?
Keep up-to-date with practice guidelines
As priorities change, keep up-to-date with the latest guidelines. Be aware of the new standard operating procedure (SOP) for general practice in the context of coronavirus (COVID-19) from NHS England. Health Protection Scotland and Public Health Wales have issued their own guidelines.
To help make sense of the new guidelines, the Royal College of General Practitioners (RCGP) has published ‘Coronavirus –Top 10 tips on what to do in primary care’ and BMA provides COVID-19: toolkit for GPs and GP practices.
RCGP and BMA also provide joint guidance on workload prioritisation during COVID-19 – pandemic level reducing.
For nurses and paramedics, the Royal College of Nursing (RCN), College of Paramedics, and The Royal College of Emergency Medicine (RCEM) offer specific COVID-19 resources.
Maintain social distancing
Social distancing measures are still essential. Where possible, telephone or video assessments continue to be a first step for patient appointments. The RCGP COVID-19 Resource Hub provides advice on remote consultations and triaging.
Guidance for people with symptoms of COVID-19 remains unchanged: those who have symptoms should self-isolate for 7 days and their household contacts must self-isolate for 14 days.
Advice for those who have been advised to shield is changing so review this regularly.
Know the latest on testing
Anyone with COVID-19 symptoms can now access swab testing in England and Wales to see if they currently have the virus. In Scotland and Northern Ireland, this applies to anyone aged 5+. Tests for essential workers, including NHS staff, are prioritised.
You can find out how to access testing for staff and patients in guidance from GOV.UK.
Of course, no test is 100% accurate and BMJ has published a useful guide to interpreting a COVID-19 test result.
You can also find information on the NHS test and trace system. This system will contact people who have been in contact with a known case and ask them to self-isolate for 14 days.
Prepare for questions about antibody testing
In May, the government announced a programme of antibody testing in England. Lab-based antibody testing of blood samples is now available to NHS and care staff. Where appropriate, clinicians may also request tests for patients in hospital and social care settings.
Antibody testing indicates who has had the COVID-19 virus and developed an immune response. Results help to improve the accuracy of data on how the virus is spreading.
Importantly, there is no strong evidence that if you test positive you will have long-term immunity that protects against re-infection, so social distancing is still important. However, research on immunity to COVID-19 is underway in a PHE study, SIREN, involving 10,000 healthcare workers.
Maintain appropriate use of PPE
Follow updated guidance on COVID-19 personal protective equipment (PPE). Advice includes specific recommendations for primary care staff, as well as ambulance staff, paramedics, and other settings.
PHE offers additional COVID-19 guidance for ambulance trusts and RCN provides its advice on PPE.
According to BMA tracker surveys, while PPE supply remains a concern, there have been improvements since the start of the pandemic.
If you need information on accessing supplies, NHS England provides details.
Care for those who’ve been caring
COVID-19 has placed many healthcare staff under immense strain. According to the BMA tracker survey (18 June), over a quarter of GPs reported worsening mental health since the pandemic.
This highlights the need to support the mental wellbeing of healthcare workers. RCN Chief Executive & General Secretary Dame Donna Kinnair urged: “As we move past the peak of the epidemic, we must care for those who’ve been caring.”
You may find the following resources helpful:
Medical Defense Society is available 24/7 to provide support for peace of mind. If your clinical duties have changed during the pandemic, or you are returning to the workforce, contact Medical Defense Society for advice about membership.
As an indemnity provider created by GPs for GPs, we pay close attention to the state of the profession. We’re acutely aware of the current shortage of GPs and the need to protect and support the skilled professionals who work across the country. In this post, we look at the latest set of data, which also shows which parts of the country have the biggest GP shortages.
GP numbers down since 2015
The number of GPs in England has fallen by nearly 1,000 since 2015 with 339 fewer full-time equivalent fully-qualified GPs in England in the last year alone. This news comes following an earlier report that showed the proportion of patients finding it difficult to get through to make an appointment with their GP had risen by 65% since 2012.
Doctors’ leaders say the average number of patients GPs should have on their list is 1,600 to provide a high-quality service. But, in September this year, the average number of patients per GP was a staggering 2,100. To maintain the top standards GPs want to set, it’s estimated that an additional 9,000 doctors would be needed.
Which parts of the country have the highest shortage of GPs?
The shortage of GPs affects different areas in the country in different ways.
The biggest overall fall in doctors since 2015 was seen in the North East (with an 11% drop) and the East of England (-7%).
The five areas of the country in need of the most GPs are:
- NHS Cambridgeshire and Peterborough (East of England), where the shortfall is 178 GPs
- NHS Birmingham and Solihull (West Midlands), 172 GPs short
- NHS Leeds (Yorkshire and Humber), 142 GPs short
- NHS Derby and Derbyshire (East Midlands), 138 GPs short
- NHS Nene (East Midlands), 128 GPs short.
The figures were published recently by the TUC. General Secretary Frances O’Grady said: “Our hardworking and overstretched GPs are working tirelessly to help patients. But there are simply not enough of them to keep up with demand.
“As a result, patients are not getting the treatments they need on time – and family doctors are stressed and overwhelmed.”
In 2018, a separate survey of 760,000 patients found 27.9% of them struggle to get through to their family doctor – a rise from 18.6% in 2012. On the back of that, Pulse magazine obtained data which showed that over the last six years, 585 practices have closed, covering a population of nearly 1.9million. Plus, in February, 42% of NHS GPs said they intended to leave or retire from the industry within five years, up from less than a third (32%) in 2014.
‘We need 5,000 GP trainees a year’
Responding to the latest NHS Digital data on GP workforce, Professor Martin Marshall, Chair of the Royal College of GPs, said: “General practice has experienced a workforce and workload crisis for a long time, resulting in many of the more experienced GPs burning out long before retirement.
“As a significant proportion of the workforce approach retirement age, effective retention strategies have to be implemented to keep people in the profession longer. It’s the only way more experienced GPs can have safe, sustainable careers in the NHS, both delivering patient care, and mentoring the next generation of GPs.
“On the positive side, recruitment efforts over recent years have seen the largest uptakes of GP trainees than ever before – and it’s something we are proud of. However, we need a steady flow of at least 5,000 GP trainees a year if were to avoid severe GP shortages.
“Reducing the undoable workload and having plans in place to ensure GPs don’t experience burnout is therefore imperative in keeping the frontline of the NHS safe for patients.”
‘We need to protect the nation’s hard-working GPs’
MDS CEO Rohan Simon added: “The latest figures are a concern and, yet again, show why we need to protect the nation’s hard-working GPs. We support any efforts being made to boost GP numbers as well as those to offer support to those currently in the post.
“When the Government introduced its state-backed indemnity scheme earlier this year it argued that high indemnity prices contributed to the low number of GPs. At that time we did say that this was just one factor – and that there should be a focus on other areas too. This shows that state scheme needs to be followed up with further action.
“MDS will continue to lobby the Government and lend its support to measures that would help GPs to have a better work life balance.
“MDS was established by GPs, for GPs. Its focus is to support the specific needs of GPs and is here to lend support wherever it may be needed. Ultimately, we want to ensure GPs can do their jobs to the best of their ability, with peace of mind that help is at hand when they need it.”
Need help or support in your role as a GP? Contact us to see how we can be of assistance.
How long medical records should be kept is a regular question asked by doctors, and with good reason. It’s a huge responsibility, and one that should be taken with great care, as record holders have a legal and ethical obligation to securely preserve records.
When it comes to the retention of medical records, there’s much to consider. There are also a number of differing circumstances, and some instances where records may need to be kept hold of for longer periods of time than the recommended minimum term.
It is also extremely important to keep in mind the principles of the General Data Protection Regulation (GDPR) when handling medical records. This is because a key principle dictates that personal data should not be retained for any longer than is necessary.
Clearly, however, what is considered ‘necessary’ can be interpreted in many different ways. It is vital, therefore, that if records are kept for longer than is recommended by health departments, the reasons are recorded and made perfectly clear.
In a time-pressured role and environment, effective record keeping is vital for all GPs. It’s important to become adept at maintaining records. It makes the job of a GP far easier when helping patients, and informing the time and care routes taken. In the same way that quality record keeping is key for protecting your judgement, it’s also vital to know how long medical records should be kept.
Minimum recommended GP record retention length
England, Wales and Northern Ireland
GP records should be retained for 10 years after the death of a patient, and electronic patient records (EPRs) must not be deleted or destroyed for the foreseeable future. These recommendations come from the British Medical Association.
The BMA took these minimum retention recommendations from the Information Governance Alliance Records Management Code of Practice for Health and Social Care 2016.
Increased patient access
During November, we discussed the importance of record keeping in healthcare and that patients will soon be able to access their records through an app with the NHS. The fact that patients will shortly have greater access and control over their medical data has brought into sharp focus what is being documented, the quality of that data and how long that data should be stored for.
There is also a whole section on the NHS website dedicated to informing patients about their health records, what is kept in those records and also how to access them.
What information can be included in the record of a patient?
The NHS informs patients that their record can include the following information:
- name, age and address
- health conditions
- medicines and treatments
- historical reaction to medicines and any other allergies
- scans, X-ray and other test results
- information regarding lifestyle, such as whether they smoke or drink
- hospital admission and discharge information
Take a read through our ‘importance of record keeping’ blog post to better understand the important considerations for good record keeping. This includes detailed information on what a patient’s clinical record should include and the other additional important details that should be documented along the way.
If you have any queries about keeping up to date, accurate records and need advice on how long you should keep medical records for, get in touch with MDS today to see how we can help and support you.