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.
GPs have an unusual relationship with their patients. Together, you might well share moments that are deeply emotional and come to learn details that they’ve shared with no-one else, not even their closest.
That’s part of the job – but it also presents a challenge to GPs. There’s a need for doctors to be able to protect patients – but there are other situations where sharing information might be necessary.
The General Medical Council has drawn up useful guidance for such scenarios. In this post, we take a look at some of the GMC’s advice to give you an understand
GP confidentiality: What the GMC says
There are six key areas highlighted by the GMC when it comes to doctor/patient confidentiality and data.
Education and training
Patients’ data should anonymised for this purpose. If it’s not possible to do so, medical professionals should ask for the patient’s consent. When obtaining this consent, you should be clear about what the information is set to be used for and who will be using it. Patients have to have the opportunity to say no – and shouldn’t feel obliged to take part.
GPs might be asked for information by someone’s employer. Similarly, data on the health of an individual might be requested by an insurance company or sports team. You should only comply with such requests if:
- you’re happy that the patient knows what is being requested and how it’ll be used
- you have seen written consent from the patient
- you only provide factual information that is relevant to the matter
- you offer to show the patient your report or send them a copy
Spread of serious disease
There are some circumstances in which the ‘public interest’ means that health information must be disclosed. The GMC outlines that this could be the case when it comes to ‘serious communicable diseases’. It states: “If you consider that failure to disclose the information would leave individuals or society exposed to a risk so serious that it outweighs the patient’s and the public interest in maintaining confidentiality, you should disclose relevant information promptly to an appropriate person or authority.”
The above scenario demonstrates that doctors have a duty to protect and promote the health of the public as well as their patients. This can also collide with doctor/patient confidentiality when it comes to driving. A driver has a legal responsibility to tell the DVLA if they have a condition or treatment that means they are unfit to drive. Doctors should tell them if they have such conditions and make clear that driving is something that isn’t safe in these circumstances (and, legally, should be reported). However, if they continue to drive when unfit a GP may feel it’s in the public interest to reveal this to the DVLA. Even then, GPs should alert patients that they feel this is necessary and let them know when they have contacted the DVLA.
Gunshot and knife wounds
It’s clearly in the public interest for the police to investigate serious crimes such as those involving gunshot or knife wounds – but doctors need to be careful not to deter patients from coming forward when they need medical assistance too. Again, this is a balancing act. If you feel that your patient and/or others are at a serious risk, you should disclose this to the authorities in a sensitive and appropriate manner.
Some patients choose to publicly criticise their GPs in the media. This can be stressful and frustrating – especially if you feel the details they have given to the press are inaccurate or misleading. However, it’s important to note that this alone doesn’t relieve you of your duty to maintain confidentiality. A public row can undermine a GP’s standing in the eyes of other patients and prolong the issue. GPs are advised to avoid commenting – or sticking to general remarks about their practice.
Any GP who is concerned about confidentiality – whether that’s maintaining this or balancing it against the public interest – should seek support. Contact us if you have a query on confidentiality or any other matter relating to your work as a GP.