Private services

AS pressure grows to cut NHS waiting times within primary care and demands for seven day working continue to increase, creative approaches to developing alternative models to build capacity and increase efficiency are emerging. A range of private providers are now offering telephone or online consultation services to help GP practices deliver improvements in patient access.

Calls to our medical advisory team on this topic relate both to members requesting information on the additional requirements in provision of indemnity in order to undertake sessions for private providers, and to practices requesting advice on whether contracting such provision is acceptable and how they can mitigate any risks to patient care.

Ensuring appropriate indemnity

MDDUS can offer an extension of membership cover to current GP members delivering this type of private service on a sessional basis. Agreement to this extension of membership depends on a number of factors, including how the private consultation service will be delivered – for example real-time encounters using telephone or web-based videocons, such as Skype, or alternatives such as email or patient contact forms. Our membership team also require reassurance that the service is to be provided exclusively to patients located in the UK, as we cannot extend cover to include consultations with patients located overseas.

Mitigating clinical risk

Consider quality. Before contracting with any private provider, GP practices should ensure that they carry out due diligence. In particular, you should seek assurances about additional indemnity and the quality of service to be provided to your patients – for example that the GPs delivering the service are appropriately trained in consulting within the medium involved, that the quality of their clinical practice and record-keeping will be audited on a regular basis and that the holding and transfer of patient information complies fully with UK data protection and information governance requirements.

Consider the service provided. Will the patient be provided with general advice or will a specific diagnosis be given? How does this clinical advice and care integrate with the service provided by your practice?

Consider who can access the service. The practice should have a clear system in place to ensure that only patients who meet a set of agreed criteria are offered a consultation via the private provider – for example where the patient has an urgent or one-off reason for the request rather than an ongoing issue or one involving more complex clinical needs.

Consider the interface. As with any service delivery shared across providers, there is risk where they interface. At present, most GPs providing this service do not have access to the patient records. This means that they must rely heavily on the patient in obtaining a clinical history relevant to the presenting condition. As is often the case in out-of-hours settings, there is the likelihood that had the patient been seen by a GP with full access to the medical records, better "situational awareness" would have resulted in more effective diagnosis and care.

Consider how new information will be reconciled. Practices must also consider whether and how new clinical information will be reconciled with the patient’s medical record. Does this happen automatically as part of the service delivery or do patients have to consent? If a patient presents with an acute problem, there is a chance that their condition will worsen and timing of information transfer here could be important, along with the quality of safety-netting by the private GP. Is the patient clear on the need to attend their local practice if red flag symptoms occur? How quickly can clinical information in the form of consultation notes be reviewed at the practice after a private consultation? Who reviews whether any further action is required and how easy is it to integrate this usefully into the patient’s record?

Many of these risks should ease as technology advances and patients can be enabled to allow other healthcare professionals to access – and possibly add to – their electronic medical records.

Actions

• GP members considering working for a private provider to deliver remote consultations should contact MDDUS to ensure that they arrange appropriate additional private indemnity for this work.
• Those members with responsibility for contracting GPs to provide these services should ensure that the individuals have obtained an extension to their membership to cover this private work.
• GP practices should take steps to risk assess their choice of provider, including the way the service will integrate with their own to mitigate any potential risks to patient safety.