Safe practice during industrial action

CURRENT and planned industrial action by a variety of healthcare workers may mean providing safe care to your patients is even more challenging than usual.

The General Medical Council recently published a position statement on industrial action, stating that any doctors choosing to take part in strike action are expected to continue following the principles in Good medical practice. In particular, the statement highlights "the importance of doctors working collaboratively with the healthcare team to keep patients safe, staying within the limits of their competence”.

The GMC acknowledges that doctors may be faced with “challenging situations during strike action, whether or not they're participating directly” and will need to use their “professional judgement to assess risk and deliver the best possible care for people”.

In previous guidance on dealing with “winter pressures”, the GMC recognised that in some circumstances doctors "may need to depart from established procedures" and this would likely apply to industrial action.

The GMC has also emphasised that it will "take into account local realities and the need at times to adapt practices at times of significantly increased national pressure" and that "in the unlikely event that you are referred to your professional regulator, they will consider the context you were working in at the time, including all relevant resources, guidelines or protocols".

Beyond normal scope

As during the Covid pandemic, the wider issue here is about how doctors deal with situations where they are drawn by necessity beyond the limits of their normal scope of working or competence. Examples would include a GP who cannot get an acutely unwell patient to hospital by ambulance, or a doctor working in out-of-hours care and managing ever increasing numbers of critically unwell patients far longer than they feel is safe to do so.

MDDUS has dealt with recent calls involving doctors having to consider whether to provide interim treatment or additional interventions to patients awaiting delayed ambulance transfer. In extreme circumstances this could mean doctors deciding, based on their clinical judgement, that it is safer to get the patient to hospital by some other means of transport, being mindful of the need to check the business or vehicle insurance stipulations if considering the use of their own vehicle.

MDDUS will continue to provide full access to support and indemnity for all doctors affected by the current industrial action. However, doctors should be mindful of their obligations towards patients.

The GMC is clear in Good medical practice that doctors must use their judgement in applying the principles in the guidance to the various situations they will face and must be prepared to justify their decisions and actions. This can mean that any additional treatment and intervention will be guided by factors such as:

• the experience of the doctor
• what they consider to be within the limits of their own competence to deliver
• what they consider can safely be administered in the setting the patient is in at the time.

Continuity of care

Hospital-based doctors may also be affected by industrial action taken by nursing, ancillary and other support staff, where only emergency and other essential care can be offered.

In particular, we would urge members to be alert to the possibility of avoidable harm arising during patient handovers at this time. Doctors should ensure effective and safe communication of patient information so that continuity of care isn’t compromised.

Handover failures are a major cause of preventable patient harm under normal conditions and can lead to delayed and incorrect diagnoses, repeated investigations and incorrect treatment. Doctors must keep in mind their obligation to communicate effectively with colleagues and to be satisfied that suitable arrangements are in place to ensure safe and effective handover of patient care.

Doctors providing additional cover during the strikes are also reminded to work within their own competence and not feel pressurised into taking on an unmanageable volume of work or tasks they feel are beyond their capability and expertise and which may affect patient safety.

Keep a clear record

As in all clinical encounters, keeping good records of a patient’s care is essential, especially during industrial action. This should include the reasons for taking a particular course of action and the nature of any unusual circumstances faced.

Indeed, GMC Chair Professor Dame Carrie MacEwen recently commented on the pressures facing the health service and stated: “Many are also finding it helpful to record the decisions they’re taking in the context of these extraordinary pressures. I would encourage all doctors to do this.”

Dame Carrie also sought to reassure doctors: “We have committed to taking account of the circumstances in which doctors are working should concerns be raised about them, and I reiterate that again here.”

Actions

• Use your judgement as to the most appropriate course of action if departing from established procedures and be prepared to explain and justify your decisions and actions if called upon to do so.
• Continue to work within the limits of your competence and always consider what can safely be administered in the particular patient setting.
• Ensure effective and safe communication of patient information is maintained so that continuity of care isn’t compromised.

Alan Frame is a risk adviser at MDDUS