As a healthcare professional, I’m concerned about the potential for concerns being raised about me if I need to depart from established procedures during the pandemic

The healthcare regulators in the UK have issued a joint statement recognising health and care professionals will have concerns about their decision making in these challenging times and acknowledging there may be circumstances requiring healthcare professionals to depart from established procedures. The healthcare regulators say they will take into consideration the context and the circumstances at the time when considering any concerns raised.

It’s therefore important to remember to:

• Seek advice where possible.
• Consult with your colleagues where possible.
• If the right information or advice isn’t available make sure you’ve weighed up the risks and benefits to your patients, your colleagues, and to yourself before making the decision to take action or not.
• Be sure there’s a clear, concise, contemporaneous record prepared as soon as possible explaining why you’ve taken the actions that you have or why you’ve not taken action.

What is my duty of care in a pandemic?

Professional codes of ethics or best practice guidelines perhaps provide little reassurance on the healthcare professional’s duty of care in a pandemic. Healthcare regulators tell healthcare professionals that they must recognise and work within their clinical scope of practice and competency at all times but what are the expected standards during an epidemic of infectious disease?

Additional advice is emerging from the healthcare regulators. If you’re asked to move into a new area ensure you receive training and support from your employer to enable you to practice safely. Communicate effectively with those around you and know who to ask for help. Use your professional skill and judgement to assess safe and effective practice. Making collective decisions with your colleagues is advisable.

As a healthcare professional do I have a duty to treat patients at a risk to my own health?

A healthcare professional’s overriding duty is to protect and promote the wellbeing of their patients. Patients trust healthcare professionals with their lives. By choosing a profession dedicated to caring for those who may be unwell healthcare professionals are assuming some level of risk to their own health, as stated below:

• The General Medical Council Good Medical Practice: A doctor must not deny treatment to patients because their medical condition may put the doctor at risk.
• The Nursing Midwifery Council Code: Must put the interests of people needing nursing or midwifery services first.
• The Healthcare Professions Council Code of Practice: Must not refuse to treat someone just because they have an infection.

Balancing the level of acceptable personal risk to you should be addressed in discussion with your colleagues, supervisors, and managers. Consider measures which can be put in place to reduce the level of risk to your patients, colleagues, and to yourself as much as possible.

If you’ve any pre-existing health conditions address these specifically with your employer and consider whether an occupational health assessment is required.

If I’m required to withdraw or withhold lifesaving treatment from my patient because it is in short supply. What do I need to consider to prevent concerns being raised about my decision making?

This is a difficult scenario which may come to confront healthcare professionals in this pandemic. The government confirms it’s presently trying to prevent this from arising by keeping up supply of critical items with demand.

However, if this fails, then the question will be whether, in extraordinary times, it’s lawful and ethical to withdraw lifesaving treatment from one patient in favour of another? In normal circumstances the answer would be neither as the law imposes a duty of care to treat the individual patient in accordance with a responsible body of medical opinion and in circumstances where obtaining consent from the patient isn’t possible, acting in the patient’s best interests is the guiding principle for making treatment decisions.

The British Medical Association and the Healthcare Regulators have issued guidance suggesting that in these unprecedented times, normal rules will be suspended.

The BMA has issued guidance stating “...if demand outstrips the ability to deliver existing standards, more strictly utilitarian considerations will have to be applied, and decisions about how to meet individual need will give way to decisions about how to maximise overall benefit” and decisions may need to be made to withhold or withdraw treatment and triage resources.

In making such decisions it’s important to check with your employer and colleagues any agreed decision making protocols.

I'm a pharmacist and have been asked to redeploy. I'm concerned about working beyond my scope of practice, what should I consider?

The General Pharmaceutical Council Standards of conduct, ethics & performances states:

• You must recognise the limits of your professional competence. Practice only in those areas in which you are competent to do so and refer to others if you need to.

• Be prepared to challenge the judgement of your colleagues and other professionals if you have reason to believe that their decisions could affect the safety or care of others.
• In an emergency, consider all available options and do your best to provide care and reduce risks to patients and the public.

However the GPhC has issued a joint statement with the other healthcare regulators in the UK acknowledging there may be circumstances requiring healthcare professionals to depart from established procedures and they will take into consideration the context and the circumstances at the time when considering any concerns raised.

• If you’re asked to move into a new area or into an area in which you have not practised for some time ensure you receive the appropriate level of training and support from your employer.
• Ensure you keep up to date with any changing guidelines.
• Continually review and consult with your colleagues about safe practices.
• Use your professional skill and judgement at all times .
• Be sure there’s a clear, concise, contemporaneous record prepared as soon as possible explaining why you’ve taken the actions that you have or why you’ve not taken action.
• A recent announcement by the PDA suggests indemnity insurance will be extended to cover pharmacists “in activities that are beyond the normal scope of their work or when they work beyond the law or the professional regulations” . It’s advisable to check your indemnity arrangements.

I am a pharmacist seeing an unprecedented surge for prescriptions requests. What if drugs are in short supply?

The Royal Pharmaceutical Society has acknowledged that things might need to be done differently. The National Pharmacy Association and the GPhC have so far clarified that pharmacists can breakdown larger packs of paracetamol into single supplies so long as they’re provided directly to patients with clear and safe information about using the drug.

In addition, the government has banned the parallel export of 80 medicines including adrenaline, insulin, paracetamol and morphine. Anyone found in breach of these rules can be reported to the Medicines and Healthcare products Regulatory Agency who can consider enforcement action.

PLEASE NOTE: this information was correct at the time of publication on 14 April 2020