Manager Practice


RISKY BUSINESS?


that a clinical view can be taken on the need for follow-up. Vulnerable patients might include: • •


children older patients who are physically or mentally frail


• patients with learning disabilities • patients with certain mental health conditions, such as dementia •


the homeless. Once safe systems are agreed and staff trained, it is important to


consider what safety nets the practice could implement to ensure that mail is being correctly actioned. Should there be a GP lead and are practices regularly auditing this activity? One solution adopted by some practices is to nominate a ‘safeguarding officer’ to whom this sort of mail may be directed to follow up with the patient. Another increasingly common issue in general practice is returned


referrals. This can occur for various reasons: the referral may be missing important information or the department may require other tests to be carried out before the patient can be seen. Practices also often see urgent referrals returned with the instruction to resend as a routine referral. A secretary or administrator may follow this instruction with the best intentions, wanting to prevent any further delay. However, these should usually go back to a GP to review (preferably to the original referrer) as they may be aware of further information that requires the patient to be reviewed more urgently. Practices contacting patients needing bloods or to provide a sample should keep a record of how and when that contact was made. In making such an appointment, a note can be added to say that it was doctor-initiated so that if the patient cancels or DNAs, staff are prompted to make further contact. Good documentation is also key in supporting the clinicians involved, should any medico-legal issues arise as a result of a patient DNA. A basic incident reporting system should be in place to identify


WWW.MDDUS.COM •


ACTION POINTS •


Identify low-risk correspondence that may have further implications if not reviewed clinically and create a process that safety nets your workflow optimising procedure.


Ensure non-clinical staff are trained in new processes and are aware of the associated risks and know who to approach for advice if concerned.


• Implement quality assurance of systems to ensure patient safety is not compromised and that staff continue to be competent in delegated tasks.


• GPs should ensure patients are fully informed about the reasons for referral and consequences should they not attend. This discussion should be documented within the record.


• Good documentation will support the clinician in any potential medico-legal issues arising as a consequence of a patient failing to attend for further care.


• When processes are up and running, it is important to ensure that the protocols/policies are reviewed regularly so that any issues arising can be fixed promptly.


Kay Louise Grant is a risk adviser at MDDUS


REFERENCES •


Pulse. How a workflow administrator saved us 40 minutes a day (accessed March 2019)


• NHS England. GP Forward View April 2016 • GMC. Good Medical Practice


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any problems or patterns of concern. The practice manager can then review these to determine whether a significant event analysis (SEA) would be helpful to “tweak” the protocols.


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