Care navigators and the duty of care to patients
Posted on 28th September 2017
The Guardian covers a worrying trend today, which is the decreasing number of GPs. They focus on Brighton to show the extent of the problem ;-
“Brighton and Hove has lost a quarter of its surgeries in two years, as pressure on the primary care sector takes its toll on family doctors across the country”
“The local health watchdog estimates that up to a quarter of the city’s surgeries have shut since 2015, with more than 33,500 patients being forced to change GPs during that time.”
The paper reports that many GPs are leaving the profession due to their reaching retirement age and some are also apparently resigning due to stress.
News also emerged last week that the NHS intends to use ‘Care navigators’ at GP practices to signpost patients towards the most appropriate type of treatment if a GP appointment is not warranted.
A care navigator is likely to be GP receptionist who has undergo some limited training. The hope is that 5% of GPs time can be saved by using care navigators.
Many patients have been dismissive of the suggestion that a care navigator might be able to prevent them from seeing their GP.
The Daily Mail summed up the anger many felt by saying that “There is no way a receptionist — given a half-day training course, according to yesterday’s report — can hope to understand the complexity of someone’s problems and safely advise them on whether or not they need to be seen by a GP or, as the scheme is supposed to work, send them to a nurse, pharmacist or dentist.”
Some patients might be worried that they would be wrongly turned away or that a time critical diagnosis was not made.
So what does the law say about Patient safety and non-clinical staff?
The use of non-clinical staff giving advice was examined in the 2015 case of Darnley v Croydon Health Services NHS Trust .
The case concerned allegations of negligence against non clinical staff and considered what legal duty of care (if any) receptionists in A&E departments owed to patients.
Mr Darnley attended A&E with a head injury and alleged that he was told by an A & E receptionist that he would have a 4- 5 hour wait before being seen for assessment. Facing such a long wait, he left and went home after only waiting 19 minutes.
Court heard that if the Claimant had waited he would actually have been seen by a triage nurse within 30 minutes. He was not told this important piece of information.
The Court of Appeal said that A&E receptionists did not owe a duty of care to patients in this situation and it would not be reasonable to impose liability on the receptionist for harm arising in this case.
The judge reached this verdict for the following reasons;
(a) the duty of non-medically qualified receptionist was to complete the relevant registration forms competently;
(b) the receptionist was providing waiting time information as a courtesy, and it was not mandatory to do so; and
(c) the court said that imposing a duty of care on (non-clinical) reception staff may result in that courtesy (and possibly other courtesies) being removed, which ultimately would be detrimental to the whole patient experience.
The Court of Appeal also concluded that non-clinical staff were not to be the subject of the same legal test as that of clinical staff .
But would the Court of Appeal have reached a different view if the evidence was that the A&E receptionist had received a half day’s training on how to triage and communicate with head injured clients?