The role of non-clinical staff in modern general practice is expanding. Julie Price, head of risk management and education consultancy at Medical Protection, looks at the risks of such staff managing correspondence.

Many practices are looking at new ways of working to reduce the ever-increasing administrative burden on GPs. This has, in some cases, included using trained non-clinical assistants to process inbound correspondence.  

Non-clinician staff can carry out delegated work where it safe to do so

There are undoubtedly advantages and risks in this approach. By using a clear and agreed workflow, non-clinician staff can carry out delegated work where it safe to do so, leaving GPs to deal with those letters requiring medical input or oversight.

It is essential that staff dealing with correspondence are trained in both ‘Read coding’ and document handling, particularly on the type of letters that need to be seen by a clinician. 

Key points to consider

• You will need more than one member of the team to be fully conversant with Read coding and document handling.
• Is there a protocol in place and flowchart to accompany the training?
• Following training, are staff assessed for their competency on this process?
• Training should include the importance of maintaining patient confidentiality; do staff undertaking this task sign a comprehensive confidentiality agreement? This is extremely important, as many of the non-clinical staff may live in the practice locality – and ensuring patient confidentiality is essential.
• Staff should be reminded throughout the training that if they are not sure about a particular letter, they should ‘ask’ rather than ‘second guess’ its importance.
• When the process is in place, clinicians should undertake regular audits, sampling 30-50 letters per week.
• Maintain an incident reporting log for staff to complete if a letter has been incorrectly workflowed. These incidents should be reviewed and discussed, and any action from the discussion implemented and documented.

Professional obligations

The medicolegal risk for clinicians is considerable in this process: for example, a letter that is not followed up could lead to a delay in diagnosis, and subsequent harm to the patient. 

Clinicians need to consider the risk and benefits carefully

When a clinician delegates a task to a non-clinical member of staff, they must ensure that the processes are robust and safe, and that the staff are trained and competent to undertake this task. 

The GMC states: “When delegating care you must be satisfied that the person to whom you delegate has the knowledge, skills and experience to provide the relevant care or treatment; or that the person will be adequately supervised. If you are delegating to a person who is not registered with a statutory regulatory body, voluntary registration can provide some assurance that practitioners have met defined standards of competence and adhere to agreed standards for their professional skills and behaviour.”¹ 

The GMC also states: “When you delegate care you are still responsible for the overall management of the patient.”²

A robust and safe system

Delegating the task of reviewing letters to non-clinical assistants may be an attractive proposition to reduce some of the bureaucratic burden on GPs. However, before implementing such a workflow system, clinicians need to consider the risk and benefits carefully and ensure the system is robust and safe, and includes staff training, monitoring, audit and incident reporting. 

The document Making Time in General Practice, by NHS Alliance, may also be useful.

Related reading

'Inappropriate advice' - Case report

References

1) GMC, Good Medical Practice: Delegation and Referral (2013), para 4
2) Ibid