Unscheduled care for health professionals
Correct as of January 2011
Doctors working in unscheduled care (UC) deliver patient care outside normal GP surgery opening times, which amounts to 70% of the week. Such doctors, via an unscheduled care provider, are usually consulted by patients without access to their records and must base their assessment of the patient solely on the information provided by the patient themselves. This factsheet gives information about some of the risks that unscheduled care doctors face and some of the issues they should be aware of.
Common risks when working in unscheduled care
An effective discussion with the patient should ultimately result in a more informed and accurate diagnosis, which will reduce the risk of medical errors occurring
It is unlikely that you will know the patient who contacts the unscheduled care service, and you will probably not have access to their medical records, or their past medical and medication history. Any treatment decision will, therefore, be made solely on the information provided by the patient at the time of the consultation.
An effective discussion with the patient should ultimately result in a more informed and accurate diagnosis, which will reduce the risk of medical errors occurring. A breakdown in communication and inadequate patient management may possibly lead to a delay in diagnosis, with serious consequences for the patient.
If your patient is a child, it is important to take into consideration the parents’ concerns. Parents are often good judges of whether or not a child is seriously unwell. You should always make complete and contemporaneous medical records of all episodes of patient care, including home visits and telephone conversations. You should complete the medical records yourself and should not pass this responsibility on to an administrator.
Telephone systems
You may be required to undertake telephone triage. This involves making a decision on the seriousness of a case, based on the evidence provided by the patient over the telephone. Your unscheduled care organisation may provide additional training before you take on telephone triage. Organisations often use decision support software, and you will need to ensure that you are familiar with this.
Ensure that you are aware of the organisation’s policy on action you should take if you are unable to contact a patient who has requested assistance.
Issues to consider if you’re thinking about unscheduled care work
If you are considering unscheduled care work there are certain issues that you should think about:
- Training – Training may be required on the computer software used by the unscheduled care service, including how to identify when a patient has previously used the unscheduled care service for the same episode of care.
- Peer review – You should be prepared to have telephone conversations and consultations recorded and reviewed on a regular basis.
Familiarise yourself with the organisation’s policies including:
- Patient safety incident report policy
- Referral system
- Dealing with test results
- How patient information is exchanged at the changeover of shifts.
Equipment
The unscheduled care service may supply the necessary equipment – or you may have to supply your own. A thorough check of the functionality of equipment will be needed. You may be provided with a fleet car and driver; or you may have to use your own car; seek clarification.
The drugs policy
You need to find out whether or not the unscheduled care service supplies drugs for home visits, and check the availability of drugs at the unscheduled care centre. You will also need to find out if controlled drugs are provided by the unscheduled care service or if the doctors have this responsibility.
Further information
- Price J, Haslam J, Cowan J, Emerging Risks in Out-of-Hours Primary Care Services, Clinical Governance: An International Journal 11(4): 289-298, 2006
- DH, National Quality Requirements in the Delivery of Out-of-Hours Services 2004
- DH, Standards for Better Health 2004.