Kate Cowan, case manager at Medical Protection, looks at some recent queries from GP practices on whether they can provide COVID-19 antibody tests to practice staff
The ongoing COVID-19 pandemic continues to pose complex dilemmas for healthcare workers. Medical Protection has recently taken a number of calls from primary care members for advice on carrying out the COVID-19 antibody test on practice staff as part of the NHS screening programme, particularly when they are not registered patients at the practice.
In deciding whether to provide any form of treatment or investigation for members of staff, there are GMC guidelines that must be considered. The GMC states in paragraph 16(g) of Good Medical Practice: “In providing clinical care you must wherever possible, avoid providing medical care to yourself or anyone with whom you have a close personal relationship.”
Ethical conflicts of interest
There is also a potential conflict of interest in the practice providing this service to an employee: it may be in the interest of the employer for the employee to remain working and it may be that, depending on current and future guidelines, the outcome of the test could affect an individual’s ability to work. In view of this, occupational health departments or other public provision of COVID-19 testing may be better placed to provide this service. Practices may wish to consider discussing this with their LMC for local guidance.
Performing the test and outcome
If the test is performed at the practice, Medical Protection would expect the following from each clinician:
- Communicate the details of any consultation and results to the patient’s GP or other appropriate practitioner.
- The clinician performing the test should be appropriately trained and competent to perform the test.
- Practices should ensure that protocols are in place as follows:
- Written instructions on the test.
- Training for the staff performing the test.
- Obtaining valid consent from the member of staff.
- Dealing and advising on any possible complications of the test.
- A written record should be kept of each test.
Practices and clinicians would also need to be clear about whose responsibility it is to action any results and communicate these to the patient. Practices would need to understand whether any action is needed in the event of a positive or negative result.
Registering staff as temporary residents
NHS England states that temporary registration at a practice would be for a patient who is temporarily a resident away from their normal place of residence and is not being provided with essential services (or their equivalent) under any other arrangement in the locality where that person is temporarily residing; or moving from place to place and not for the time being resident in any place. Practices should consider whether registering members of staff as temporary residents for the provision of COVID antibody testing meets this criteria.
The issue of whether a person can be registered as a temporary resident is covered by the GMS contract. The LMC or BMA may be better placed to advise on whether this registration is appropriate in this situation.
Any decision to register staff as temporary residents should be considered very carefully in terms of the confidentiality of the staff involved, as the full medical records may become available for other staff to view.
Indemnity
England
NHS Resolution have stated that, where you are appropriately trained and competent to undertake this activity, and you are not covered for this activity under your existing indemnity/insurance arrangements, you will be indemnified under the Clinical Negligence Scheme for Coronavirus (CNSC). The CNSC has been established by NHS Resolution to meet liabilities arising from the special healthcare arrangements being put in place in response to the coronavirus outbreak. Further information is provided in NHS Resolution’s Clinical Negligence Scheme for Coronavirus FAQs.
Antibody testing undertaken in NHS trusts will be covered under the Clinical Negligence Scheme for Trusts. Further information on the rollout of the antibody testing programme is set out in an NHS England and Improvement letter sent out on 25 May 2020.
Scotland, Wales and Northern Ireland only
The devolved administrations have taken an equivalent approach to England. While the existing state indemnity coverage is different in Scotland and Northern Ireland from that in England and Wales, the indemnity powers provided by the Coronavirus Act 2020 are comparable across the four nations. In all four nations staff providing NHS services related to the coronavirus outbreak will have indemnity under the Act, where they are not already covered by an existing indemnity arrangement. The full guidance is here.
Non-claims assistance
Members of Medical Protection are entitled to seek assistance with any non-claims matters that are within the usual scope of Medical Protection assistance and that arise from the member undertaking COVID-19 antibody testing of their staff.
For answers to many other COVID-19 related queries, visit our advice hub