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NHS England has struck a deal with independent hospitals to expand capacity as the COVID-19 pandemic drains the organisation’s resources. The agreement will add nearly 20,000 fully qualified staff and 8,000 hospital beds across England.
Lockton has gathered a few answers for questions triggered by this new development as well as general queries around the coronavirus outbreak. Please click the questions below to reveal each answer.
For any questions that aren't covered in the FAQs above please contact firstname.lastname@example.org.
A: Please contact us as soon as possible and provide a brief summary of what you are doing and where. Insurers are usually happy to consider providing coverage for these activities following an assessment of the exposure. Where this work is being carried out in the NHS, you need not contact us; the policy will not provide cover for this work (in accordance with cover provided by the State / Government directives) other than for the provision of defence costs and legal expenses available for any disciplinary matters arising.
A: We at Lockton are all too aware of the financial pressures being faced by our consultant clients at this time, particularly those with an extensive private practice. Accordingly, we are working hard with insurers to achieve an affordable solution. Due to the claims made nature of the policy, it is not possible to simply cancel the policy with immediate effect. MedicaInsure polices are underwritten on a “claims made” basis. This means that claims are dealt with under the terms of the policy in force at the time the claim is notified and not the policy that was in force at the time of the original error or omission. For this reason it is important that you do not allow your insurance cover to lapse or cancel. Please note that cancellation of your policy will mean that you will be responsible for settling any claims notified during the period for which cover is not in force.
Moreover, as pointed out above, you also need to maintain cover in the event of regulatory or disciplinary action and, in the case of those working in GP practices and the out of hour’s environment, for complaints and inquests handling. Thus far in respect of saving money, insurers have advised:
- Where there is a negative impact in excess of 10% on your estimated Private Practice activities / income, this will be addressed at your following renewal, since it is simply too early to determine the ultimate impact.
- Where you have entered into a finance agreement arranged by us please let us know immediately so we can see if we can negotiate a deal for you.
- MedicaInsure policies include 60 day premium payment warranty whereby we ask that payment is made of the policy within 60 days of the inception/renewal date. So, for a policy due 1st May 2020 – payment would be due 29th June 2020.
- Alternatively, policies can be paid via Close Premium Finance whereby you can elect to pay your premium over ten monthly instalments. For existing clients paying by instalments, we are currently working with our instalments provider to assist during this period and we are hopeful that freezing/reduced payments will be available in the coming days. An update will be provided further on this shortly.
- Where you are due to renew your insurance, under future earnings, insert a figure reflecting the move away from private practice since you are likely to be required to provide front-line NHS activities for 3 months or in accordance with any Government directives. This is of course subject to change and you will need to monitor Government advice on cancellation of elective work and the likely period this will exist. Your accountant should be able to help with your earning projections.
A: It depends. Please see the points below for more detail:
- The policies we offer provide cover where there is an injury to a patient as a result of a negligent act, error or omission arising out of the provision of medical and clinical professional services. This would apply if the act of negligence arose while treating a patient who has or may have Coronavirus.
- These policies also offer cover for defence costs and legal expenses for any disciplinary matters arising from both NHS and Private Practice activities.
- However, clinical negligence cases arising from clinical work carried out for the NHS are not covered and we repeat the guidance above regarding staff performing NHS activities as a result of the Pandemic. If you are at all unsure, please check with your relevant NHS trust for additional details.
- Whilst the policies covers you if you end up treating a patient who has or may have Coronavirus, they do not provide cover for the transmission by you of Coronavirus to a patient(s), meaning that they will not respond to circumstances or claims where it is alleged you have transmitted the disease. This stance is in accordance with industry standards and should not impact on your day to day activities whilst responding to this pandemic or where allegations of negligence arise.
A: The GMC advice states that unless an emergency is declared they are unable to give any temporary registration to those who may wish to volunteer. In the event of an emergency being declared or where a registered individual wishes to volunteer, please follow the advice below:-
- For those who do not have temporary registration, cover will not be granted;
- For individuals granted temporary registration – please follow the above advice depending on where the work is being undertaken – NHS vs Private Practice.
- For registered individuals who want to volunteer in line with their current scope of practice – please contact the GMC and register your interest and then follow the advice above on where the work is being undertaken – NHS or Private Practice.
- For registered individuals who want to volunteer outside their current scope of practice – please ensure you have been granted authority and retain evidence of this in writing. Please follow the above advice on where the work is being undertaken - NHS or Private Practice
A: Remote consultations will become the norm for some months as efforts focus on limiting the spread of the virus. Insurers can implement cover on the same terms as if you were seeing the patient in a face to face appointment. Best practice, must be maintained including but not limited to, onward referral or scheduling a face to face appointment if the patient’s medical condition(s) require.
This is a constantly evolving situation and as such some of the guidance will change. We hope that this article assists at this uncertain time. Please do not forget that we are available to offer unlimited assistance where possible, whether in respect of your cover, your role or concerns about your welfare. We will also endeavour to keep you updated on individual Insurer views as responses may differ depending on Insurer.
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A: We suggest that you have policies and guidelines in place that protect children and vulnerable adults. Please find below some tips below.
- Policies and guidelines need to be accessible to all staff on site.
- Make sure staff is aware of how to identify and report concerns – pay particular attention to your staff who are being transferred from other wards or units or coming out of retirement and may be unfamiliar with the increasingly stringent rules. Likewise, newly qualified medical students. Ultimately, push the point that if any member of staff is worried about a patient they are under a duty to raise the issue through the correct channels.
- Make all staff aware of who the safeguarding lead is and how to contact them; all the more important when individuals may be self-isolating so ensure that deputies are also identified and fully briefed.
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A: The physical health of your employees, arguably above all other sectors at the moment, is paramount. We have put together some measure that will hopefully be useful.
- Send reminders to all patients that they should not be attending practices unless in an emergency. Put physical signs up at the entrance to the premises reiterating this.
- Where possible call patients on the day before their appointment to check they are still symptom free if they are attending for a physio appointment for example.
- Keep track of protective equipment availability. We appreciate that there is currently a large shortage but ensure that where you have control over orders and supplies, your figures are correct and that staff know where to collect their equipment such as masks, and how to fit them.
- Reiterate the importance of hand-washing and of disposing of used tissues etc. Advocate protective face masks where people are working in particularly vulnerable situations.
- Consider putting up tape so that where patients are collecting prescriptions or attending appointments you ensure that they are standing at an appropriate distance away from your staff. Where practical, see if patients can wait outside or in their cars before being called in (judgement needs to be used here as you do not want an increase in complaints from the public)
- Where clinically appropriate enforce telephone or video consultation services and investigate the possibility of sending prescriptions in the post.
- If some of your staff can transfer clinical practice to the home – perhaps acupuncturists or physios – ensure they have adequate insurance in place and remind them that they must call the patient ahead to check they are symptom free and keep the workspace meticulously clean.
- If someone becomes unwell in the workplace with symptoms of coronavirus, they should:
- keep at least two metres (seven feet) distance from other people
- go to a room or area behind a closed door
- avoid touching anything
- cough or sneeze into a tissue and put it in a bin, or if they do not have tissues, cough and sneeze into the crook of their elbow
- use a separate bathroom from others, if possible.
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A: There are a few factors to consider if a patient is indeed an appropriate candidate for remote consultation. Remote consultations may be appropriate where:
- The patient’s request or clinical needs appears straightforward
- The doctor has access to the patient’s full medical records. If the patient is a new patient and their records are unavailable for some reason you will have to think very carefully, taking into account the points in this section and the one below, as to whether you can proceed Either way, you must document your ultimate decision
- There is no need for the doctor to examine the patient
- The patient has capacity to decide about treatment or a course of action
- There is a safe system in place if the doctor needs to prescribe medication; and
- The doctor can give the patient all the information they need or want about treatment options either over the phone, online or video link.
- The patient is known to the doctor
- There is sufficient and reliable information for safe and effective decision making (or if a carer or member of the MDT can help) e.g. trained care home staff may assess and convey vital signs reliably
- You are contacted by an existing patient and you hold their medical records, but they are out of the country and unable to return for quarantine or restricted travel reasons and have a pre-existing condition; at this point you should make a reasoned decision on the safest course of action for the patient. This may include consulting remotely or advising the patient to seek medical assistance locally. It is very much a case by case decision and we advise you contact us at the time so insurers can give further advice.
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