The philosophy behind the approach to indemnity in Out of Hours work and telephone pharmacist diagnosis and/or triage.
As the pressures on primary care increase, increasingly, pharmacists are being asked to work in a range of new settings. It is recognised that pharmacists have been involved in one form of face to face diagnosis or another for many years and often this involves triage.
Predominantly, this has occurred in a community pharmacy where ‘walk in’ customers ask pharmacists to help them out with minor ailments. These are relatively anonymous and usually transient transactions; typically there are no comprehensive patient’s records available. The community pharmacists in these transactions do not hold themselves out to be the definitive answer to the ills of the patient. The patients are usually told to go to their GP if their condition does not resolve itself in a few days. In such circumstances, patients generally accept that if their condition does not clear up, then that means that they should make an appointment to see their GP.
However, some of the new settings in which pharmacists are now being asked to operate are changing the dynamics of these relationships. In particular, where a patient telephones a GP surgery for an assessment of their condition (triage) or if a patient telephones their GP surgery during an out of hour’s period. In such circumstances, the patient may well have already been to see a community pharmacist and their condition has not cleared up.
In this case, telephone triage and diagnosis becomes a much more risk laden activity for any healthcare professional to be involved in, a much greater expectation to getting it right exists not just in the mind of the patient, but also by the legal system in the event of a civil claim for compensation should a misdiagnosis occur. If it is not possible to see the patient face to face, then the process of diagnosis becomes that much more difficult. Nevertheless, despite this, the burden of responsibility and therefore liability is just the same as in a situation where a face to face meeting in a GP surgery had occurred. A pharmacist involved in trying to triage and/ or diagnose a patient over the telephone may well have access to the full patients notes (if operating out of a GP surgery), will likely be working in a situation where the patient is fully registered so there can be no possibility that this can be classed an anonymous transaction. In the case of providing a telephone triage service during out of hours, the pharmacist will be further disadvantaged because they are unlikely to have the patients GP readily available to double check their thought process.
The risks markedly increase if the pharmacist is providing these telephone services from a call centre environment. Typically, calls from a wide geographical area are channelled into a small number of centres throughout the UK where a team of healthcare professionals are available to provide triage and/or diagnostic services. Sometimes, these call centres are designed to support GP practices who may channel their out of hours calls through to their preferred service provider. Sometimes, these call centres are designed to try and keep patients from visiting their GP surgery in the first place (e.g. the NHS 24/7 service or similar).
In both cases, the services hold themselves out to being able to provide a full blown NHS service and notwithstanding that there may well be inadequacies in terms of access to information, there is an expectation of getting it right in the mind of the patient.
Indemnity cover for the telephone diagnosis and/or triage and operating and out of hours service is excluded from the main PDA members scheme, but it is available upon direct application as a standalone insurance scheme provided by independent underwriters.
Equally, the underwriters providing solely the telephone diagnosis and/or triage and out of hours service cover will not provide the much wider indemnity cover and other benefits as provided by PDA membership.
To enjoy the wide range of indemnity and other benefits provided by dint of PDA membership pharmacists should complete their standard PDA membership application and then make contact with the specialist underwriters as a separate exercise.
Pharmacists are invited to call 0121 694 6897 or contact piacommercial.com for more details of the specialist independent underwriters.