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Practicing outside of your normal scope during the Covid -19 pandemic

Both the Ministry of Health and DHBs have alluded to redistributing the health workforce in order to manage rising numbers of COVID -19 cases. It is not inconceivable that a clinician may be asked to “go help out on the COVID ward “when respiratory medicine and ventilators are a distant undergraduate memory. This can potentially put your Practicing Certificate at significant risk, however there are guidelines which, if followed, will deliver safe care and mitigate the risk.

Medicus would like to draw your attention to the relevant Medical Council guidelines which can provide a framework in order to mitigate the risk. The short answer is to establish an appropriate collegial relationship to provide guidance and oversight, and to notify the Medical Council of your intended departure from your registered scope of practice.

1. In the Registration reference on the Medical Council website you will find the following.

You must establish a collegial relationship with a vocationally-registered colleague if:

  • you are vocationally-registered but working outside your vocational scope, or

  • your practice is limited to non-clinical practice.

The colleague you choose must be vocationally-registered in the area of medicine you are working in that is outside of your vocational scope.

For example, if you were a gastroenterologist and were asked to be re-tasked to the Covid-19 ward to monitor patients on ventilators. Before doing so you would need to seek out an intensivist or respiratory physician as a mentor, someone to provide oversight and who ultimately would share the responsibility for your practice.

It is critical you record your interactions and discussions with your “supervisor” to mitigate any complaints or issues which may arise.

2. The second part of guidance pertains to situations where you may have clinical concerns when resources are stretched but you are unable to put things right. The Medical Council has produced guidance in these situations in the form of a statement.

“If you are concerned that patient safety may be at risk from inadequate premises, equipment or other resources, policies or systems, put the matter right if possible. In all other cases you should record your concerns and tell the appropriate body.”

In these circumstances it is important that you document your concerns and send these concerns to who you think is most relevant with respect to managing or accepting the risk.

Having identified a concern that is outside your control you have flagged it and passed it on to the relevant person or organisation who you believe can influence this situation. If you are not sure, call Medicus for advice.

Medical council statements :

3. The third reference is a little more specific and facilitates interns assisting with the Covid -19 response. It is not dissimilar from preceding principles, in that a suitable mentor/supervisor must be identified and again Medicus advises logging your support and interactions to best protect yourself from any subsequent issues.

“Prevocational educational supervisors will need to ensure that any non-accredited clinical placement that interns are assigned to are in an appropriate environment, and that an appropriate level of clinical supervision is in place. The clinical supervisor on the placement will need to ensure a safe environment and that interns are asked to do tasks that are in line with their stage of training and skill level, noting that supervisors may not be present for all the clinical work.”

Medicus recognizes these challenging times and wish to provide the best framework for our members to avoid risk, and provide the best care for their patients.

Article written by Dr Andrew Dunn


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