Contents
1 Introduction
Due to problems in professional or therapeutic relationships patients may ask to change the lead clinician involved in their care. The term ‘lead clinician’ covers anyone who delivers leadership in a particular aspect of clinical care; it includes doctors, nurses, occupational therapists, physiotherapists, psychologists, and any other clinician who may be taking the lead in a particular part of a patient’s care.
Where a patient asks to change a lead clinician, we should be responsive and flexible; if possible any issues should be resolved through local discussion between the parties concerned.
2 Purpose
To guide what should happen when a patient requests a change of lead clinician.
3 Scope
All clinicians and patients; for patients under 16 who lack capacity to make such decisions, this policy will apply to their parent or guardian.
4 Responsibilities, accountabilities and duties
4.1 Lead clinician
Should try to resolve the matter locally and if necessary, make the case that the change requested is inappropriate base on the patient’s mental state; if the issues cannot be resolved, they should inform the patient of the process outlined in this policy. They should then inform their team manager of the request. At this point they should also inform the patient of other support available; including advocacy support or support from the patient advice and liaison service, details are available via the ‘have your say’ link on the trust website. Where the request is made via another trust employee who is not the lead clinician, then they should inform the team manager and the lead clinician who must then follow this policy.
4.2 Team manager
Should contact the patient to acknowledge receipt of the request and discuss the request with the lead clinician. They should also inform their service manager of the request and if it is felt appropriate, make efforts to arrange the change requested.
4.3 Service manager
Should, if necessary, assist in arranging the change in lead clinician. For internal audit purposes they should also monitor the number of requests received and response times.
4.4 Care group medical or nurse director
Should become involved to assist in arranging a change in lead clinician only when it has not proven possible for the team manager or service manager to make appropriate arrangements.
4.5 Care group director
Should assist in arranging a change in lead clinician when the lead clinician is the care group medical director, they should also co-ordinate the investigation of any complaints which are received in relation to any aspect of this policy.
5 Procedure and implementation
5.1 How to request a change in lead clinician
Any staff member to whom a patient raises concern about their care and treatment under a particular lead clinician should be able to inform the patient of how to request a change, this should be via awareness of this policy and direction of the patient to its content where necessary.
5.2 Request by the patient
Most requests are made verbally or in writing and in this case, the staff member to whom the request is made should notify their team manager who in turn should notify the lead clinician. The lead clinician or team manager should then arrange to meet with the patient and discuss the reasons for their request and attempt to resolve the matter.
5.3 Requests made on the patient’s behalf
Requests can only be made with the patient’s consent, or where the patient is under the age of 16 where the patient is Gillick competent. Any staff member to whom the request is made must explain that consent is needed and without it the request will be refused. They should pass details of the request to the lead clinician who should contact the patient to ask their views. If the patient consents the person who originally made the request should be informed of the outcome.
If a patient under 16 years of age is not Gillick competent then consent should be gained from the parents or guardian.
If the patient lacks capacity and is over 16 years of age to consent to the request being made and has appointed someone to act on their behalf under a lasting power of attorney for health and welfare or a deputy for health and welfare has been appointed by the court of protection, then they may make a request for a change in lead clinician.
Any requests from interested parties not appointed in a legal capacity in respect of patients who lack capacity to consent should be considered as part of the Mental Capacity Act best interests decision making process. The best interest decision- making process should consider the provisions of the Mental Capacity Act (2005) and its associated Code of Practice (2007). Patients should be enabled to participate as much as possible in the decision making process and staff should follow the trust’s Mental Capacity Act (2005) policy.
5.4 Advocacy
Anyone receiving a request for a change in lead clinician should tell the patient that support can be provided by a carer, relative, patient advice and liaison service or professional advocacy; information should be provided on how to access these services.
5.5 Language or communication difficulties
Where necessary arrangements should be made to have an interpreter or other support with them at all meetings, in line with the trust policy on the use of interpreters.
5.6 Patients detained under the Mental Health Act
Requests made by detained patients would only be agreed to in exceptional circumstances, but all requests should be considered. When a request is declined this should be discussed with the patient once their mental state has improved.
5.7 The role of the team
In any discussions around change of lead clinician the role of the team should be considered and discussed with the patient. Clinicians do not work in isolation so in many instances the patient will need to be made aware that a change in lead clinician will necessitate a change of team so that care can be delivered in a safe, effective, and coherent way.
5.8 Circumstances preventing a change of lead clinician
This includes situations where there is a limited choice of alternative clinicians to transfer care to due to the specialist nature of services offered (for example, where there is one such specialist within the care group). This may also include instances where a patient needs urgent or emergency treatment. Where this is the case, the request will be passed to the service manager and the care group director who will write to the patient explaining the situation.
5.9 Repeated requests for a change in lead clinician
When patients make repeated requests for a change in clinician the clinical team will need to decide whether it is in the patient’s best interest for the trust to accommodate such requests. If it is felt not to be, then the request will be passed to the service manager and the care group director who will write to the patient explaining why. If the patient remains dissatisfied, they should be advised to contact their general practitioner about referral to another provider or transfer of care to another locality within the trust; they should also be informed of their right to make a formal complaint.
5.10 Change in lead clinician is not clinically appropriate
In these circumstances the lead clinician and team manager should meet the patient and explain this decision carefully documenting it in the patients notes. If they remain dissatisfied, they should be directed to the service manager or their general practitioner to discuss the matter or make a formal complaint to the trust.
6 Training implications
All staff need to be aware of the key points that the policy covers but the policy has no specific training requirements or implications.
7 Monitoring arrangement
7.1 Number of requests per team or ward
- How: Exception reporting.
- Who by: Service manager.
- Reported to: Care group.
- Frequency: Quarterly.
7.2 Number of formal complaints received in relation to this policy and implementation of resultant action plans
- How: Complaints review .
- Who by: Service manager.
- Reported to: Care group.
- Frequency: As and when necessary.
8 Equality impact assessment screening
To access the equality impact assessment for this policy, please email rdash.equalityanddiversity@nhs.net to request the document.
8.1 Privacy, dignity and respect
The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, ‘not just clinically but in terms of dignity and respect’.
Consequently, the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity, and respect, (when appropriate this should also include how same sex accommodation is provided).
8.1.1 Indicate how this will be met
No issues have been identified in relation to this policy.
8.2 Mental capacity act
Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individual’s capacity to participate in the decision-making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.
Therefore, the trust is required to make sure that all colleagues working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason, all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005)to ensure that the rights of individual are protected, and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.
9 Associated documents
- Interpreters policy (provision, access and use of, for patients, service users and carers), clinical policies
- Mental Capacity Act 2005 policy, clinical policies
- Patient advice and liaison service policy, corporate policies
10 References
- Mental Capacity Act 2005 and associated code of practice.
Document control
- Version: 3.1.
- Unique reference number: 363.
- Approved by: COVID-19 gold command.
- Date approved: 20 February 2024.
- Name of originator or author: Dr Graeme Tosh.
- Name of responsible individual: Executive director of nursing and allied health professionals.
- Date issued: 26 February 2024.
- Review date: November 2024.
- Target audience: Clinical staff.
Page last reviewed: May 13, 2024
Next review due: May 13, 2025