In his speech on patient safety on 21 June 2013, the Secretary of State for Health signalled his support for the practice of hospitals identifying a named consultant who is responsible for a patient’s care. This happens in a number of trusts already – University College London Hospitals NHS Foundation Trust and Kings College Hospital in London have agreed to introduce it and the Department of Health would encourage others to do so, including mental health providers. At a seminar hosted by the Academy of Medical Royal Colleges on 25 September 2013, it was clear there was a strong professional consensus on this approach and the Academy is leading work to take it forward. The Academy will produce key principles with worked examples on how this can be implemented in a way that sustains professional support.
The government is also proposing the introduction of a named accountable clinician for patients receiving care outside hospitals, starting with vulnerable older people. The government proposes that the most vulnerable elderly would benefit from having someone in primary care taking responsibility for ensuring that their care is coordinated and proactively managed. Just as patients in hospitals are under the care of a named consultant, we need to ensure that when a vulnerable older patient needs follow-up or ongoing support having left hospital, that somebody is accountable for their care. Although this clinician may not provide the care directly themselves, they would be the person with whom the buck stops and would be an identifiable point of contact for a patient or their family.
The government has been testing its proposals over the summer through engagement with patients, carers, health and social care staff, and will be setting out its plan for improving out-of-hospital care for vulnerable older people later in the year. This was reflected in the refreshed Mandate to NHS England for 2014/15.
Following the Secretary of State for Health’s support for hospitals to reintroduce the practice of placing the name of the responsible nurse or doctor above a patient’s bed, so making it clear the responsible clinician for that patient’s care during their stay in hospital, the Academy of Medical Royal Colleges agreed to lead the work with the professional community to produce guidance. This guidance has a strong professional consensus around it – and the various contributing Royal Colleges have signed up to it and have been promoting it with their members.
The guidance describes the purpose of the responsible clinician role and named nurse with some key considerations for implementation including:
- the overall responsibilities for the coordination and continuity of a patient’s care during their hospital stay including discharge, any transfers within hospital and readmission;
- the role as a point of contact for the patient, their carers and family (the guidelines includes a set of key messages to patients that hospitals might wish to use);
- the role of the named nurse role recognising the need for more flexibility because of shift working arrangements; and
- displaying information about accountable clinicians including the importance of patient consent.
To date more than two thirds of Trusts reported that they have implemented the ‘Name Above the Bed’ or a similar initiative. The General Medical Council is also working with the Academy of Medical Royal Colleges to strengthen the professional, non-technical skills needed by doctors in postgraduate curricula.
The adoption of the Academy of Medical Royal Colleges’ guidance on the role of the responsible clinician will be reflected in the regulatory and planning frameworks of the NHS. The Government will also be discussing with the professions, NHS England and employers what further action is needed to foster a stronger culture of professional responsibility for individual patients and ensuring continuity of care for people with complex and multiple needs. As part of this, the Academy of Medical Royal Colleges has now agreed to consider developing this approach to apply outside of the inpatient setting and will publish preliminary findings in the spring of 2015. The Academy of Medical Royal Colleges is developing for May 2015 a new definition of clinical accountability that will span hospital and out-of-hospital care. NHS England will ask clinical commissioning groups to publish by the end of 2015 the percentage of their patient population living with long-term conditions who are receiving care and support in line with this definition.