In these unchartered waters with unprecedented challenges, we are all going to experience a period of disruption and uncertainty!
As we continue to wrestle with the evolving guidance from Government, maintain as normal an approach as possible to the needs and demands of patients and protect ourselves and our families, we wanted to share a few words on initial issues and the office contingency steps SEMPRIS is preparing to take.
1. Telephone and Video Consultations
Many members are adopting telephone and video consultations in response to the current challenges. I can advise that the Underwriters have confirmed that SEMPRIS members are covered to provide video and tele-consultations to their patients during the Covid-19 pandemic, subject to the Policy Terms & Conditions, including Territorial and Jurisdictional Limits (Territorial includes Worldwide ex USA & Canada and jurisdiction is the EU)
Skype is the preferred platform for video purposes where dedicated software is not available. Please refer to the note in the advice below from DWF Law regarding recording video. (and telephone consultations).
To date, we understand that BUPA and AXA have advised they will meet the cost of such consultations and we would anticipate that the others will likely follow, but please check.
The following advice, ‘Indemnity issues to consider re video consultations’ has been provided by Joanne Staphnill, Partner DWF Law and medico-legal advisers to SEMPRIS. Whilst targeted at video use, the principles will also apply to telephone.
The points below are intended to apply to an Insured doctor’s private practice. For NHS practice, the doctor should follow guidance issued by their Trust about video consultations.
The Insured doctor needs to consider whether they are doing a video consultation as a pure ‘one off’ or whether they are moving towards video consultations being a more significant feature of their private practice (either by choice as a business venture, or in response to infection control measures such as the current Covid-19 situation). They then need to contact their brokers (Paragon) to ask them to check with the Underwriters if necessary, whether their policy covers video consultations. We cannot advise on policy coverage, and the answer could potentially depend on whether the video consultations are a significant change from the Insured’s practice as described on his/her proposal form to purchase the policy.
The following points assume that the Insured doctor’s policy does cover video consultations in principle, and that the doctor is competent to carry out video consultations:
- Location: The Insured doctor needs to ascertain where the patient is physically located, and make sure they know what the ‘Territorial Limits’ of their policy are.
- Territorial Limits: Every policy has ‘territorial limits’, stated in the policy schedule. If the patient is physically located in a country that is not included in the policy’s ‘territorial limits’ then it would be at least arguable that the doctor is not insured for that consultation. This would be because s/he is arguably providing medical professional services to someone outside of the territorial limits, even if the doctor is physically located in the UK.
- Outside the UK/EU: Similarly, the policy will only cover claims if they are made in the UK or the European Union. If the patient is physically located outside of the UK and/or EU, then it may be imprudent for the Insured doctor to go ahead with that video consultation, because the policy would not respond if the patient went on to make a claim in the courts of their country outside the UK or EU.
- Security/encryption: Another aspect that the Insured doctor needs to be extremely careful about is the security/encryption of the video consultation or other remote consultation service. I don’t know enough about video conferencing providers to know which ones are secure/encrypted and which ones are not, so each individual doctor will need to give careful thought to what video conferencing service to use to ensure that the consultation cannot be accessed by anyone else, which could in turn be a breach of patient confidentiality or a cyber event under the cyber policy.
- Device Security: Similarly, the doctor needs to think about the security of the device s/he is using for the video conference. For example, a smart phone falls within the definition of ‘portable media device’ in the cyber policy, so the phone must be encrypted for the cyber policy to respond to a loss of data if (for example) the phone is lost. If the doctor is going to use a smart phone for video or other remote consultations, then before any such interactions take place the doctor needs to make sure that the device is properly encrypted (and not just password protected).
- Recording: The doctor needs to take care to ensure that s/he is not inadvertently recording the consultation (e.g. because of an auto-record feature on the video conferencing service). There are situations in which it is acceptable to record a consultation, but there is express GMC guidance to follow on that and if the recording is made inadvertently then the doctor is unlikely to be able to comply with that guidance.
In general, it is good risk management to follow the GMC guidance on remote consultations, which you can find here: https://www.gmc-uk.org/ethical-guidance/ethical-hub/remote-consultations The GMC consulted on the question of remote prescribing etc and was gathering evidence up to February 2020. We do not know if or when the GMC will update its guidance pursuant to that consultation, but doctors should stay alert to news from the GMC on this point.
This link also provides helpful reference – https://www.gponline.com/conducting-online-consultations-medico-legal-advice/article/1440537
2. SEMPRIS – Office Contingency Arrangements
With effect from Monday 23rd March and in line with the latest Government advice, SEMPRIS will operate a remote working policy for all staff. We have ensured that each team member has remote access to the full SEMPRIS office system in order to deal with administration of renewals, policy documentation and queries relating to members’ cover and their policies.
Where possible, we would encourage all members to use e-mail contact, but should an enquiry be urgent or necessitate a conversation with a member of the team, please do not hesitate to call the general enquiries number 0208 652 9018 (24hrs). Your call will be answered by Comxo who provide the SEMPRIS out of hours telephone service. Comxo will take the details of your call and then arrange for a member of the SEMPRIS team, including myself, to return your call.
DWF Medico-Legal Helpline – 0333 010 2826 (24hrs)
Members of SEMPRIS benefit from the expert legal support and representation offered by DWF Law. Please continue to call DWF on the same number for legal advice, support with claims and event notification and assistance on all issues arising from professional practice. The service is available from 9am – 6pm on all working days and on a 24-hour basis for emergency calls. Together with specialist lawyers, DWF provide exceptional levels of personal service 24/7.
As the situation continues to unfold there will undoubtedly be many more questions. Please do not hesitate to contact the office and these will be addressed as rapidly as possible. Under the circumstances and in the absence of our daily face-to-face access to underwriters, some queries may take a little longer to deal with than normal.
We are very grateful for your understanding and cooperation in these unusual times and remain committed to providing the very highest level of indemnity protection and service level to you. I will continue to update you on any indemnity issues raised by the situation.
With very best wishes
Neil Redman
Director
17/03/2020
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