I’m wondering who will assume responsibility as RC for an inpatient ward within a hospital, when there is no RC? Does it automatically fall onto the Medical Director by default? Can a Hospital Manager allocate a Consultant Psychiatrist to become the RC?
I wondered if the case took a different trajectory and an acting consultant without AC approval is placed in post; who will then assume RC Responsibilities - I assume it would be their line manager and supervisor who is supporting/guiding the AC application, thus the Med. Director?
Is there any specific guidance around this, and perhaps rights as doctors to refuse such roles for any reason? Thank you in advance.
This is all covered in chapter 36 of the MHA Code of Practice. Briefly, the hospital should have procedures in place for identifying the most appropriate Approved Clinician to be the Responsible Clinician.
Thank you Guy, I’ve had a look at the chapter, and it only mentions as you quote, ‘the hospital should have procedures’. It’s not clear to me what exactly those procedures were, I wondered if you were aware? Thank you.
Potentially - subject to the MD being AC/Sec12 Approved.
Potentially subject to para 36.10 of MHACOP - and mindful that the ‘real Hospital Managers’ (as against MHA Hospital Managers) will have a say.
The least best option for a quick fix is to hire some locum who is S12/AC approved at Wes Streeting’s “£5000 per shift” - in the short term. Am I allowed to joke on this forum?
Probably - but I’ve never seen it. Somebody can create guidance on the back of an envelope and call it ‘policy’ - cuz it’s increasingly new territory - in the unspoken major shortage of RCs who are UK-qualified consultant psychiatrists.
But interestingly the new RC found from somewhere, will be burdened to ‘consent’ all patients in quick time without actually knowing case histories, the reliability of diagnoses, and as I expect numerous cocktails of medications. It’s the usual paper exercise. I say it as I found it several times in the last 10 years.
I wondered if you or anyone could expand on the rights of a RC with a current, fixed inpatient caseload to refuse additional RC role of patients from other wards, and if it can be argued that it must fall for the Medical Director?
Hello,
The right to refuse extra work is a contractual one and not defined by the MHA or the Cod of Practice. Most contracts will have some clause that internal cover is needed for emergency absences, but beyond this you probably do not have any contractual duties. I cannot comment on contracts outside of the NHS. It is an issue for the managers and you can say no. The Medical Director has the right to ask someone to do it, who equally can so no, or agree to it with appropriate renumeration.
Based on my experience, most employers don’t actually know what a contract is, nor are they aware and therefore not concerned about workload factors. And further the intricacies of grounds for breach of contract is ‘nobody’s’ business, from what I have seen of employers’ attitudes. [Hence why so many silly cases end up at Employment Tribunals etc.]
I regularly refuse to take on excessive work - and to do other dodgy stuff. I can do that because I know the GMC’s 31 Standards for doctors inside out (i.e. I have the means to rapidly - within seconds - find relevant clauses, not from the internet). With that knowledge I inform them which standards I would be breaching in taking on excessive work (or other dodgy practices). Caution: I am not saying that GMC standards define contractual terms.
What I am saying is this: “Force me to breach any GMC standard and you render the contract for my services void. Explanation of a consequence is not a threat - it’s informing ‘you’ what you are doing.” - and I tell them that in pretty much those plain terms.
Fortunately perhaps, I’ve only had to ‘walk’ (suddently) after an explanation, once in 30-odd years of medical practice. In other situatons - no explanation - just notice and quick departure.
Obviously, I am not everybody - nor is everybody me. I do things differently. But I do recognise that I’m meant to do what ‘everybody’ else does.
There are two issues in the question:
a) Rights of RC … to refuse additional role for other patients.
b) If it could be argued that it must fall to the Medical Director.
The second part is easier. The answer is this simple: there is no ‘automatic anything’. How? Because of several ‘hoops’ to jump through in mental health law. The MD must be suitably qualified etc - hence nothing ‘automatic’ about it. This is not some loose idea about ‘medical cover’ (not that you said so).
The first part on Rights of RC to refuse extra cover is not so straightforward.
The first problem is the use of the word ‘Rights’. People use this word ‘all the time’ but they don’t know what the words actually mean. [I don’t now what you know so I share my experience/knowledge for the benefit of others]. The classic is when patients assert “I have a Right to fresh air… to smoke tobacco if I like.” (as per S17 leave). And I go ‘You don’t’ and then a complaint is landed on me, which then takes six hours of my time. Fiiiinne! I enjoy Trusts wasting public money - not that I agree with that. But the point is that even health personnel use the word ‘Rights’ without actually understanding what the word truly means. Rights mean that ‘you’ have the legal right to enforcement in a court of law of some Right set out in law. End of (to keep it simple).
My knowledge (subject to a well referenced correction) is that medical ACs (aka RCs) have no enforceable Rights to refuse to cover any upper limit of caseload from mental health law. One-hundred percent true is that a certain medical RC at Rampton was covering 97 patients approximately 3 years ago. Rubbing your eyes? Scratching your head - doing a double-take? Wondering if it’s true. That’s your cognitive dissonance rapidly going into overdrive. Obviously I’m not at liberty to disclose details but rest assured that I know the fact because the senior medical doctor told me in a face to face conversation in an office, whilst swearing to blow off. I believed him as we went back a long way. He’s not a liar. Think: ‘Where is the CQC in all this?’ Asleep obviously, avoidant or information hidden from them - take your pick. Then think: ‘Where is the RCPsych in all this?’ - sure they are clear on the point of caseloads but they have no real power, and they won’t know what’s going in every neck of woods (because nobody tells um).
There are Rights of medical RCs but that comes from Employment law. I couldn’t possibly give a summary on such a vast intricate area of law because doing so will lose context, accuracy and meaning. What medical doctors tend to do is say, "I’m not a lawyer… " and soldier on to do dodgy things. You had one example above but I’ve seen several like that in terms of work load over the last 30 years. Most doctors from my long experience are basically afraid of courtrooms. How would I know? I’ve spoken with perhaps hundreds of them over my career, and I see and hear their fear of taking legal action on contractual grounds. But what’s the big fear? Obviously - its not just about courtrooms; it’s about being blacklisted across the whole of the UK via ‘word down the phonelines’ - or WhatsApp these days.
So - for an easy life and as life is too short (I’m told). Cover any number of patients they force ‘you’ to cover (tic). Nobody will know and nobody cares, until a patient ends up dead and you’re hauled before the GMC or the courts. In the words of Clint Eastwood, “Do you feel lucky… etc” - gambling their careers, and patients’ lives. Lots of doctors do - apparently.
But seriously - alternatives are - and not a full list (opinion - not advice):
1 - Contact a defence body for advice. In my case defence insurers - one phone call and I get through within 15 minutes to a real lawyer (all of them with real experience in fighting for doctors at GMC and courts).
2 - With or without the above advice, I would put in writing exactly what I am being ‘told’ to do, my objections, the potential risks and adverse consequences, and that by undertaking the excessive workload I pass full responsibility for negligence (in law) to ‘the Trust’ or other employer. No objection to my very clear letter within three working days means acceptance of liability and all consequential damages that may arise (including loss of career, loss of pension etc etc).
Yes - if you’re wondering - I walk around with several rods in my back! It’s great fun!
You will repeatedly read me saying, ‘I’m not everybody and everybody is not me.’ Yes - I march to the beat of a different drum, and I pay for that by my choice.
Am I allowed to joke on this forum? 
