Accountability in mental health teams
The Standards and Ethics Committee, working with the Department of Health and the Royal College of Psychiatrists has prepared the advice below to explain how Good medical practice and our explanatory guidance on Delegation and referral applies to consultant psychiatrists working in multi-agency teams.
Accountability in mental health teams
Consultants' roles and responsibilities are developing and changing. They vary according both to the specialty and the type of healthcare environment in which they are provided. Changing working practices, such as multi-disciplinary and multi-agency team work, and changes in the range of skills and competencies of other healthcare practitioners, present a number of opportunities as well as challenges in providing safe and effective care. Many of the issues are best resolved by clarity between consultants and their employing organisation about appropriate roles and responsibilities. Consultants should raise with their employing bodies any issues where ambiguity or uncertainty about responsibilities may arise. Consultants also need to be clear about the expectations of the GMC.
All doctors are accountable to the GMC for their conduct and the decisions they take. Good medical practice (2013) sets out the principles which should underpin their professional work and against which their conduct may be judged. Good medical practice does not try to address, in detail, all the circumstances in which doctors may work. This guidance explains how the principles in Good medical practice apply for doctors working in multi-disciplinary or multi-agency mental health teams.
1. Doctors should be competent in all aspects of their work including: reviewing and auditing the standards of the care they provide; training and supervising colleagues; and managing staff and the performance of the teams in which they work where and when they have direct line management responsibility.
2. Doctors should do their best to ensure that the systems in which they are working provide a good standard of care to patients. Where doctors cannot be satisfied, nor take steps to resolve problems, they should draw the matter to the attention of their Trust or other employing or contracting body.
3. To these ends, doctors should establish clearly with their employing or contracting body both the scope and the responsibilities of their role. This includes clarifying: lines of accountability for the care provided to individual patients; any leadership roles and/or line management responsibilities that they hold for colleagues or staff; and responsibilities for the quality and standards of care provided by the teams of which they are a member. This is particularly important in circumstances in which responsibility for providing care is spread between a number of practitioners and/or different agencies.
4. Doctors are not accountable to the GMC for the decisions and actions of other clinicians.
5. This means that if a consultant delegates assessment, treatment and care to a more junior doctor, the consultant is not accountable to the GMC for the decisions or actions of the junior doctor but the consultant is responsible for ensuring that the junior doctor is appropriately trained, experienced and supervised.
6. Psychiatrists can delegate the care of those patients for whom they agree to take responsibility. But many psychiatrists work in systems that are not based on referral of patients to a specific consultant. Instead, the multi-disciplinary teams of which they are a member may provide health and social care services to a substantial number of patients. Referrals are made directly to such teams and decisions about allocation to an appropriate professional are made according to the teams' policies. In these teams, the responsibility for the care of the patients is distributed among the clinical members of the team. Consultants retain oversight of a group of patients who are allocated to their care and are responsible for providing advice and support to the team. They are not accountable for the actions of other clinicians in the team. However, in accordance with paragraph 2, they must do their best to ensure that arrangements are in place to monitor standards of care, and to identify potential or current problems. They should notify their employer about any unresolved concerns or problems.