Coronavirus: Your frequently asked questions

Your health and wellbeing

Should I attend work if I have symptoms of coronavirus?

If you know or suspect you are infected with coronavirus, you should follow the current public health advice. If your symptoms worsen, seek medical attention. Be aware that when unwell, your judgement is likely to be clouded, so don’t simply continue to self-treat if your condition worsens.  

Paragraph 28 of Good medical practice says that if you suspect you have a serious condition that could be passed on to patients, you must consult a suitably qualified colleague and follow their advice about any changes to your practice they consider necessary. 

I have a long-term health condition. What should I do?

If you have a pre-existing health condition that places you at increased risk, you should discuss working arrangements with your employer. It may be appropriate to ask another suitably qualified clinician to take over the care of patients who are suspected to have, or have been diagnosed as having, coronavirus.

What should I do if I feel exhausted?

This is a hugely stressful time and many staff will be working long hours and struggling to sleep. It’s vital to keep hydrated and well fed, and get the rest you need, and your team and employer should be doing what they can to support you with this. There’s a really helpful poster on self-care for NHS staff. 

The Association of Anaesthetists have lots of useful resources on fighting fatigue. There’s advice on managing the impact of shift work on your health.

How can I help my colleagues?

Regularly check in with your team members to see how they are feeling and let them know that they have your support. You could consider setting up a buddy system for each shift, which pairs experienced with less experienced team members so people can keep an eye on each other and support each other to take their breaks. 

If you think that a colleague is too tired to drive home after a shift, make sure you discuss your concerns with them before they leave – there may be an alternative, safer way for them to travel or there may be on site accommodation available.  

Carry out regular team debriefs to say thank you, celebrate successes, and provide a wellbeing safety net.  

What can I do if I feel overwhelmed?

We are in unprecedented and frightening times. It is okay not to feel okay. 

The NHS offer a range of wellbeing support. You can also call their support line on 0300 131 7000 between 7am to 7pm, 7days a week or text FRONTLINE to 85258 for 24/7 support via text.  The helpline provides confidential listening from trained professionals and specialist advice - including coaching, bereavement care, mental health and financial help. 

Newcastle upon Tyne NHS Foundation Trust, University Hospitals Birmingham NHS Foundation Trust and the Association of Anaesthetists have developed helpful tips for looking after your mental wellbeing and managing stress. 

NHS Education for Scotland also have tips on stress, coping and resilience during the coronavirus outbreak. 

You might find it helpful to turn off news alerts and just get news once a day from a trusted source.

The BMA Counselling service is available to all doctors 24 hours a day, seven days a week on 0330 123 1245 and their website has an extensive directory of sources of support. This support is available for all doctors.

I am a newly qualified doctor / I am returning to the register – how can I best prepare myself for practice?

There will undoubtedly be concerns for doctors facing unexpected situations in uncertain times. We know that doctors are working to do their absolute best for patients in the current crisis and it is important that everyone feels supported. You may still have colleagues working in the NHS who you can connect with to get an idea of what they are dealing with. Here are some suggested resources you may wish to look at: 

• Remind yourself of our key guidance: Good medical practice, Consent: patients and doctors making decisions together and Confidentiality. 
• The BMA provide some guidance for returning to clinical practice after absence.
• Confirm that your employer is offering an induction and take them up on this as soon as you can.
• Consider joining webinars run by your hospital, royal college or indemnity bodies. 

What can I do if my employer asks me to cancel my annual leave? 

This is a matter for employers and isn’t covered by professional standards for doctors. However, our Leadership and management guidance says that doctors in leadership positions must promote the health and wellbeing of staff they manage (paragraph 73). 

Working safely

Do you set guidance on what level of PPE is appropriate while working in the pandemic?

Doctors should use PPE in line with the most up to date guidance issued by the four UK health departments. Employers and contracting bodies should take all necessary steps to make sure staff are suitably equipped for their clinical setting in line with that guidance.

How should doctors approach treatment of patients if they think their PPE is inadequate?

If the recommended level of PPE isn’t immediately available, difficult decisions may need to be made quickly about the safest and best course of action, taking account of the clinical situation.

We know that a doctor’s priority will be the welfare of their patients, alongside their own wellbeing and that of the healthcare team in which they work. 

We do not expect doctors to leave patients without treatment, but we also don’t expect them to provide care without regard to the risks to themselves or others. This pandemic is an unprecedented challenge in which clinicians are understandably balancing the imperative to provide care  with their own fears. 

We understand that this may lead to doctors having to make very difficult decisions where they have to use their professional judgement.

Doctors will need to consider:

• whether treatment can be delayed, or provided by another team;
• what course of action is likely to result in the least harm in the circumstances;
• whether alternative actions or additional steps can be taken to minimise the risk of transmission;
• whether any doctors or other healthcare professionals are at a higher risk from infection than other colleagues.

You should try to work with colleagues to find the best way forward in the circumstances. Our expectation is that doctors will do their best in the circumstances they face, considering the welfare of the patient and the risk to their own or others’ health to make these difficult decisions. 

How does that sit with your core guidance, Good medical practice, which says that you must not deny treatment to patients because their medical condition may put you at risk?

The advice on our ethical hub on working safely during the pandemic explains how Good medical practice applies to these specific circumstances.  GMP (para 58) is clear that if a patient poses a risk to your health or safety, you should take all available steps to minimise the risk before providing treatment or making other suitable alternative arrangements for providing treatment.  That’s important because we recognise that it’s not just patients who need protection.

The fundamental duty of a doctor is to make the care of your patient your first concern. We understand that, particularly in these unprecedented and stressful times, doctors may also have significant concerns for their health and that of their families. All our guidance requires professional judgment and the application of principles to the context doctors face. 

What else should I do if my personal protective equipment (PPE) is inadequate?

If you and other healthcare staff may be put at risk by PPE which is below the standard set out in the most up to date guidance, you should raise your concerns with your employer. You should make a record of your decisions and how you handled your safety concerns. 

Will doctors face action if they refuse to treat patients?

If a concern was raised with us about a doctor refusing to treat a patient because of their concerns about inadequate PPE, we would need to look at the specifics and manner of that refusal, as we would with any other concern referred to us. 

We published a joint statement with other health regulators in March setting out how we will regulate during this unprecedented period. This makes clear that where a concern is raised about a registered professional, it will always be considered on the specific facts of the case, taking into account the factors relevant to the environment in which the professional is working. We would also take account of any relevant information about resource, guidelines or protocols in place at the time.

Does that mean it’s OK to refuse to treat a patient if a doctor doesn’t have the right PPE?

We expect patient safety to be a doctor’s priority and there would be a clear conflict with doctors’ ethical and professional values if patients did not receive treatment. We would expect you to use your professional judgement and to have considered carefully how to work together with colleagues to provide the best care possible in the circumstances. 

While a lower standard of PPE may increase risk to some degree, doctors would need to consider how to provide care to patients, including whether the available equipment allows treatment to continue. 

If having tried and exhausted alternative means of treating a patient you believe that this is not possible without unreasonable risk to you and to other healthcare professionals, you should escalate your concerns, record your decision and how you tried to address safety concerns.

It’s important that you keep a clear and contemporaneous record of your decisions in the event that a concern is raised about your practice.  

Can't you just set out ‘you would be right/wrong to make this/that decision’?

No two sets of circumstances are the same, and we would have to look at the specifics of any concern raised with us. We do not speculate on scenarios nor do we reach any conclusions without full knowledge of all of the factors involved.

Our expectation is that doctors will use our guidance and their professional judgement to take difficult decisions, and that they will work positively and constructively with colleagues and employers to try to find appropriate alternatives. They should document those discussions and decisions and be able to explain them.

What if I’m asked to work in a different speciality or outside my competence?

As a doctor you are playing a vital role in this pandemic. You may be working in unfamiliar circumstances or surroundings, or in clinical areas outside of your usual practice.

All doctors have a duty to recognise and work within their competence. But in these exceptional circumstances, doctors at every level may be required to work at the limits of their comfort zone and in some cases beyond.

When deciding the safest and best course of action in such circumstances, we advise you to:

• consider what is within your knowledge and skills, and how your existing skills could be used in a different healthcare setting
• identify what skills and experience other members of the healthcare team could offer 
• be willing to seek professional advice and clinical supervision from colleagues. This may come from a senior, peer or a more junior colleague who is acting within their usual clinical setting or scope of practice
• seek additional training and guidance as far as you reasonably can in the circumstances. This can include preparing for work in a new setting by accessing online or local training to help improve your knowledge and skills in advance
• make sure you know who go to for support and professional advice.

In an emergency you should provide the safest care you can. If you think that patients are being exposed to avoidable risk, you should tell a senior colleague or manager and work with colleagues to find the best possible solution in the circumstances. Make sure to record any concerns about working outside of your competence and how this could impact on patient safety. 

We recognise that doctors may feel anxious about how context is taken into account when concerns are raised about their decisions and actions in very challenging circumstances. The primary requirement for all doctors is to respond responsibly and reasonably to the circumstances they face. Read more about how we will carry out our role at this difficult time.

Doctors in training

If you are required to work in a less familiar clinical setting or at the limits of your competence for your stage of training, your employer should provide appropriate induction and clinical supervision. Supervision should be from an appropriately qualified senior doctor who is competent to make decisions within the relevant speciality or healthcare setting about treatment or discharge of patients. 

Medical students

Medical students who volunteer to work within the NHS during the pandemic should do so with the permission of their parent medical school and only be asked to work in an appropriate role within their level of competency. They should receive an induction to the role and be appropriately supervised. They should only undertake tasks which don’t require professional registration and which are covered by NHS indemnity. If they have any medico-legal questions, they should consider seeking advice from a medical defence organisation. The Medical Schools Council has published a statement of expectation for schools, students and employers on  volunteering for the NHS. 

A friend/family member is worried that they have coronavirus and has asked for advice. What should I do?

It can be helpful and reassuring for a doctor to give advice to friends and family about coronavirus which explains and reinforces public health messages. But it can be more problematic if a doctor is providing medical care to someone they are close to.

In paragraph 16(g) of Good medical practice, we say doctors should ‘wherever possible’ avoid giving medical care to themselves or anyone with whom they have a close personal relationship. There are good reasons for giving this advice. Where a doctor provides care to a patient with whom they have a close personal relationship, a loss of objectivity may occur. And it can cause difficulties in terms of record keeping and continuity of care. 

But there will be circumstances where it is necessary or justified, for example in emergencies or in circumstances where it is not possible to seek medical care from another doctor. 

As in all situations, we expect doctors will behave responsibly, reasonably and will be able to explain their decisions and actions if they’re called on to do so.

Remote consultations

I don’t feel confident providing remote consultations. What help can you give me?

We appreciate that many doctors are being asked to make sudden and unexpected changes to adapt to remote working for everyone’s safety during the pandemic. We understand this may be daunting and it may take you time to adjust.

Familiarise yourself with our remote consultation page in our ethical hub which describes the principles of good practice when treating patients remotely and provides links to sources of advice and support from other organisations. 

During the pandemic, we recognise that doctors may need to depart from this advice and apply their professional judgement to make best use of the resources available to them. 

I want to provide remote consultations as part of my GP practice. How do I do this?

Practices are being advised to move to a ‘triage first’ model for patient consultations as a way of minimising the risk of infection for staff and patients in response to coronavirus. Recent NHS guidance across the UK advises GP practices on the appropriate use of face-to-face and remote consultations in the current circumstances. We have provided links to relevant guidance at the bottom of this page. 

NHSE/I’s webinar focuses on practical steps that staff can take to establish a ‘total triage’ model using online, telephone triage and how best to use video consultations. The University of Oxford has also published guidance to support rapid roll out of video consultations in GP practices in the context of coronavirus which you may find helpful.

I don’t think a remote consultation meets the needs of my patient. What should I do?

We usually advise doctors to consider whether a remote consultation is suitable to meet the needs of their patient and to signpost or refer to face to face care where appropriate. But we recognise that during the pandemic many services are changing their delivery models to protect patients and staff and suitable face to face alternatives may not always be readily available. Recent NHS guidance across the UK advises that patients should be enabled to get advice and care without attending a GP practice unless in-person care is clinically required. 

Doctors should use their professional judgement in applying our guidance to the situations they face making best use of the available resources and follow any local and national protocols and guidance on appropriate care pathways.

The patient won’t give consent for me contact their GP to access their medical records. What should I do?

If a patient won’t provide consent for you to contact their GP or share information with other health professionals about the episode of care you provide you should consider if it is safe to prescribe. If it is not safe, you should explain you can’t prescribe because it is unsafe to do so and refer to other services. 

If you are unable to access the patient’s medical records for example due to unexpected service closures during the pandemic and you can’t leave the patient without access to appropriate care you may need to apply your professional judgement in deciding what to do in the best interests of the patient, taking into account the potential for safeguarding issues.

You may find it helpful to signpost patients to our resource on what to expect when accessing care online to help them understand why you need this information to help you keep them safe.

Decision making and consent

How does your guidance on consent apply during the pandemic?

All our ethical guidance continues to apply as far as is practical in the circumstances. The primary requirement for all doctors is to react responsibly and reasonably to the circumstances they face.

While some interventions need a signature because of local policies, nothing in our guidance requires that patients’ written consent must be obtained. For most healthcare decisions doctors can rely on a patient's verbal consent. The important thing is that the patient has had the opportunity to consider relevant information and has decided to go ahead with the intervention. In other words, the patient:

• understands what they're giving their consent to
• is aware of the likely outcome
• as far as possible, has time and support to consider information (including risks of harm, potential benefits, uncertainties and likelihood of success) about the recommended option and reasonable alternatives, including the option to take no action.

For doctors carrying out procedures which routinely need a patient's written consent, they should still try to obtain this. But all decisions about a patients’ treatment and care should be recorded in the patient’s record even if written consent is not obtained.

How should doctors make decisions about prioritising access to treatment?

In the highly challenging circumstances of this pandemic, doctors will need to provide the best service possible within the resources available.

If more individuals have life-threatening conditions than can be treated at once, doctors will have to make very difficult decisions about how to allocate resources. We advise doctors who are faced with these decisions to:

• take account of current local and national policies that set out agreed criteria for access to treatment
• be confident that decisions are based on clinical need and the likely effectiveness of treatments, and don’t unfairly discriminate against particular groups
• take account of patient wishes and expectations when considering options for treatment and care
• be open and honest with patients and the rest of the healthcare team about the decision-making process and the criteria for setting priorities in individual cases
• keep a record of decisions and the reasons for them.

As far as practical, these decisions should not rest on individual clinicians’ shoulders. They should be taken following discussion with colleagues and, if possible, with input from local ethics committees. It’s also essential that employers recognise the significant emotional distress that clinicians will experience. They should take steps to provide appropriate support, including psychological support and advice from any local clinical ethics committees, where they exist. 

Where decisions are made to withhold or withdraw some forms of treatment from patients, doctors should still take all possible steps to alleviate the patient’s symptoms and distress and respect their dignity. The patient’s wishes, preferences and fears in relation to their future treatment and care should be explored as far as possible. This includes what interventions would be considered or undertaken in an emergency, such as cardiopulmonary resuscitation. If the patient is dying, they should receive the best available end of life care. We have detailed advice about treatment and care towards the end of life.

We recognise that doctors may feel anxious about how context is taken into account when concerns are raised about their decisions and actions in very challenging circumstances. The primary requirement for all doctors is to respond responsibly and reasonably to the circumstances they face. Read more about how we will carry out our role at this difficult time.

Confidentiality and social media 

How does your confidentiality guidance apply during the pandemic?

The principles in our Confidentiality guidance still apply. 

If a disclosure is required by law (for example, under health protection regulations) doctors must disclose information relevant to the request (paragraphs 17 and 18).

If disclosure is not required by law, doctors should usually ask for a patient’s consent to disclose information. But that is not always possible - for example because action must be taken quickly to detect or control outbreaks of communicable diseases (paragraph 14e).

Doctors can disclose information about patients without consent in the public interest if failure to do so may expose others to a risk of death or serious harm. The benefits to an individual or to society of the disclosure must outweigh both the patient’s and the public interest in keeping the information confidential (paragraphs 63-70).

The Information Commissioner’s Office has published a statement about how it will consider complaints about data protection practices during the pandemic along with resources that answer frequently asked questions. NHS X has also published advice which sets out some of the tools that doctors can use to support individual care, share information and communicate with colleagues during this challenging time.

How does your social media guidance apply when sharing information about coronavirus?

Our guidance Doctors’ use of social media recognises the benefits that online platforms can have for patient care and communication but also reminds doctors:

• not to use publicly accessible social media to discuss individual patients or their care (paragraph 14)
• not to disclose identifiable information about patients online (paragraph 12) 
• that communications intended for friends or family may become more widely available (paragraph 69).

The guidance also says that, if doctors identify themselves as a doctor in publicly accessible social media, they should identify themselves by name (paragraph 17).  This is because patients and the public generally respect doctors and trust their views – particularly about health and healthcare. Doctors are accountable for their actions and decisions in other aspects of their professional lives – and their behaviour must not undermine public trust in the profession. This shouldn’t be any different online.

Leadership

How can I best support my team?

Doctors in leadership roles are under unprecedented pressure and making decisions amid uncertainty, and rapidly evolving guidance. Self-care and seeking any support you need is vital so that you can, in turn, support your colleagues. 

Our chair Dame Clare Marx has written about the importance of compassionate leadership and how ‘kindness, civility and collaboration are not a distraction from delivering care, they’re an essential part of it’. Professor Michael West, co-author of the independent wellbeing report Caring for doctors, Caring for patients, and Suzie Bailey, Director of Leadership and Organisational Development at The King's Fund, have written about why compassionate leadership matters in a time of crisis. 

Our Leadership and management  guidance says that doctors in leadership positions must promote the health and wellbeing of staff they manage. It emphasises working collaboratively across the multi-disciplinary team, demonstrating respect and kindness, and stressing the importance of clear communication. Now more than ever leadership needs to encourage kindness, civility and collaboration.

You may have colleagues that have been redeployed, or who have returned to practice with temporary registration as part of the response to help out in the pandemic. It is vital that they feel supported and are given some time to adjust. Colleagues new to the team should have an induction and hold team debriefs to say thank you and celebrate successes. Where possible, provide spaces for staff to meet and also have time alone away from patients. 

Research from Dr Suzanne Shale explores how leaders create supportive patient-centred cultures. It highlights the lived experiences of doctors in senior leadership roles, their leadership journeys, their everyday challenges, and what they see as their role in shaping their organisation’s culture.

These are extraordinarily difficult times for NHS staff, which are likely to continue for some time. Ensuring good support is in place will help reduce staff exhaustion and moral injury. 

Information and resources about managing fatigue and supporting doctors returning to practice are in the Your health and wellbeing section of this Q&A.

What should I do if colleagues raise concerns?

It important to create a culture in your workplace where staff feel safe and supported to raise any concerns. Our speaking up web guide  give advice and tools to help doctors follow the processes set out in our guidance. Ensure you have a system in place for raising concerns that is open, transparent and fair. Log these and let colleagues know what actions have been taken in response.

Follow the guidance on the use of personal protective equipment (PPE)   that has been issued jointly by the Department of Health and Social Care, Public Health Wales, Public Health Agency Northern Ireland, Health Protection Scotland and Public Health England. If there are difficulties with supply of PPE equipment be clear with colleagues about this and what you are doing about it. 

Identify colleagues who may have additional vulnerabilities and follow national guidelines for clinical staff with underlying health conditions. Be mindful that all colleagues will respond to this situation differently and those who don’t have vulnerabilities may nevertheless experience significant anxiety and this should be managed supportively.

Our Leadership and management guidance says:  

87 If you have a management role or responsibility, you will often have to make judgements about competing demands on available resources. When making these decisions, you must consider your primary duty for the care and safety of patients. You must take account of any local and national policies that set out agreed criteria for access to particular treatments and allocating resources, and make sure that these policies are available to clinical staff.

88 If you are concerned about how management decisions might conflict with your primary duty to patients, you must take steps to manage or deal with any conflict; for example, by:

• asking for colleagues’ advice
• declaring the conflict to your board or other decision-making body
• asking for advice from external professional or regulatory bodies, including defence organisations, if necessary. 

We have more information about PPE in our Working safely section of this Q&A.

What should I do if colleagues are expressing their views directly through the media?

Doctors are entitled to hold and express personal views. They also have an overriding duty to patients, and to uphold the public’s confidence in the profession. Doctors should consider this carefully before making negative comments publicly, bearing in mind the risk of undermining work to reinforce important public health measures during this emergency crisis. It's vital that doctors raise any concerns that may adversely affect patient safety and/or their own well-being, but it is equally important that these are raised via the appropriate channels.  Doctors should continue to follow our Raising and acting on concerns guidance and you should also direct colleagues to our guidance on Doctors’ use of social media.

You may also need to remind colleagues of the importance of protecting the privacy of high-profile patients from media intrusion, emphasising that all the normal rules of patient confidentiality apply.

There is more information for all doctors in our Confidentiality and social media section of this Q&A.

End of life care

What does advance care planning look like during a pandemic?  

Advance or anticipatory care planning (ACP) helps patients to consider what they want to happen if they become so unwell that they cannot make decisions about their medical care and treatment.  It’s important that these discussions are personalised to the individual patient’s wishes and needs and that they are recorded. Advance care plans  are not blanket policies that can be applied to a group of patients. 

Patients should be offered the opportunity to discuss ACP as early as possible, so they can explore options and express their preferences, including if they want an advance care plan at all. 

A good advance care plan is where the patient feels they have expressed their wishes and been heard. Those involved in providing care for the patient should know about the plan, including family and informal carers if the patient agrees. They may need to be involved with reviewing it, as the situation evolves.  

However, during the current crisis, ACP discussions and decisions may be taking place in highly pressurised situations and may often be extremely difficult for all concerned. You should do your best to ensure they are handled sensitively and with compassion.  

It may be helpful to draw on the patient centred resources available from organisations such as Age UK and Compassion in Dying. The Resuscitations Council’s Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) can also support personalised care planning for a person’s clinical care.

Read more about why advance care planning matters 

What should I discuss with my patient when creating an advance care plan?

Discussions should be tailored to the individual patient, but could include: 

• the goals of treatment  
• care at different stages in the patient’s journey
• types of interventions, including palliative treatments 

It’s important to be clear and honest about options. Cardiopulmonary resuscitation (CPR) is one area of decision making where patients and their carers highly value clear explanations.

For example, if the clinical team decides that CPR will not work for the patient in certain circumstances, and a do not attempt CPR (DNACPR) notice is appropriate, this should normally be discussed with the patient directly, or with family, friends or carers if the patient lacks capacity.  

Patients and those close to them may have unrealistic expectations about the likely success of CPR, or not realise the risks of serious injuries or complications that may result from attempting CPR. It’s also important to explain that a decision on DNACPR doesn’t mean that other care would be denied or stopped.

Read more about having an ACP discussion

What if a patient already has an advance care plan?

You should review the plan to make sure it remains relevant in the current circumstances and to explore specific issues related to care during the pandemic. For example, a patient might not want to go to hospital or be put on a ventilator if they are ill with coronavirus, but they still might want to go to hospital and receive treatment for any other illness. 

Where the patient has capacity, discussions should be carried out directly with them, and with their permission, those close to them such as family, friends or carers. 

Where the patient doesn’t have capacity, you should consult those close to them for their views about what would be in that patient’s best interests or of overall benefit to them in the circumstances. You should do your best to find out if the patient has nominated someone to be consulted about their wishes and preferences, or if they’ve appointed a legal proxy (not available in Northern Ireland) who can make the relevant decisions on their behalf.  

How can I support caregivers where patients are treated at home?

Family and friends can play a vital role in supporting and helping to deliver care and treatment to their loved ones. Doctors play a key role in making sure local arrangements are appropriate and safe for the patient and the carer. 

Doctors should: 

• work collaboratively with carers and the whole healthcare team to develop an agreed care and treatment plan, which must be documented, and may need to be reviewed on a regular basis
• discuss and agree an advance care plan, in case the patient deteriorates 
• ensure anyone giving additional care is suitably trained and has support
• always ensure decisions about treatment and care are made on a personalised basis 
• be guided by relevant local and national guidance, although it may be necessary given the current exceptional circumstances to deviate from these. In such cases, the doctor should make a record and must be prepared to justify their decision.

How does your guidance on end of life care apply in a pandemic?

All our ethical guidance continues to apply as far as is practicable in the circumstances. The primary requirement is for doctors to act responsibly and reasonably.

You should follow our Treatment and care towards the end of life guidance covering ACP (paragraphs 50 – 74) and CPR (paragraphs 128-146), as far as possible, being honest about any uncertainties or likely outcomes for the patient.