Ethical and Legal Aspects of the ACCP Role. Danny Bryden, Sheffield Teaching Hospitals NHS Trust

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1 Ethical and Legal Aspects of the ACCP Role Danny Bryden, Sheffield Teaching Hospitals NHS Trust

2 An Advanced Role We cover both minor and major illness and injuries. We carry out physical examinations and diagnosis of patients, are able to prescribe medicines, request/interpret diagnostics and make referrals to other specialties, whilst providing support and teaching to nursing teams and junior doctors

3 What I ll Cover Today Court Structures Professional Responsibilities & Practice Standards Regulation of ACCPs and current potential stress points caveat that legal systems differ in operational detail

4 Courts and Tribunals Coroner s Court/ Procurator Fiscal- investigatory Civil Courts -adjudication Criminal Courts- adjudication Professional Practice Tribunals- investigatory & adjudication

5 Basis of Professional Responsibility, Duty of Care Contractual responsibility clinical negligence Neighbour principle Donoghue v Stevenson

6 Clinical Negligence- Civil Law Duty of Care Breach of Duty Harm results (Causation) All 3 parts must be demonstrated by the claimant

7 Standard of Care Bolam v Friern Hospital [1957] McNair J, reasonable doctor ordinary skilled man exercising and professing to have that special skill Bolitho [1998] opinion can be subject to logical analysis Montgomery v Lanarkshire Health Board [2015], reasonable patient in issues of consent

8 Delegation responsibilities What is the standard? Nettleship v Weston [1971]= no allowance for inexperience Wilsher v Essex HA [1986]= doing your best if inexperienced was rejected Recognition of inexperience and calling for supervision discharges your duty Includes an element of evidence based practice, keeping up to date and thinking practice that is logical

9 Criminal Negligence Gross negligence manslaughter conviction No reasonably skilled doctor would have done it R v Adomako R v Misra and Srivastata

10 Do patients need to know what the ACCP role is? Must explain and disclose relevant risks Nurse, doctor, physiotherapist all legal titles Failure to comply may render actions a criminal offence

11 Tiers of Regulation Professional eg GMC, NMC, CHRE - independent of local interpretation Work based- prone to breakdown Team based Personal eg GMP

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13 What is Advanced? Experienced...highly clinical experienced professionals...developed and educated skills members and theoretical of knowledge care team to who a very are high standard...empowered able to diagnose to and make treat...or high-level refer clinical you to an appropriate decisions. specialist Skills for NMC Health 2007

14 The profession s perception? Although we are working at an advanced level of practice, we are still nurses and it remains central to our role. It does not stop us from providing our basic nursing care, and we still undergo our...appraisals and registration. The role is a new pathway for nursing progression with the focus on enhancing clinically rather than branching into a managerial type role

15 Medical Oversight and Regulation Medical School Generic training Specialist training Consultant Practice PG Schools & LETBs GMC Royal Colleges/Fac ulties

16 ACCP Oversight Primary Professional Training HEI & local Trusts? ACCP Training Royal Colleges/Fac Qualified ACCP ulties

17 Who does the GMC do? Provides advice on ethics & professional conduct standards Oversees medical education FICM Maintains a register of qualified/licensed practitioners Investigates (adjudicates) fitness to practice allegations NMC?

18 Governmental View nature of work and the level are identical to that done by existing regulated professionals, so [hard to argue that the role] should not be subject to statutory regulation as a new profession in their own right

19 Proposed UK Working Party Is the role different enough to warrant regulation as a profession? do recruits come from a variety of backgrounds? contribution to workforce development for service delivery agreed training standards No new regulator evidence for efficacy of the role level of risk and impact on public safety level of demand for a nationally transferrable qualification and scope of practice

20 What is Advanced? Registered Nurse Formal mechanism needed to protect advanced titles from misuse. Hybrid roles & new roles - autonomous... a genuine advance? Personal satisfaction and achievement vs professional isolation Issues of transferability between employers and countries

21 Regulatory Issues of the ACCP role Lack of a protected title and voluntary register Surety of accredited standards and proficiency Accountability for higher levels of practice Risk to patients & the profession?

22 Further Reading Medicine, Patients and the Law- Brazier & Cave, 2011 Regulation of Advanced Nursing Practice- Rose O Shea, PhD thesis, 2013

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