Regulatory advice for doctors amidst Coronavirus pandemic
Shannett Thompson
As the number of confirmed coronavirus cases surged in the UK this week, the government rushed emergency legislation through both Houses, and the Coronavirus Act 2020 (‘the Act’) subsequently received Royal Assent on 25 March 2020.
The legislation gives the government wide-ranging powers to respond to the current coronavirus pandemic. It is time limited to two years and will be reviewed by MPs every six months. Health Secretary Matt Hancock told MPs the emergency legislation will allow "extraordinary measures" never before seen in peace time in the UK, but that the powers would only be used "when strictly necessary" and would remain in force only for as long as required.
The Act has three main objectives:
- to give further powers to the government to slow the spread of the virus;
- to reduce the resourcing and administrative burden on public bodies; and
- to limit the impact of potential staffing shortages on the delivery of public services.
Key provisions of the Act affecting the healthcare workforce
The legislation allows the UK and devolved governments to ‘switch on’ the new powers when they are needed and, importantly, to switch them off again once they are no longer necessary, based on the advice of the respective Chief Medical Officers of the four nations.
We consider the main provisions below and how these will impact those working in the healthcare sector:
Increasing the number of available health and social care workers
In order to increase the available healthcare workforce, the Act will remove barriers to allow NHS and adult social staff who have retired in the last three years, or who are not currently in clinical practice, to return to work. The legislation enables regulators such as the Nursing and Midwifery Council (NMC) and the Health and Care Professions Council (HCPC) to “emergency register suitable people as regulated healthcare professionals, such as nurses, midwives or paramedics. This might include (but will not be limited to) recently retired professionals and students who are near the end of their training.”[1] Similarly, the Act enables regulators to temporarily add social workers who may have recently left the profession, to their registers, to ensure continuity of care for vulnerable children and adults.
Regulators will be trusted to use this new power as they see fit. In practical terms, they will be able to automatically re-register professionals who have recently retired or whose registration has lapsed, as well as permitting early registration of final year medical students. The restrictions on the number of hours retired staff who return to the NHS can work will be suspended, and volunteers in the health and social care sector who have to take unpaid leave will have access to a UK-wide compensation fund.
A possible 60,000 more nurses
The NMC has indicated that there are potentially 60,000 additional workers available through re-registering nurses, midwives and nursing associates who have left the register in the last three years. It is also estimated that there are approximately 18,000 third year undergraduate student nurses working to qualification who it is hoped will be registered early.
Many have called for the NMC to use its emergency powers to reduce the total number of clinical hours required to achieve registration, in the hope that this will reduce the burden of student supervision on the NHS. The regulator will need to carefully balance this however, with ensuring those who achieve registration have passed the relevant academic and skills assessments and are competent and safe to practise.
A potential pool of 15,500 additional doctors
The General Medical Council (GMC) already has similar powers, so there was no need for the government to include provision for emergency regulation of doctors in the legislation. Our recent blog, Regulatory advice for doctors amidst Coronavirus pandemic, discusses the GMC’s approach to regulation in light of COVID-19 and the key factors doctors need to be aware of when choosing to return to the frontline.
The GMC has indicated that re-registering those who have left the register in the last three years could provide up to 15,500 additional doctors.
The GMC is not currently planning to register final year students early, however advises that this could change in the future. The GMC further advises that medical students may be able to volunteer in the NHS if they are willing and able to, and can carry out duties that do not require registration.
Almost 8,000 returning clinicians and counting
Currently, 7,563 recently retired clinicians have answered the call to return to work to help with the emergency. Health Secretary Matt Hancock confirmed to MPs that priority would be given to ensure their training was up to date and they were fully insured, whilst the chief executive of NHS England, Sir Simon Stevens, said that “dedicated refresher training” is needed.
Easing the burden on frontline staff
The Act will reduce the administrative burden on frontline staff by, for example, reducing the number of administrative tasks they have to perform and allowing key workers to perform more tasks remotely and with less paperwork. Non-urgent operations and services will be cancelled or delayed to release staff that can be deployed to other critical services.
Provisions are included that will amend mental health and mental capacity legislation and which relax requirements on both health services and local authorities to carry out assessments. This aims to facilitate faster discharge from hospital into the community to free up beds, space and staff so that those with the virus can be prioritised. As part of this, mental health patients who need urgent attention can be treated by using just one doctor’s opinion rather than the current requirement of two.
The GMC confirmed last week that doctors due to revalidate their licences between now and September (which is an estimated 36,000) can delay doing so until next year to focus on their frontline duties. GMC Chief Executive, Charlie Massey, hopes this should help “to free up vital time” and says “We’re doing everything in our power to support doctors and employers on the frontline, where patients need them most. We hope this will help ease the burden on doctors already working so hard to deliver the best possible care.”
Managing the deceased with dignity and respect
The government’s proposal said “We want to ensure the deceased are treated with the utmost respect and dignity and that the current procedures in relation to death and still-birth registration and management are modified to enable this and to protect public health. This will take account of the fact that families who have lost a loved one may be self-isolating, and that there may be reduced capacity to register and manage deaths as a result of pandemic-related sickness absence.”
In addition to other changes, the Act expands the list of people who can register a death to include funeral directors acting on behalf of the family and will remove the requirement that any inquest into a death from coronavirus must be held with a jury. It will also remove the need for a second confirmatory medical certificate, in order for a cremation to take place.
We know that these are worrying times for healthcare professionals, and that the fast-paced updates make it difficult to keep on top of the most recent guidance. Whilst these measures are clearly necessary to help alleviate staff shortages and to keep people safe during this unprecedented time, it is important that these changes are implemented and monitored to ensure that the best interests of frontline staff are protected.
The information in this blog is current at the time of publishing.
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