We must make sure risk mitigation does not lead to discrimination

Many practices and organisations have been anxious to introduce additional measures to protect staff who could be at higher risk from COVID-19. NHSE has also asked organisations to complete risk assessments to ensure the safety of at-risk staff.

Safety is, of course, paramount. But safety measures mustn’t accidentally end up being used to discriminate against clinicians deemed to be higher risk.

It’s not just about someone’s risk level

Each individual clinician must fully assess their risk.

Pre-existing health conditions, age and gender all contribute to how at-risk someone may be. Public Health England’s report on the impact of COVID-19 on BAME communities has also demonstrated that ethnicity is a contributing factor. 

But individual risk is only one part of the picture.

The second part is for practices to create as safe a working environment as possible: facilitating social distancing and hand hygiene, providing appropriate PPE, or changing working practices to minimise exposure.

The third part is combining the duties of clinicians and the practice to find the safest ways for the two to work together. That’s why the BMA has advised that GP practices should work with their locums to make sure their risk assessment covers all staff who deliver sessions.

That could look like redeploying more at-risk individuals to tasks that are lower risk, like online consultation, or agreeing a safe way for higher risks tasks to be performed.

Either way, these risk assessments must be the result of a conversation between both the practice leadership and clinician.

Sharing risk levels before booking staff could lead to discrimination

Staff who are at higher risk - whether over 55, male, BAME, or with diabetes - are still highly qualified staff, doing excellent work. The risk assessment frameworks have been created to allow them to continue this work in the safest way possible - not to stop them working entirely.

Sharing sensitive information like a personal risk level before booking work could lead to staff being passed over because they are seen as too great a risk to take on, or being automatically dismissed from performing certain types of work without consultation. 

The GPs we’ve spoken to or heard from agree. While they would be happy to coordinate with practices on their risk assessment once work is booked, many felt that either sharing their risk level or the reason for it before booking work (for example, in their profiles) would be inappropriate.

Risk level doesn’t mean appetite for risk

Just because a clinician has a low risk score doesn’t mean they are comfortable working shifts that put them face to face with COVID-19 patients.

And just because someone has a higher risk score does not mean that they want to exclusively deliver online or telephone consultations. 

If a clinician has considered their personal risk and is comfortable working in a particular setting, the onus is on the practice to discuss the implications of the work with them, and then mitigate any risks.

Since many protective measures are already in place for staff, whether or not they are at higher risk, taking on certain shifts is often a question of choice or overall policy, not capability.

We have to give people tools to manage risk

At Lantum, we want to give clinicians as much detail and as much choice as possible, so they can make the best, most informed decisions about the kind of sessions they want to take on. 

• GPs can search work by extra COVID-19 shift properties, like whether they are online consultations, have appropriate PPE supplied, or are face-to-face with patients
• Practices can mark shifts that require face-to-face contact with a patient suspected of having COVID-19 as C-19 Patient shifts
• Practices can fill out the description with the exact demands of each job they post

Ultimately, those working in healthcare manage their own personal risk everyday. To remove their ability to do so, instead of providing tools to help do it better, would be a mistake.

How you can mitigate risk for your staff

NHS Employers has released guidance on how to enhance your existing risk assessments for staff. 

It is based on the Faculty of Occupational Medicine’s Risk Reduction Framework for NHS staff to reduce their risk at work - the last two pages condense the factors to consider in assessing work patterns and staff risk. 

You can also read our COVID-19 risk assessment guide for GPs here.

If any GPs who find work through Lantum want to get in touch about how this might affect them, the Clinical Governance team is happy to speak to you.