SH CP 154 Medical Consultant Change Request Procedure Version 1 Summary: Keywords (minimum of 5): (To assist policy search engine) Target Audience: This document outlines the Trust s procedure for requesting a change of medical consultant. Medical, consultant, consultant change, change request, consultant psychiatrist, psychiatrist. Doctors, Care Co-ordinators, PALS Team and Locality Managers, Lead Clinicians. Next Review Date: April 2022 Approved & Ratified by: Medical Advisory Committee Date of meeting: 16 th April 2014 Date issued: Author: Sponsor: Chief Medical Officer Chief Medical Officer 1
Version Control Change Record Date Author Version Page Reason for Change 7/3/18 Dr Sarah Constantine, Acting Medical Director and Responsible Officer 1 4 Minor change to wording, no further amendments required, review date extended for further 4 years Reviewers/contributors Name Position Version Reviewed & Date 2
Contents 1. Introduction 4 2. Procedure for requesting change of medical consultant 4 3. Process if Consultant Psychiatrist supports the change 4 4. Process if Consultant Psychiatrist does not support the change 5 5. Process for identifying Consultant when agreement cannot be reached 5 Page Appendices A1 Procedure for requesting change of medical consultant flowchart 6 A2 Form A Procedure for requesting change of medical consultant 7 A3 Form B Procedure for requesting change of medical consultant if current consultant does not agree 8 3
1. Introduction 1.1 There are a number of reasons why a patient may request a change in the Consultant Psychiatrist responsible for their treatment. It may be that the patient believes that the therapeutic relationship has broken down. However, at times the difficulties with the therapeutic relationship may be secondary to the patient s mental health problems. 1.2 Sometimes a patient may request a change of Consultant when they are acutely unwell, and experience shows that subsequently, when the acute crisis has resolved, the patient is agreeable to continue with that particular Consultant Psychiatrist. Any request from a patient to change their Consultant Psychiatrist should be considered with this in mind. Changing the Consultant could also require a change in other disciplines of staff caring for the patient in order to ensure effective multidisciplinary care. 1.3 This procedure will also apply to parents or guardians of children under 18 years of age. In the case of patients who do not have capacity to consent, relatives may make an application on their behalf; patients should be enabled to participate as much as possible in the decision-making, and whenever possible their consent sought before any changes are made 2. The procedure for requesting change of medical consultant is outlined on the flowchart on Appendix 1 2.1 Patients who are under the care of a community team should be advised in the first instance to discuss their desire to change their Consultant with their GP or Care Coordinator. The GP or Care Co-ordinator will then be able to help determine with the patient whether consideration of a change of Consultant is in the patient s best interest. 2.2 It may be that a second opinion from another Consultant regarding the treatment plan would address the concerns that the patient may have. This should be offered, if appropriate, and the Clinical Service Director in the area may help identify an appropriate Consultant to offer a second opinion. 3. Process if Consultant Psychiatrist supports the change 3.1 If the current Consultant Psychiatrist supports the change then he/she should detail in the electronic patient record why it would be in the patient s interests for a change of Consultant to take place, and then discuss with colleagues the possibility of transfer (bearing in mind the issues mentioned above). If a Consultant colleague agrees to accept the patient then the patient and GP and other relevant clinical staff should be informed, and arrangements made for transfer of care. 3.2 If agreement cannot be reached with another local Consultant to take over care then refer to section 5 below: Process for identifying Consultant when agreement cannot be reached. 4
4. Process if Consultant Psychiatrist does not support the change 4.1 If a patient raises a request for change with the consultant, or with someone else as described in 2.1 above, and this is communicated with the consultant, and the consultant does not agree that transfer is in the best interests of the patient, the issue should be escalated to the Clinical Service Director for resolution. This can be done in writing by the patient, GP, care-co-ordinator, or other as appropriate. The attached for A can be used. It is the responsibility of the Clinical Service Director (or Clinical Director if the request concerns the Clinical Service director) to ensure that clinical issues from a multi-professional perspective are considered. The Clinical Service Director will then make a decision, and make arrangements for transfer of care if deemed appropriate. 5. Process for identifying Consultant when agreement cannot be reached 5.1 In cases where agreement cannot be reached then the Clinical Director should be contacted for further advice and the Clinical Director would then be responsible for taking the final decision and identifying another consultant to take over care if appropriate. 5.2 NB: At any stage of the process the service user should be advised that advocacy services and PALS are available to provide information and support through this process. 5
Appendix 1 PROCEDURE FOR REQUESTING CHANGE OF MEDICAL CONSULTANT NB: In the first instance it is advised that the patient should discuss a change of medical consultant with their consultant if they feel able to do so, or with their GP, care coordinator, team manager or PALS. Patient requests change of Consultant Consultant informed and considers request Transfer agreed and arrangements made within 28 working days Consultant decides not in best interest of patient and discusses with patient If patient still requests transfer, CSD to be informed by consultant or advocate of the patient CSD review and make decision considering patient, consultant and MDT views * If Clinical Service Director is the current consultant proformas go to the Clinical Director 6
Appendix 2 FORM A PROCEDURE FOR REQUESTING CHANGE OF MEDICAL CONSULTANT (To be completed by patient) Patient s Name:... DoB:... Current Consultant:... NHS No:... Reason for request for change: Signed:... Date:... Please forward to: Clinical Service Director for Area/Service Clinical Service Director office use Date Received: Forward To: Date: cc to: Outcome: 7
Appendix 3 FORM B PROCEDURE FOR REQUESTING CHANGE OF MEDICAL CONSULTANT IF CURRENT CONSULTANT DOES NOT AGREE THIS IS IN BEST INTEREST OF PATIENT S HEALTH (To be completed by current Consultant) Patient s Name:... DoB:... Current Consultant:... NHS No:... Reason for not supporting request for change: Signed:... Date:... Please forward to: Medical Directorate, Sterne 7, Tatchbury Mount, Calmore, Southampton, SO40 2RZ who will forward to appropriate Lead Clinician Lead Clinician office use Date Received: Forward To: Date: cc to: Outcome: 8