Requesting a Second Opinion Policy DOCUMENT CONTROL: Version: 2 Ratified by: Quality and Safety Sub Committee Date ratified: 31 July 201 Name of originator/author: Doncaster Locality Manager, Adult Mental Health Name of responsible Clinical Quality Group committee/individual: Date issued: 22 august 2017 Review date: July 2020 Target Audience Clinical Staff
SECTION CONTENTS PAGE NO. 1. INTRODUCTION 3 2. PURPOSE 3 3. SCOPE 3 4. RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES 3 4.1 Lead Professional 3 4.2 Team Manager/Ward Manager 4 4.3 Service Manager/Matron 4 4.4 Associate Medical Directors/care Group Directors 4 4.5 Medical Director 4 5. PROCEDURE/IMPLEMENTATION 5 5.1 Informing patients of their right to request a second opinion 5 5.2 How the patient is to make the request 5 5.3 Requests for a second opinion made on behalf of the patient 5.4 Advocacy support for the patient 5 5.5 Patients who have communication difficulties 6 5.6 Requests made by patients who are detained under the Mental Health Act and receiving inpatient care 5.7 Arranging a second opinion 6 5.8 Patients who decline a second opinion from a clinician within the Trust or remain dissatisfied following a Trust second opinion 5.9 Dealing with patients who make repeated requests for a change of Lead Professional 5.10 Action if a second opinion is not felt to be clinically appropriate 6. TRAINING IMPLICATIONS 8 7. MONITORING ARRANGEMENTS 8 8. EQUALITY IMPACT ASSESSMENT SCREENING 8 8.1 Privacy, Dignity and Respect 8 8.2 Mental Capacity Act 9 9. LINKS TO ANY ASSOCIATED DOCUMENTS 9 10. REFERENCES 9 5 6 7 7 8 Page 2 of 9
1. INTRODUCTION Models of care within the Trust allow for a number of professionals within the clinical team to act as the Lead in relation to the care and on-going treatment of patients. In the context of this procedure the term lead professional also describes the role of the care co-ordinator in some services. This model of care is responsive to the individual needs of patients and allows for more patient choice in relation to the staff involved in their care and treatment. It is recognised that there may be occasions when a patient will request a second opinion in relation to their diagnosis or treatment plan, and whilst a patient does not have the legal right to request a second opinion the Trust will as far as possible and where it is felt to be clinically appropriate to do so, support any patient who feels that this is the route they wish to take. Due to the demographics of the Trust it is anticipated that most requests will be considered within Trust resources, but should any patient wish to seek a second opinion from outside of the Trust this will be considered, and it will be made clear to them that such a decision will not prevent them from accessing Trust services. 2. PURPOSE The purpose of this document is to set out the Trust procedure for dealing with a patient request for a second opinion. 3. SCOPE This procedure applies to all clinical staff and covers all patients and the parents of children less than eighteen years of age unless a child is judged to have the capacity to make their own decisions in this regard. A request made under this procedure can be in relation to a Consultant, another Doctor, or any other discipline who is the Lead Professional for a patient. 4. RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES 4.1 Lead Professional The Lead Professional is responsible for: Informing any patient who expresses the wish to pursue a second opinion of the process. Discussing the request with the patient and taking steps to resolve the matter at a local level. Examples of how local resolution could be achieved are through : o Providing additional information to the patient in order to alleviate any concerns they may have. o Changing appointment times, or increasing contact for a set period of time. Page 3 of 9
o A review of the treatment plan. Letting the patient know what support is available to help them with their request. This may include advocacy support or support from the Patient Advice and Liaison Service (PALS), contact details available via the Have your Say link on the Trust website/home page. 4.2 Team Manager/Ward Manager The Team Manager/Ward Manager is responsible for: Acknowledging receipt of the request from the patient. Discussing the request with the Lead Professional. Informing the Service Manager / Matron of the request. 4.3 Service Manager/Matron The Service Manager/Matron is responsible for: Including the patients right to a second opinion in any service information literature they develop. Arranging formal consideration of any request for a second opinion on the care provided by non-medical staff or one which is required due to nonresolution at mediation. Monitoring the number of requests received under this policy and compliance with the agreed time-frames. 4.4 Associate Medical Directors/Care Group Directors The Associate Medical Director/ Care Group Directors will be responsible for: Dealing with requests for a second opinion on the care provided by medial staff. The investigation of any complaints which are received in relation to any aspect of this policy. 4.5 Medical Director The Medical Director will be responsible for: Dealing with requests for a second opinion on the care provided by an Associate Medical Director. The investigation of any complaints which are received in relation to any aspect of this policy and the care provided by an Associate Medical Director. Page 4 of 9
5. PROCEDURE/IMPLEMENTATION 5.1 Informing patients of their right to request a second opinion Each clinical area should include the right of the patient to request a second opinion in any service literature. In addition to this it is the responsibility of any staff member (with the support of the Ward/Team Manager) to whom a patient may raise concern about their care and treatment to inform the patient of their right to seek a second opinion should it not be possible to address any concerns on a local level. 5.2 How the Patient is to make the request Most requests will be made verbally and if this is the case, the staff member to whom the request is made (with the support of the Ward/Team Manager) should notify the Lead Professional who will then arrange to meet with the patient and discuss the reasons for their request and attempt to resolve the matter at a local level.. 5.3 Requests for a second opinion made on behalf of the patient Any request on behalf of an adult patient can only be made with their consent. If consent is not in place the staff member to whom the request is made must explain that consent is needed and that without it the request cannot be actioned, but that arrangements will be made for the request to be discussed with the patient in order to ascertain their wishes. Arrangements will then be made for the patient s Lead Professional to meet with the patient at the earliest opportunity to discuss the request and ascertain if the patient wishes to proceed with the second opinion. Details of this discussion and action taken is to be recorded in the patients clinical records, and if the patient consents, the person who originally made the request on their behalf is to be informed of the outcome. Action if the Patient lacks capacity In the case of patients who may not have capacity to consent to requesting a second opinion, their representative(s), e.g. attorney or relatives, may make an application on their behalf. In such cases, the best interest decisionmaking process should take into account the provisions of the Mental Capacity Act (2005) and its associated Code of Practice (2007). Patients should be enabled to participate as much as possible in the decision making process and staff should refer to the Trust s Mental Capacity Act (2005) policy. 5.4 Advocacy support for the patient Some patients may need to be supported, either in making the initial request or during the meeting with their Lead Professional. This support can be Page 5 of 9
provided by a carer, relative, Patient Advice and Liaison Service (PALS) or professional advocate. When receiving a request under this procedure the clinician who receives it is to make the patient aware of the support that is available and how to access it. 5.5 Patients who have communication difficulties In the case of patients whose first language is not English or who have communication problems due to visual/hearing or other impairment, arrangements are to be made for them to have an appropriate Interpreter or other support with them at all meetings. Staff are to refer to the Trust Policy on the use of interpreters for further details. 5.6 Requests made by patients who are detained under the Mental Health Act and receiving inpatient care Due to the clinical complexities of caring for and treating such patients, any request made under this policy would only be agreed to in exceptional circumstances, although all requests will be considered on their individual merits. In the event that such a request is declined on clinical grounds it is to be discussed again with the patient prior to discharge. 5.7 Arranging a second opinion In the event that the patient declines the offer of a meeting with their Lead Professional to discuss their concerns or one is held but the matter remains unresolved, and the Lead Professional feels that the request for a second opinion is reasonable and clinically indicated a second opinion will need to be considered in line with this policy. If the result of this consideration is that a second opinion should be actioned this will be arranged by the Service Manager/Matron or other appropriate professional detailed within this policy who will notify the patient in writing as to the date and time that this will occur and : All requests for a second opinion are to be formally considered and a decision provided to the patient within two weeks of receipt. If the formal consideration supports the request the first step will be to request that a Trust clinician from the same discipline and of equal professional standing to the patient s current Lead Professional undertakes the second opinion. This could be a clinician from anywhere within the Trust. If the clinician undertaking the second opinion is from outside the patient s locality of residence they will travel to meet with the patient in their locality of residence. The Modern Matron/ Service Manager will arrange an interview room for the consultation to take place in. Page 6 of 9
The Modern Matron/Service Manager will ensure that the clinician undertaking the second opinion has access to all the relevant clinical records for the patient. The outcome of the assessment by the second opinion clinician is to be fully documented in the patient s clinical records. The second opinion clinician will contact the current Lead Professional to discuss the findings from their assessment. The second opinion clinician will inform the patient of the outcome of their assessment in writing. 5.8 Patients who decline a second opinion from a clinician within the Trust or remain dissatisfied following a Trust second opinion. The Trust will consider a request for a second opinion from a clinician within another Trust (or a third opinion if a second opinion has already been provided within the Trust) only in exceptional circumstance. If the patient declines a Trust clinician second opinion or remains dissatisfied following a Trust clinician second opinion, or has their request for an opinion outside of the Trust declined they will need to be advised to see their GP and request that a referral is made to another Trust. It should be made clear to the patient that if they chose to do this it may mean that they will have to travel to another hospital for the appointment and that it will be their responsibility to make the necessary arrangements as the Trust will not provide transport. In addition it should also be made clear that in these circumstances the Trust will not be responsible for the reimbursement of any costs incurred through the provision of a second opinion by a clinician outside of the Trust. 5.9 Dealing with Patients who make repeated requests for a second opinion. Whilst every effort will be made to accommodate patients requests under this policy, there may be occasions when a patient makes repeated requests for a second opinion, and in these cases the clinical team will need to make a decision as to whether or not it is in the patient s best interest for the Trust to continue accommodating such requests. If it is decided not be in the best interest of the patient, the request will be passed up to the Service Manager/Matron and relevant Care Group Director who will write to the patient explaining that their request will not be considered and the reason why. In the event that the patient remains dissatisfied, they are to be advised to speak with their GP about the possibility of a referral to another service provider or transfer of care to another service/locality within the Trust, and informed of their right to make a formal complaint in respect of the decision. Page 7 of 9
5.10 Action if a second opinion is not felt to be clinically appropriate. In the event that it is not felt to be in the best clinical interest of the patient to pursue a second opinion the Lead Professional is to meet with the patient to fully explain the reasoning behind this decision. A record of this discussion is to be made in the patients clinical records, and they are to be informed that if they are dissatisfied with the decision they can approach the Service Manager and/or their GP to discuss the matter or make a formal complaint to the Trust. 6. TRAINING IMPLICATIONS There are no specific staff training needs identified in relation to this policy. Staff will be made aware of the policy contents in the following ways: The reissue of the policy will be included intrust communications. Discussion at Team/Ward meetings. 7. MONITORING ARRANGEMENTS Area for Monitoring Number of requests made under this policy per team/ward. Number of formal complaints received in relation to the outcome of any requests made under this policy and implementation of any resultant action plans. How Who by Reported to Frequency Exception reporting Complaints review Modern Matrons/ Service Managers. Service Managers/ Matrons Care Group Governance Groups Care Group Governance Groups Quarterly As and when complaints are received which relate to this policy. 8. EQUALITY IMPACT ASSESSMENT SCREENING The completed Equality Impact Assessment for this Policy has been published on this Policy s webpage on the Trust s Policy website 8.1 Privacy, Dignity and Respect Privacy, Dignity and Respect The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi s review of the NHS, identifies the need to organise care Indicate how this will be met All identified issues in relation to the Page 8 of 9
around the individual, not just clinically but in terms of dignity and respect. As a consequence the Trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided). impact of this policy on the privacy; dignity and respect of patients have been addressed within the policy. 8.2 Mental Capacity Act Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals capacity to participate in the decision making process. Consequently, no intervention should be carried out without either the individuals informed consent, or the powers included in a legal framework, or by order of the Court Therefore, the Trust is required to make sure that all staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act. For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act 2005 to ensure that the interests of an individual whose capacity is in question can continue to make as many decisions for themselves as possible. All individuals involved in the implementation of this policy should do so in accordance with the Guiding Principles of the Mental Capacity Act 2005. (Section 1) 9. LINKS TO ANY ASSOCIATED DOCUMENTS Patient Experience in Adult NHS Services (NICE Clinical Guidance 138) recommendation 1.3.9, February 2012 Patient experience in adult NHS services: Improving the experience of care for people using adult NHS services Interpreters Policy (Provision, Access and Use of, for Patients, Service Users and Carers) - Clinical Policies Mental Capacity Act 2005 Policy Clinical Policies Patient Advice and Liaison Service (PALS) Policy - Corporate Policies Patient Information Policy - Corporate Polices 10. REFERENCES Mental Capacity Act 2005. Page 9 of 9