The BMA has called upon the NHS to introduce an effective system of risk assessment for all doctors, including those from a BAME (black, Asian or minority ethnic) background and ensure that doctors can work in a way that minimises risk to themselves and patients.
All doctors should have an individual risk assessment in their workplace, including those returning to the NHS from retirement or other branches of medicine.
Individual risk assessments for staff are separate to, and do not replace the need for, risk assessment of the workplace. This must take account of COVID-19 hazards and appropriate mitigation for them including the use of social distancing and PPE (personal protective equipment).
To empower doctors to be appropriately risk assessed, the BMA has brought together resources that can help.
If you are a GP partner looking for support to carry out a risk assessment with your staff, these tools will also help you.
The approach in primary and secondary care
Depending where you work, the approach to individual risk assessment will vary. In primary care, it may not be clear where responsibility for risk assessments lies and occupational health services are not available to all staff. The BMA is working with NHS England to find a solution to the lack of occupational health support for general practice.
In secondary care and public health, it is generally your line manager who will carry out a risk assessment with input from an occupational health service where available. For doctors who work in multiple settings, you may require separate assessments.
Doctors already identified as being at greater risk
A risk assessment should not replace the advice some doctors will have received, by letter or text message, explaining that they have already been determined as clinically vulnerable or clinically extremely vulnerable. A clinical evaluation of increased vulnerability should take precedence over any other risk assessment tools.
For doctors in these groups, working arrangements to mitigate their additional risk from COVID-19 should have already been implemented and should be maintained until they are informed otherwise.
Risk assessments should be conducted on an individual basis and consider a range of factors that may put doctors and health care workers at greater risk from COVID-19, or have a greater impact of the disease.
Factors relevant to an assessment of COVID-19 risk include:
- biological sex
- health conditions, and
Current evidence for COVID-19 shows that those from a BAME background, those of Filipino birth and those who are older have been disproportionately affected by COVID-19, with specific underlying conditions increasing risk of severe illness. In addition, being male has also been associated with severe disease.
We have produced guidance on the increased risk to BAME doctors.
Tools to help you understand your risk
The Faculty of Occupational Medicine has published a risk reduction framework to be used with all NHS staff to inform safe working during COVID-19. The guide is intended to identify those within the workforce at greater risk, consider workplace hazards and deliver a more comprehensive individual risk assessment.
Doctors can also use (and share with their line manager or practice) tools for assessing their risk, which may support both you and your employer to work more safely. NHS Employers suggest a range of materials to support risk assessment and the discussions needed to inform it.
A risk stratification tool, which uses a scoring mechanism, has been submitted for peer review, and in the absence of any other locally or nationally agreed approach, may form a framework for discussions.
Pregnant healthcare workers
In the UK, significant protections already exist for pregnant healthcare workers and these should continue to be followed in relation to COVID-19.
Considering the limited evidence available, pregnant women should only continue to work in patient facing roles up to 28 weeks gestation, provided a risk assessment has been undertaken and the working environment and/or individual duties can be modified.
The Royal College of Obstetricians and Gynaecologists (RCOG), Royal College of Midwives (RCM) and FOM have produced detailed guidelines.
When to get a risk assessment
You should ask your line manager or GP partner/practice manager if you are concerned about your risk of getting COVID-19. A risk assessment can be important for your physical and psychological safety at work.
You can ask for an existing risk assessment to be repeated if you think there has been a significant recent change in your circumstances which might increase your risk of COVID-19. For example, a worsening of an underlying health condition or a change in the nature of the work that you are being asked to do.
Who will carry out your risk assessment
If you are working in a hospital, your line manager should complete a risk assessment with you. You may find undertaking a self-assessment of your risk first is helpful preparation for discussions you may have with a manager.
If you are working in a GP practice, speak with your GP partner/practice manager about carrying out a risk assessment with you. The BMA is working with NHS England to find a solution to the lack of occupational health support for general practice.
If you are a GP partner or a single-handed GP, you may need to undertake a self-assessment.
GP practices should provide a risk assessment working with locums who deliver sessions at their surgery.
What the risk assessment process will look like
Risk assessments should be done in a one-to-one setting, recognising this will require sensitive discussions. Those with responsibility for implementing the risk assessment should listen carefully to your concerns, provide support and consider any adjustments that might be necessary.
Discussing health conditions
You should not be formally required to discuss health or other conditions if you do not wish to, though it is important to recognise that for a comprehensive assessment of your risk, it is helpful to mention anything you think is relevant.
If you are uncomfortable about discussing a particular issue but would welcome some support and advice, you can contact the BMA.
If the risk assessment raises issues which require follow up, for example establishing the severity of an underlying health condition, this should be done through an occupational health service, if available.
Disagreements about conclusions reached
Occupational health services should not be used by your employer to determine your overall risk, or as an adjudicator in circumstances where there is a difference in view between the assessor and the doctor being assessed.
Where there are disagreements about the conclusions reached between managers and staff, locally agreed grievance resolution processes will apply. You can contact the BMA for assistance.
After the risk assessment
If you are identified as being at high risk, your employer should take steps to mitigate the risk, as far as they are able.
These steps could include alternative clinical or non-clinical work where the risk of contracting COVID-19 is lower based on an environmental risk assessment and/or supporting remote working where possible.
If you are a GP partner and are concerned about the impact on your practice as a result of staff being removed from front-line patient care, your CCG should provide you with support to ensure you can continue to deliver services.