COVID-19: risk assessment

All doctors should have a risk assessment, including those returning to the NHS and existing staff. We cover risk factors, tools to help you and what the process should be.

Location: UK
Audience: All doctors
Updated: Thursday 16 July 2020

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.

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 mitigation for them including the use of social distancing and PPE.

To empower doctors and GP partners to be appropriately risk assessed, the BMA has brought together resources that can help.

 

Tools to help understand the risks to you or your practice

Publisher Tool Purpose
The BMA Risk stratification tool To help facilitate your work-based risk assessment
Uses a scoring mechanism to help you quantify your biological risk
The Faculty of Occupational Medicine Risk reduction framework To inform safe working during COVID-19
To identify those within the workforce at greater risk, consider workplace hazards and deliver a more comprehensive individual risk assessment
NHS Employers Risk assessment materials Assessing doctors' risk which may support you and your employer
Resources for doctors to share with your line manager or practice
ABMA and ALAMA Risk scoring BAME staff

Medical risk assessment
Used by some GP practices and occupational health services to assist in risk assessing staff

Risk factors

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:

  • age
  • ethnicity
  • biological sex
  • disability
  • health conditions, and
  • pregnancy.

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.

 

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.

 

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.

You should not be asked to sign a waiver of risk by your employer. Your employer has a duty of care to their employees and must take measures to protect your health and safety while at work. 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.

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.

 

The approach in primary and secondary care

Depending where you work, the approach to individual risk assessment will vary.

Primary care

If you are working in a GP practice, it may not be clear where responsibility for risk assessments lies and occupational health services are not available to all staff.

The BMA has long called for an occupational health service to be provided to all practices and their staff. The need for this service is now more crucial than ever and we have asked that it is established as a matter of priority to protect healthcare workers and to allow practices to continue to offer effective treatment and support to their patients.

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.

The impact on primary care

The adjustments required for high risk staff could have wide ranging and significant impacts on individual practices, other staff and patients, particularly where it is a smaller practice, a rural practice and/or a practice with predominantly BAME and high-risk staff/doctors.

 

Implications for primary care

The adjustments required for high risk staff could have wide ranging and significant impacts on individual practices, other staff and patients, particularly where it is a smaller practice, a rural practice and/or a practice with predominantly BAME and high-risk staff/doctors.

Mitigation may include working from home or removal from areas that are considered hazardous (ie hot sites). This will imply: 

  • a reduction in workforce and in activity levels that could affect patient safety, increase stress on remaining clinicians and increase financial insecurity, eg through reduced QOF compliance
  • that practices may be required to use locum support and/or increase their procurement of PPE at significant cost
  • an increase in length of appointments may result when taking PPE on and off.
  • that practices may have difficulty fulfilling training/mentoring requirements or providing usual levels of home visits.
How commissioners can support practices
  • Ensure practices have access to comprehensive OH support. Support for practices should go beyond the minimum standards outlined in the national OH occupational health specification for primary care. OH access in primary care should be fully funded and include occupational health screening/assessments and virology/vaccinations/immunisations.
  • Continued access to PPE, preferably by direct supply from commissioners, and reimbursement for PPE at the level determined by the risk assessment.
  • Additional financial support to maintain/increase stringent infection control eg for cleaning products such as wipes and gels.
  • Ensure continued access to and investment in IT equipment and support including phone lines, broadband, laptops, software, cyber security, and training to enable remote/homeworking. The IT infrastructure should be able to support high quality remote consultations. CCGs should ensure regular upgrades are rolled out, eg replacing Windows 7 operating systems with Windows 10.
  • Provide for locum support and ensure locum GPs to be able to provide remote consultations and be part of the IT and local system infrastructure at short notice if needed.
  • Reduce practice workload by eliminating unnecessary CCG paperwork and suspending unrealistic deadlines. 
  • Continue COVID-19 volunteering / social prescribing schemes. 
  • Make self-referral the default option for all appropriate services to reduce risk for practice staff and patients.
  • Assure GP practices that they will not be held in breach of contract if they were not able to provide services on the basis of a properly conducted risk assessment.
  • Provide employment liability insurance guarantee for any claims arising from COVID-19 as long as due process has been followed by the practice.
  • Review public messaging around 'returning to normal' which is increasing risk in general practice, especially for smaller practices who will not be able to cope with increased demand. This could increase risk on vulnerable staff and on patients. Ensure CCGs work with LMCs/practices and provide additional resources if there is a spike in workload.
  • Recognise that as bloods/smears and other clinics resume, these can’t be done as normal due to the requirements to clean room and comply with IPC regulations after every patient.
  • Hospitals should ensure patients are safely discharged back into the community. They should be given clear advice for what to do if their symptoms worsen and where to access help.
  • Remote consultations taking place in secondary care and other parts of the system should complete all tasks associated with the consultations without referring patients to general practice to reduce risk to general practice staff and patients.
  • Depending on the severity, future COVID-19 waves or pandemics caused by other novel pathogens may require staff to be redeployed both in and or out of primary care. This will require protocols between different sectors of the NHS and social care to ensure staff and providers are treated and can act swiftly during times of public health crises.

Secondary care and public health

If you are working in a hospital, it is generally your line manager who will carry out a risk assessment with input from an occupational health service where available. You may find undertaking a self-assessment of your risk first is helpful preparation for discussions you may have with a manager.

For doctors who work in multiple settings, you may require separate assessments.

 

Speaking out if you think you're at risk

Risk assessment in Wales

As a result of our campaigning for improved protection for doctors during the pandemic, a new and consistent approach to COVID risk assessment in Wales has been published.

We would encourage you undertake a self-assessment and discuss the results with your employer or fellow partners immediately. It is the responsibility of employers to ensure a risk assessment is undertaken, the results recorded and actions taken to protect individuals.

If you are a GP partner and are concerned about the impact on your practice you should speak to your local health board.

We, in partnership with other health unions, have raised concerns about some of the scoring and threshold markers. We would encourage any member concerned about the process or outcome of the assessment to contact us.

 

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.

 

Need help? For 24/7 emergency COVID advice please call us. For all other non-emergency enquiries normal opening times apply.
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