Medical emergencies and the deteriorating patient policy (independent specialist doctor)

1. What the regulation says

Care and treatment must be provided in a safe way for service users. (Reg 12(1) (the headline duty))

assessing the risks to the health and safety of service users of receiving the care or treatment, (Reg 12(2)(a) (risk assessment))

doing all that is reasonably practicable to mitigate any such risks, (Reg 12(2)(b) (risk mitigation))

ensuring that persons providing care or treatment to service users have the qualifications, competence, skills and experience to do so safely, (Reg 12(2)(c) (staff competence))

ensuring that the equipment used by the service provider for providing care or treatment to a service user is safe for such use and is used in a safe way, (Reg 12(2)(e) (equipment safety))

where equipment or medicines are supplied by the service provider, ensuring that there are sufficient quantities of these to ensure the safety of service users and to meet their needs, (Reg 12(2)(f) (sufficient equipment + medicines supply))

where responsibility for the care and treatment of service users is shared with, or transferred to, other persons, working with such other persons, service users and other appropriate persons to ensure that timely care planning takes place to ensure the health, safety and welfare of the service users. (Reg 12(2)(i) (shared / transferred responsibility))

Regulation 18 adds the staffing and competence duties that this policy operationalises for life-support and anaphylaxis training:

Sufficient numbers of suitably qualified, competent, skilled and experienced persons must be deployed in order to meet the requirements of this Part. (Reg 18(1): the headline duty)

receive such appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform. (Reg 18(2)(a): support, training, supervision and appraisal)

The full text is at https://www.legislation.gov.uk/uksi/2014/2936/regulation/12 and https://www.legislation.gov.uk/uksi/2014/2936/regulation/18. Where this policy and the regulation diverge, the regulation wins.

2. Plain-English summary

Care and treatment must be provided in a safe way. The regulation lists the areas a provider must address, including risk assessment, risk mitigation, staff competence, safe premises, safe equipment, sufficient equipment and medicines, medicines safety, infection prevention and shared-care planning. Regulation 12 is central to CQC's safety expectations. For the training and competence elements of this policy, Regulation 18 requires you to deploy enough suitably qualified, competent, skilled and experienced staff, and to give them the support, training, professional development, supervision and appraisal necessary to carry out their duties.

3. Purpose

A medical emergency can happen in any clinic: a collapse, anaphylaxis, chest pain, a faint that does not recover. In a single-handed practice there is no crash team down the corridor, so the practice has to be ready to recognise and treat an emergency and get the patient to hospital safely. This policy sets out how the practice prepares for, recognises and manages a medical emergency and a deteriorating patient.

The practice must verify this policy against current Resuscitation Council UK guidance before adoption.

4. Sources to verify before adoption

• Resuscitation Council UK, guidelines and quality standards for primary and out-of-hospital care: https://www.resus.org.uk/
• Resuscitation Council UK, emergency treatment of anaphylaxis guidance: https://www.resus.org.uk/
• GMC, Good medical practice (responding to emergencies and recognising the limits of competence): https://www.gmc-uk.org/
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12 (safe care and treatment): https://www.legislation.gov.uk/uksi/2014/2936/regulation/12

5. Scope

This policy applies to:

• the medical emergencies that could occur at the practice
• the equipment, drugs, training and arrangements to manage them
• the doctor and any staff present

6. Anticipating the emergencies that could occur

The practice identifies the emergencies most likely to arise from the patients it sees and the procedures it does (for example anaphylaxis after an injection, a vasovagal collapse, chest pain, hypoglycaemia, or a complication of a procedure), and prepares for them.

7. Equipment and drugs

• the practice keeps the emergency equipment and drugs appropriate to its work, which may include an anaphylaxis kit with in-date adrenaline, oxygen, and an automated external defibrillator, kept where they can be reached quickly
• emergency equipment and drugs are checked regularly and after any use, restocked and kept in date, with the checks recorded
• staff know where the equipment is and how to use it

8. Recognising deterioration

• the doctor and staff watch for early signs that a patient is becoming unwell, and act early rather than waiting for a full collapse
• a patient who deteriorates is assessed using a structured approach (such as airway, breathing, circulation, disability, exposure), and treated and escalated without delay

9. Managing an emergency

When an emergency occurs the practice:

• starts immediate treatment within the doctor's and staff's competence, following the relevant Resuscitation Council UK algorithm (for example for anaphylaxis or cardiac arrest)
• calls 999 for an ambulance early, because the patient will need hospital care that the practice cannot provide
• keeps the patient safe until the ambulance arrives, and gives the ambulance crew a clear handover of what happened and what was done
• where the practice gives injections, follows the anaphylaxis arrangements, including the observation period after vaccination or injection

10. After an event

• the patient is referred to hospital where needed, and the practice follows up the outcome where it can
• the event is recorded in full and logged as a patient-safety incident
• the emergency equipment and drugs are checked and restocked
• the practice debriefs and reviews how the emergency was handled, and improves its readiness

Operational controls to adapt

Roles and responsibilities

• Registered Manager: owns emergency-readiness governance, confirms equipment, medicines, training and drills are current, and reviews emergency incidents and audit findings.
• Resuscitation or emergency lead: maintains the emergency kit list, check schedule, drill plan, emergency algorithms and restock process.
• Doctor or clinician in charge: recognises deterioration, leads the ABCDE assessment, starts treatment within competence, calls 999 early and gives the ambulance handover.
• Support staff: know how to summon help, bring equipment, clear the area, support basic life support within competence and record times during an emergency.
• Governance lead: checks that debriefs, duty-of-candour decisions, CQC notification decisions and improvement actions are completed.

Emergency response procedure

1. Complete pre-session readiness checks. Confirm emergency drugs, oxygen where held, AED, airway equipment, suction where held, observation equipment and emergency contact routes are available before clinical work starts.
2. Recognise deterioration early. Any collapse, chest pain, breathing difficulty, allergic reaction, seizure, severe bleeding, severe pain, confusion or abnormal observations is treated as urgent until assessed.
3. Use a structured assessment. Assess airway, breathing, circulation, disability and exposure, record observations and repeat them at clinically appropriate intervals.
4. Call 999 early. Do not wait for full collapse where the practice cannot safely manage the risk on site. Record the call time and reference if available.
5. Treat within competence. Follow current emergency algorithms, including anaphylaxis and basic life support, and record medicines, dose, route, batch where relevant and time.
6. Allocate roles. One person leads, one calls emergency services, one brings equipment, one records times and one manages privacy and other patients where staffing allows.
7. Give a structured handover. Use a clear summary of situation, background, assessment and response, including observations, treatment given, medicines, allergies and relevant history.
8. Recover the system after the event. Restock equipment, replace medicines, document the event, debrief, decide on duty of candour and CQC notification, and open improvement actions.

Records and register links

The emergency-readiness and event record should include:

• emergency equipment and medicine check date, checker, batch, expiry, missing items and corrective action
• staff life-support, anaphylaxis and emergency-drill training records
• event timeline, observations, ABCDE findings, treatment, medicines, 999 call time and handover details
• patient transfer destination, outcome follow-up, family or carer communication where appropriate and clinical record update
• debrief notes, duty-of-candour decision, CQC statutory-notification decision and learning
• linked incident, risk, training, medicines, equipment, complaint or improvement-action reference

Missing equipment, expired medicines, delayed 999 calls, unclear event records, overdue training and repeat drill failures are opened on the incident, risk or improvement-actions register.

11. Training and drills

• the doctor and staff are trained in basic or immediate life support and in anaphylaxis treatment to the level the practice's work requires, and are refreshed on the required cadence
• the practice runs occasional emergency drills so the team can act quickly and knows its roles and where the equipment is
• the practice records who is trained and the next refresher dates

12. Audit cadence

The practice checks, on a stated cadence, that:

• emergency equipment and drugs are present, in date and checked
• the doctor and staff are trained in life support and anaphylaxis and are in date
• any emergency was managed per the algorithm, 999 was called early, and the event was recorded and reviewed
• drills are run and readiness is improved

The doctor and the Registered Manager review the results and record the improvement actions that follow.

13. Sources and further reading

This template is based on CQC's guidance for providers and managers, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and other topic-specific legislation and guidance listed below. It is a starting point for adaptation, not a substitute for legal, clinical, HR, safeguarding or specialist professional advice.

• CQC Regulation 12: Safe care and treatment
• CQC Regulation 18: Staffing
• Resuscitation Council UK guidelines and quality standards
• NICE sepsis and deterioration guidance
• Sector-specific emergency guidance
• GMC, Good medical practice (responding to emergencies; recognising the limits of competence)
• GMC remote prescribing and consent guidance
• Medical indemnity provider guidance
• CQC Regulation 17: Good governance
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (https://www.legislation.gov.uk/uksi/2014/2936/regulation/12)

Related reading

• Related policy: Medical emergencies and deteriorating patient policy
• Related policy: Emergency medicines and equipment checking policy
• Related policy: Incident reporting, investigation and learning policy
• Related policy: Duty of candour policy
• Related policy: Safe care and treatment policy

14. When to seek further advice

Seek specialist advice where the issue involves serious harm, safeguarding, deprivation of liberty, restraint, children, professional misconduct, controlled drugs, radiation, termination of pregnancy, infection outbreak, water safety, employment dismissal, DBS barring referral, or regulatory enforcement.

15. Document control

This sample policy template was issued by Verivius. It is a template, not a substitute for legal advice or the tenant's own policy-development process. Where this template and live law or regulator guidance diverge, the live source wins.