1. Purpose
A single-handed independent specialist works without colleagues on hand, without an easy second opinion, and is the only person delivering the service. Three risks follow: drifting outside their competence with no one to check them, working without adequate indemnity, and leaving patients without care when they are away, unwell or stop practising. This policy sets out how the practice manages its scope, holds proper indemnity, and keeps care continuous.
The practice must verify this policy against current GMC guidance and the legal requirement to hold indemnity before adoption.
2. Sources to verify before adoption
- GMC, Good medical practice (working within competence, continuity of care, and indemnity): https://www.gmc-uk.org/professional-standards/professional-standards-for-doctors/good-medical-practice
- The statutory requirement for doctors to hold adequate and appropriate indemnity or insurance (verify the current legal position): https://www.gmc-uk.org/
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12 (safe care and treatment) and Regulation 17 (good governance): https://www.legislation.gov.uk/uksi/2014/2936/regulation/17
3. Scope
This policy applies to:
- the range of work the practice takes on
- the indemnity it holds
- the arrangements for continuity when the doctor is unavailable or the practice closes
4. Working within scope and competence
- the practice defines, and records, the conditions and procedures it offers, and the doctor works within their training, competence and registration
- where a patient's needs fall outside that scope, the doctor refers to an appropriate service rather than managing beyond their competence
- because there is no colleague on site to act as a check, the doctor actively seeks advice, a second opinion or peer review where a case is complex or uncertain, and takes part in appraisal and continuing professional development
5. Arrangements for advice and referral
- the practice has named, reliable routes to specialist advice and to urgent and emergency care, and the doctor uses them rather than carrying risk alone
- where a patient needs care the practice cannot safely provide, including urgent care, the practice refers promptly and supports the patient through the handover
6. Indemnity and insurance
- the doctor holds adequate and appropriate indemnity or insurance for all the work the practice does, and keeps it current
- the cover is checked against the actual scope of work, so a new or higher-risk activity is not carried out before cover is confirmed
- the practice keeps evidence of current cover
7. Continuity when the doctor is unavailable
Because one person delivers the service, the practice plans for that person being away or unwell:
- patients are told how to get help when the doctor is unavailable, including who to contact and the route to urgent care
- arrangements are in place so that results, urgent messages and follow-up are handled, not left, during planned and unplanned absences
- where possible, cover or a referral arrangement is in place for patients who need to be seen while the doctor is away
8. Fitness to practise
The doctor does not practise when their own health or any other factor means they cannot do so safely, and has arrangements (including their own GP and occupational support) and a plan for what happens to patients if they become unable to practise at short notice.
9. Closing the practice
If the practice closes or the doctor stops practising, there is a plan for: telling patients, transferring or continuing the care of patients under active treatment, and keeping and making available the clinical records for the required retention period (see the clinical records and information governance policy).
10. Recording
The practice records its defined scope, its current indemnity, its advice and referral routes, and its continuity and closure arrangements, and keeps them up to date.
11. Audit cadence
The practice checks, on a stated cadence, that:
- work stays within the defined scope and competence, with referral out where needed and peer input sought
- indemnity is current and matches the actual scope of work
- continuity arrangements cover planned and unplanned absence, including results and urgent follow-up
- fitness-to-practise and closure plans are in place
The doctor and the Registered Manager review the results and record the improvement actions that follow.