Scope of practice, indemnity and continuity 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))

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))

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 17 adds the governance and records duties that this policy operationalises:

Systems or processes must be established and operated effectively to ensure compliance with the requirements in this Part. (Reg 17(1): the umbrella duty)

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/17. 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. Alongside this, you have to run effective systems and processes to comply with everything else in Part 3, including the quality, risk and records duties in Regulation 17, and a single-handed doctor must hold adequate and appropriate indemnity and work within the competence set out in GMC Good medical practice.

3. 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.

4. 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

5. Roles and responsibilities

• Doctor / Registered Manager: owns the declared scope of practice, confirms competence before any new service starts, keeps indemnity current, and signs off continuity and closure arrangements.
• Nominated Individual or provider director, where applicable: checks that the service being offered matches CQC registration, statement of purpose, insurance and business continuity arrangements.
• Administrative or clinical support staff: book only services the practice is authorised and competent to provide, use the approved escalation routes during absence, and report scope, indemnity or continuity concerns.
• Governance lead or nominated reviewer: reviews scope changes, incidents, complaints, adverse outcomes, peer-review findings and improvement actions.

6. Scope, indemnity and continuity procedure

The practice follows this procedure to keep the service safe:

1. Define the current scope. Keep a written list of the consultations, procedures, investigations, prescribing activity and follow-up arrangements the practice offers.
2. Check competence. For each activity, record the doctor's training, experience, continuing professional development, appraisal or peer-review evidence that supports safe practice.
3. Check CQC and business fit. Confirm the activity fits the provider's regulated activities, statement of purpose, premises, equipment, staffing, emergency arrangements and patient information.
4. Check indemnity before work starts. Confirm with the indemnity provider or insurer that cover includes the activity, setting, patient group, remote element, procedure type and any higher-risk feature.
5. Assess the risk of the activity. Identify what could go wrong, what equipment or support is needed, when a second opinion is required, and when the patient should be referred elsewhere.
6. Approve or decline the work. Do not offer a service until competence, indemnity, registration fit and continuity arrangements are confirmed.
7. Plan continuity. Name who checks results, urgent messages, referrals, patient queries and active follow-up when the doctor is away or unwell.
8. Tell patients the route for help. Patient information explains what the practice can and cannot provide, how to get urgent help, and what happens during absence.
9. Review after change. Recheck scope and indemnity after any new procedure, new premises, new equipment, remote-service change, complaint, incident, serious adverse outcome or CQC registration change.
10. Escalate safety or probity concerns. If the doctor may be working outside competence, without suitable indemnity, while unfit to practise, or outside registration, pause the activity and seek advice from the indemnity provider, responsible officer, GMC, CQC or legal adviser as appropriate.

7. 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

8. 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

9. 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

10. 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

11. 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.

12. 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).

13. 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.

14. Records and register links

The scope, indemnity and continuity evidence trail should include:

• declared service scope and any exclusions
• CQC registration and statement-of-purpose check for each activity
• competence evidence, continuing professional development, appraisal or peer-review record
• indemnity or insurance certificate and written confirmation of cover for higher-risk or new activity
• advice, referral and emergency escalation routes
• continuity plan for planned and unplanned absence
• active-patient follow-up list used during absence or closure
• closure plan, records-transfer plan and patient communication template
• scope-change risk assessment and approval decision
• incidents, complaints, adverse outcomes, peer-review findings and improvement actions linked to scope or continuity

Scope drift, indemnity gaps, unplanned absence failures and closure risks are tracked through the risk register and improvement-actions register. Serious patient-safety events are opened on the incident register and reviewed at the governance meeting.

15. Training and competence

The doctor keeps competence current through continuing professional development, appraisal, peer review, audit and feedback from incidents, complaints and outcomes. Any staff who book patients or answer queries receive training on the practice's current scope, exclusions, urgent escalation routes, absence plan and how to raise a concern if a request falls outside the approved service.

Training and competence evidence is held in the training matrix or governance file. Scope changes are not launched until the competence and indemnity evidence has been reviewed.

16. 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.

17. 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 17: Good governance
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (https://www.legislation.gov.uk/uksi/2014/2936/regulation/12)
• 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 with the GMC): https://www.gmc-uk.org/
• GMC remote prescribing and consent guidance
• Medical indemnity provider guidance

18. Related reading

• Related policy: Clinical records and information governance policy
• Related policy: Prescribing and private prescriptions policy
• Related policy: Consent and shared decision-making policy
• Related policy: Medical emergencies and the deteriorating patient policy
• Related policy: Business Continuity and Emergency Preparedness Policy

19. 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.

20. 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.