What is a Duty Doctor?
The Duty Doctor (DD) is the doctor in your surgery named on the day to deal with out of the ordinary or urgent issues.
Their role is to:
- support AHPs (paramedics, nursing team, pharmacists, etc.) with urgent queries or requests that they have in relation to their caseload on the day
- support the prescription team and clinical pharmacists in signing urgent prescriptions; separate to the repeat prescription workload which is divided between prescribers working on the day
- field urgent requests (referrals, urgent test results, etc.) from third party colleagues (district nurses, hospital consultants, care homes etc.) that have been triaged by reception lead/paramedic and deemed to require GP input
- support care navigators with urgent queries in relation to patient bookings
- address patient requests for home visit by either preparing a plan for home visit by Care Coordinator/Paramedic on site or by GP themselves, within a safe and appropriate timeframe
- support trainee doctors in the absence of a GP trainer
- be available to address any medical emergencies on site
When are they available?
The on call sessions are split into AM and PM sessions:
- AM - 8:30 - 13:30
- PM - 13:30 - 18:30
It will not be the same doctor every day, but at the start of the day, the DD will be identified on EMIS (see screenshot ▶️) .
- The screenshot shows that the on-call DD on that particular morning (AM) for Knight’s Hill (KH) is Dr. Nathan Brown (green arrow →).
- The DD has two 15 minute appointments available within their on-call sessions that are reserved for face to face support (purple arrows →).
The DD may not always be on site, but they must always be contactable.
They will also be seeing routine patients whilst on-call, so you may have to wait until they are finished with a patient before you get a response.
What Gets Escalated?
It is difficult to pinpoint exactly what could get escalated on any day - medicine is dynamic and plenty of scenarios can play out in that time.
However, the decision to escalate will be based on the following principles:
- discussing/seeing a patient who has become unwell on the day within the surgery
- a paramedic or PA may need advice about a patient they are seeing or on their list
- external queries from third parties (London Ambulance, NHS 111, District Nurses, Safeguarding leads, etc.) that have been triaged and cannot be dealt with by other staff
- requests for prescriptions
- alarming test results that may arrive through usual channels or by phone from a laboratory or other consultants
- patients seeing AHPs who need urgent GP assessment/input/prescription
- patients or staff on site with medical emergencies
How to Escalate to/Access the Duty Doctor
Escalating can vary from site to site, but as a general rule, most times you should check with your lead or team before escalating something (unless it is a patient in the surgery who suddenly becomes unwell).
Should you need to escalate, then, depending on how urgent the situation, you can contact the DD via Teams or EMIS, catch them between appointments, knock on their door, or add directly to the EMIS duty doctor list for same day requests (▶️).
General principles for escalation practice
List best practice
Most things you can add directly to the DD list. For example (not an exhaustive list):
- urgent medication changes after being triaged by pharmacist
- safeguarding documents
- urgent hospital results/letters/prescriptions that require GP attention → allocate to DD by usual channels within workflow modules on EMIS, then log queries or note in the DD list to check letters/prescriptions/results.
- any urgent queries in which a patient is not in immediate danger
Some situations will require a more pro-active response
If a third party calls requiring urgent DD attention → inform DD as soon as they are free/in between patients.
The person who receives the call must be sure to take clear notes → ask the caller what response time is expected, check contact details are logged correctly, and advise that we will address the matter ASAP but may not be immediate if the DD is with a patient at the time of the call.
For something alarming (e.g., high vitals, alarming results, etc.) or if a patient suddenly becomes unwell in an appointment → approach DD in person, being mindful that they may be with a patient.
Medical Emergency: if a patient/staff member is in immediate danger (e.g., passes out in the waiting room) → press the panic button (this will notify DD and others), call 999 and follow the Medical Emergency Protocol.
