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Requesting Medical Support: GP, Paramedic, and Specialist Services Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} has a clear, structured, and efficient process for requesting medical support from GPs, paramedics, and specialist services. Prompt access to medical assistance is essential for maintaining the health, safety, and well-being of the people we support and ensuring compliance with CQC regulations.

This policy ensures that:

• Medical support is requested promptly and appropriately based on clinical needs.
• Staff follow clear escalation pathways for GPs, emergency paramedic support, and specialist services.
• All interactions with healthcare professionals are documented accurately and in compliance with GDPR and CQC standards.
• People we support receive timely, person-centred, and safe medical care in emergencies and non-emergency situations.
• Care home staff are trained and competent in recognising when to seek medical support.

2. Scope

This policy applies to:

• All staff, including carers, nurses, team leaders, and managers, involved in identifying health concerns and escalating medical support requests.
• People we support, ensuring their medical needs are met efficiently.
• GPs, emergency paramedic services, and specialist clinicians, supporting continuity of care.
• Management teams, responsible for overseeing compliance and reporting requirements.

3. Legal and Regulatory Compliance

This policy must be implemented in accordance with the legislation, regulations and statutory requirements applicable to adult social care services in England.

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

The following Fundamental Standards are particularly relevant to requesting and obtaining medical support:

• Regulation 9 – Person-centred care: Care and treatment must be appropriate, meet the person’s needs and reflect their preferences. People must be involved, as far as reasonably practicable, in decisions about their care and treatment, including decisions concerning access to medical assessment, treatment and specialist services.
• Regulation 11 – Need for consent: Care and treatment must only be provided with the consent of the relevant person. Where a person aged 16 or over lacks capacity to make the particular decision, staff must act in accordance with the Mental Capacity Act 2005. Consent and capacity must be considered in relation to the specific decision required and must not be assumed solely because of a person’s diagnosis, disability, age or previous decisions.
• Regulation 12 – Safe care and treatment: Care and treatment must be provided safely. Staff must identify and respond appropriately to deterioration or changes in a person’s physical or mental health, assess relevant risks, take reasonably practicable action to reduce those risks and obtain appropriate medical support without avoidable delay. Where responsibility for care and treatment is shared with or transferred to another service or healthcare professional, staff must work with those involved to support timely and safe care planning and continuity of care.
• Regulation 13 – Safeguarding service users from abuse and improper treatment: A failure to obtain necessary medical attention may constitute neglect. Any suspected or actual neglect must be managed in accordance with the service’s safeguarding procedures.
• Regulation 17 – Good governance: Accurate, complete and contemporaneous records must be maintained concerning health concerns, observations, escalation, professional advice, decisions, actions, outcomes and follow-up arrangements. Systems must enable the provider to identify, monitor and manage risks to people’s health, safety and welfare.
• Regulation 18 – Staffing: Staff involved in recognising deterioration, requesting medical assistance, responding to emergencies or implementing healthcare advice must have the appropriate competence, skills, training, support and supervision necessary for the duties they perform.
• Regulation 20 – Duty of candour: Where an incident associated with the provision of care meets the statutory definition of a notifiable safety incident, the registered person must comply with the statutory duty of candour, including the applicable notification, explanation, apology and record-keeping requirements.

Other Relevant Legislation and Requirements

This policy must also be read and implemented in accordance with:

• Mental Capacity Act 2005 and its Code of Practice: Where there is reason to doubt a person’s capacity to make a particular healthcare decision, capacity must be assessed in relation to that specific decision. Where the person lacks capacity, any decision made on their behalf must be made in their best interests and in the least restrictive way, taking account of any valid and applicable advance decision, lasting power of attorney, court-appointed deputy or other lawful authority.
• Care Act 2014: The service must have regard to safeguarding responsibilities, wellbeing and the prevention of abuse and neglect, including neglect arising from a failure to obtain necessary healthcare.
• UK General Data Protection Regulation and Data Protection Act 2018: Health information is special category personal data and must be processed lawfully, fairly and securely. Information must only be shared where there is an appropriate lawful basis and only to the extent necessary for the person’s care, treatment, safeguarding or another lawful purpose.
• Human Rights Act 1998: Decisions concerning medical care, treatment, privacy, family involvement and personal autonomy must respect the person’s applicable human rights.
• Equality Act 2010: Reasonable adjustments must be made where required to enable disabled people to access, understand and participate in healthcare and communication about their health needs.

Staff must also follow applicable current NHS urgent and emergency care arrangements and locally commissioned healthcare pathways.

4. Requesting Medical Support: Step-by-Step Process

4.1. Identifying When to Seek Medical Support

Staff must be trained to recognise signs of illness, deterioration, or medical emergencies.

Non-Emergency (GP or Specialist Referral) Signs:

• Persistent symptoms (e.g., fever, ongoing pain, infections, respiratory issues).
• Deterioration in mobility, cognition, or mental health.
• Unexplained weight loss or nutritional concerns.
• Medication side effects or adverse reactions.
• Routine medical reviews or chronic condition management (e.g., diabetes, heart disease).

Emergency (999 Paramedic) Signs:

• Severe breathing difficulties (e.g., gasping, choking, severe asthma attack).
• Loss of consciousness or unresponsiveness.
• Suspected stroke (FAST test: Facial drooping, Arm weakness, Speech difficulties, Time to call 999).
• Suspected heart attack (chest pain, breathlessness, nausea).
• Severe bleeding or trauma.
• Acute confusion, seizures, or severe allergic reactions (anaphylaxis).

4.2. Requesting GP Support for Non-Urgent Medical Needs

Where a person requires medical assessment or advice but their condition is not immediately life-threatening or otherwise appropriate for an urgent emergency response, staff must contact the person’s GP practice or other appropriate primary care service without avoidable delay.

Before contacting the GP, staff must, so far as it is safe and practicable to do so:

• identify the reason for the request;
• obtain relevant observations appropriate to the person’s condition and the competence of the member of staff;
• identify changes from the person’s normal presentation or baseline;
• review relevant care plans, clinical information, known diagnoses, allergies and current medicines;
• establish when the symptoms or changes first occurred and whether they are worsening; and
• identify any relevant advance care plan, emergency healthcare plan or other clinical instruction.

The GP practice may be contacted by telephone or through an approved local NHS or GP digital consultation system where this is appropriate to the person’s needs and the urgency of the concern.

Information provided to the GP must be accurate, relevant and sufficient to enable an appropriate clinical decision. Staff must clearly describe any deterioration or change from the person’s normal condition.

The advice, treatment plan, prescription, referral or other instruction given by the GP or other healthcare professional must be recorded promptly and communicated to relevant staff.

Any required changes to the person’s care plan, risk assessment or monitoring arrangements must be made without avoidable delay.

Where a GP response, visit or review is expected, staff must continue to monitor the person’s condition. If the person’s condition deteriorates, the original escalation pathway must be reconsidered immediately and staff must seek more urgent medical assistance, including NHS 111 or 999 where indicated. Staff must not continue waiting for a routine GP response where the person’s condition has become urgent or life-threatening.

4.3. Contacting NHS 111 for Urgent Medical Advice

NHS 111 must be considered where a person requires urgent medical help or advice but the situation does not appear to be immediately life-threatening, or where staff are uncertain which urgent healthcare service is appropriate.

Staff must not delay contacting NHS 111 solely because a nurse, manager or senior member of staff is not immediately available.

The member of staff making the call must provide accurate information and have relevant care records available wherever practicable. This should include:

• the person’s name, date of birth and current location;
• the presenting concern and relevant symptoms;
• when the symptoms or deterioration began;
• relevant observations and changes from the person’s normal presentation;
• known medical conditions;
• current medicines and known allergies where relevant;
• relevant recent treatment or healthcare contact;
• any relevant advance care plan or emergency healthcare plan; and
• any communication needs or reasonable adjustments required.

Staff must follow the advice provided by NHS 111 and accurately document the advice, actions required, responsible person and any timescale for review or follow-up.

Where NHS 111 advises that an ambulance, urgent clinical review or another healthcare service is required, staff must facilitate this without avoidable delay.

If the person’s condition worsens while awaiting a call-back, clinical review or other service, staff must reassess the situation immediately. Where the condition becomes life-threatening, staff must call 999.

4.4. Calling Emergency Services – 999

Where a person appears to have a life-threatening illness or injury, staff must call 999 immediately. Seeking approval from a manager, family member, GP or other person must not delay the emergency call.

Examples include, but are not limited to:

• severe breathing difficulty or inability to breathe normally;
• choking with severe airway obstruction;
• loss of consciousness or unresponsiveness;
• suspected cardiac arrest;
• suspected stroke;
• suspected heart attack;
• severe or uncontrolled bleeding;
• severe trauma;
• prolonged or otherwise serious seizure activity;
• severe allergic reaction or suspected anaphylaxis; or
• any other presentation that appears immediately life-threatening.

When calling 999, staff must provide the information requested by the emergency call handler, including the care home’s location, the person’s condition and relevant information available about the person.

Staff must follow instructions provided by the emergency call handler.

Pending the arrival of emergency services, staff must:

• remain with the person where safe and practicable;
• provide first aid, cardiopulmonary resuscitation or other emergency assistance within their training and competence and in accordance with emergency service instructions;
• continue to observe the person’s condition;
• call 999 again if the person’s condition or circumstances materially change;
• ensure ambulance staff can gain prompt access to the premises;
• make relevant care records, medicines information and clinical documentation available to the ambulance clinicians; and
• ensure any required reasonable adjustments or communication needs are communicated to the attending clinicians.

Relevant advance care planning documentation, including any emergency healthcare plan, Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) recommendation, valid and applicable advance decision to refuse treatment, or decision made by a person holding relevant legal authority, must be identified and made available to the attending healthcare professionals where applicable.

A Do Not Attempt Cardiopulmonary Resuscitation decision applies to cardiopulmonary resuscitation and must not be interpreted as an instruction to withhold other clinically appropriate assessment, treatment or emergency assistance.

The registered manager, person in charge or other designated senior person must be informed of the emergency as soon as reasonably practicable, but this must not delay emergency treatment.

Relatives, next of kin or representatives must be informed in accordance with the person’s wishes, confidentiality requirements, capacity and any lawful authority held by the representative. Staff must not assume that a person described as “next of kin” automatically has legal authority to make healthcare decisions on behalf of the person.

The emergency, observations, escalation, advice received, actions taken, persons informed and outcome must be recorded promptly in the person’s care record.

4.5. Referrals to Specialist and Community Health Services

Where a person requires assessment, treatment or advice from a specialist or community healthcare service, staff must follow the relevant NHS or locally commissioned referral pathway.

Services may include, according to the person’s assessed needs:

• tissue viability services;
• community nursing services;
• mental health services and crisis services;
• palliative and end-of-life care services;
• falls prevention or falls assessment services;
• speech and language therapy;
• dietetic services;
• physiotherapy;
• occupational therapy; and
• other specialist health services.

The referral must contain accurate and relevant information about the person’s needs, current condition, risks and the reason for referral.

The person’s consent must be obtained where they have capacity to make the relevant decision. Where the person lacks capacity, staff must act in accordance with the Mental Capacity Act 2005 and any relevant lawful decision-making authority.

All referrals must be recorded and tracked until an appropriate outcome has been confirmed.

Staff must not regard submission of a referral as completion of the process. Where a response is not received within the expected timeframe, or where the person’s health needs change or deteriorate while awaiting assessment, staff must follow up or escalate the referral as appropriate.

Advice and recommendations received from specialist services must be recorded, communicated to relevant staff and incorporated into the person’s care plan, risk assessment and support arrangements where applicable.

Where care is shared between the care home and external healthcare professionals, the service must ensure that responsibilities, monitoring arrangements, follow-up actions and escalation requirements are understood and documented.

4.6. Consent, Mental Capacity and Refusal of Medical Support

A person who has capacity to make a particular healthcare decision has the right to make that decision, including the right to accept or refuse medical assessment, treatment or referral, even where staff or others consider the decision unwise.

Staff must provide information and support in a way the person can understand and must make reasonable adjustments to support the person to participate in the decision.

A person’s capacity must not be assumed to be lacking because of their age, appearance, diagnosis, dementia, learning disability, mental health condition, communication difficulty or because they make a decision that others consider unwise.

Where there is reason to doubt whether the person has capacity to make the specific decision required at that time, an appropriate mental capacity assessment must be undertaken and recorded in accordance with the Mental Capacity Act 2005.

Where the person lacks capacity to make the relevant decision, any decision made on their behalf must:

• be made in their best interests;
• take account of the person’s past and present wishes, feelings, beliefs and values;
• involve relevant people who should properly be consulted;
• consider whether the required outcome can be achieved in a less restrictive way; and
• take account of any valid and applicable advance decision to refuse treatment, health and welfare lasting power of attorney, court-appointed deputy or applicable court decision.

A relative or person identified as “next of kin” does not automatically have legal authority to consent to or refuse medical treatment on behalf of an adult who lacks capacity.

Where a person with capacity refuses recommended medical assessment or treatment, staff must record the refusal, the information provided to the person and any advice obtained from an appropriate healthcare professional. Staff must continue to provide appropriate care and monitoring and must seek further clinical advice where the person’s condition changes.

Nothing in this section prevents staff from calling 999 or seeking emergency clinical assistance where this is necessary. Decisions regarding emergency care and treatment must be made in accordance with the applicable legal framework, the person’s capacity, any valid advance decision and any person with relevant lawful authority.

5. Documenting and Communicating Medical Requests

5.1. Accurate Record-Keeping

All concerns about a person’s physical or mental health, requests for medical assistance and subsequent actions must be documented accurately, completely and contemporaneously in the person’s care record.

The record must include, where applicable:

• the date and time the concern was first identified;
• the nature of the symptoms, signs or change in condition;
• relevant observations and changes from the person’s normal presentation;
• any immediate action taken;
• the date and time medical assistance was requested;
• the service or healthcare professional contacted;
• the name or role of the healthcare professional where available;
• information provided to the healthcare professional;
• advice, treatment, prescription, referral or instruction received;
• whether the person consented to the proposed action;
• any relevant mental capacity assessment or best-interests decision;
• any refusal of assessment or treatment and action taken in response;
• any escalation or repeat contact required;
• details of transfer to hospital or another healthcare service where applicable;
• information shared with relatives or representatives and the basis for doing so where relevant;
• changes made to the person’s care plan, risk assessment or monitoring arrangements;
• outstanding actions, the person responsible for completing them and the required timescale; and
• the outcome and any subsequent follow-up.

Records must be accurate, secure and accessible to authorised staff who require the information to provide safe care.

Records and information-sharing must comply with Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, the UK GDPR and the Data Protection Act 2018.

5.2. Informing Relatives, Next of Kin and Legal Representatives

Information about a person’s health and medical care is confidential and must only be shared where there is an appropriate lawful basis.

Where the person has capacity, staff must have regard to the person’s wishes regarding who should be informed about their health, medical appointments, treatment or transfer to hospital.

The person’s recorded communication preferences and consent regarding involvement of relatives or representatives must be followed unless there is a lawful reason to depart from them.

The term “next of kin” does not in itself give a relative or other person legal authority to receive confidential information or make healthcare decisions on behalf of an adult.

Where the person lacks capacity to make the relevant decision, staff must act in accordance with the Mental Capacity Act 2005 and involve appropriate persons as part of the best-interests decision-making process where required.

Where a person holds a valid health and welfare lasting power of attorney, is a court-appointed deputy with relevant authority, or otherwise has lawful authority in relation to the particular decision, their legal authority must be verified and respected within its lawful scope.

Information may also be shared without consent where there is another lawful basis for doing so, including where sharing is necessary to protect the person’s vital interests, meet safeguarding obligations or comply with another legal requirement. Only information that is necessary and proportionate for the purpose must be shared.

The person’s care records must identify, where applicable, who was informed, what information was shared, when it was shared and any relevant authority, consent or other lawful basis for sharing.

6. Staff Training and Responsibilities

6.1. Staff Training and Competence in Medical Escalation

Staff must receive training, support, supervision and competency assessment appropriate to their role and responsibilities in relation to recognising and responding to changes in people’s health.

Training and competency requirements must include, where relevant to the staff member’s role:

• recognising deterioration or significant changes in physical or mental health;
• recognising medical emergencies and knowing when to call 999;
• knowing when and how to contact the GP, NHS 111 and other healthcare services;
• obtaining, recording and communicating relevant observations within the staff member’s competence;
• communicating effectively with healthcare professionals;
• consent and the Mental Capacity Act 2005;
• relevant emergency and first-aid procedures;
• cardiopulmonary resuscitation where required for the staff member’s role;
• understanding relevant advance care planning documentation;
• accurate record-keeping and information-sharing; and
• following local escalation and referral pathways.

Staff must not undertake clinical observations, assessments, treatment or delegated healthcare activities unless they have received the appropriate training and have been assessed as competent where competency assessment is required.

The registered provider must ensure that sufficient competent staff are available to respond appropriately to deterioration and medical emergencies.

Training must be refreshed at intervals determined by applicable legislation, recognised training requirements, risk assessment, competency assessment, changes to guidance and the needs of people using the service.

Where a competency concern is identified, appropriate action must be taken before the staff member undertakes the relevant task without the required support or supervision.

6.2. Role of Managers in Medical Support Requests

The registered manager or delegated responsible manager must ensure that effective arrangements are in place for people to obtain appropriate medical assessment, advice and treatment without avoidable delay.

Management responsibilities include:

• ensuring staff understand and follow the service’s escalation pathways;
• ensuring staff have access to up-to-date contact details and locally commissioned healthcare pathways;
• ensuring sufficient suitably trained and competent staff are available;
• ensuring staff know how to respond to deterioration and medical emergencies;
• ensuring concerns regarding delayed or unsuccessful access to healthcare are escalated appropriately;
• ensuring referrals and outstanding healthcare actions are monitored to completion;
• ensuring medical advice and changes to treatment are incorporated into care plans and risk assessments where required;
• monitoring the quality and completeness of records relating to medical escalation;
• reviewing incidents, delays, failures to escalate and adverse outcomes;
• identifying patterns, themes and learning from incidents and near misses;
• implementing and monitoring corrective actions where concerns are identified;
• ensuring safeguarding procedures are followed where a failure to obtain appropriate healthcare may amount to neglect; and
• ensuring the statutory duty of candour is considered and applied where a notifiable safety incident has occurred.

7. Monitoring and Compliance

The registered manager must maintain effective oversight of compliance with this policy and must take action where concerns are identified.

Monitoring must include, at a frequency proportionate to the size and risks of the service:

• review of medical escalation records;
• review of delays in obtaining medical assessment or treatment;
• review of emergency ambulance calls and transfers to hospital;
• review of referrals that remain outstanding or require follow-up;
• review of incidents in which deterioration was not identified or escalated appropriately;
• review of staff training and competency requirements;
• review of relevant safeguarding concerns, incidents, complaints and feedback; and
• confirmation that required actions arising from healthcare professional advice have been completed.

Where audits or reviews identify omissions, repeated delays, unsafe practice or other concerns, the registered manager must identify the cause, implement appropriate corrective action and monitor whether the action has been effective.

Learning from incidents, complaints, safeguarding concerns, healthcare professionals, people using the service and their representatives must be used to improve medical escalation arrangements.

The service must be able to demonstrate to CQC that it has effective systems for identifying and managing deterioration, responding to emergencies, making and following up referrals, supporting safe transitions between services and ensuring continuity of care.

8. Related Policies

• CH11 – Safe Care and Treatment Policy​.
• CH13 – Safeguarding Adults from Abuse and Improper Treatment Policy​.
• CH17 – Infection Prevention and Control Policy​.

9. Policy Review

This policy will be reviewed annually or sooner if CQC regulations, NHS guidelines, or operational needs change.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
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