DC128-Requesting Medical Support: GP, Paramedic, and Specialist Services Policy

Registration Number: {{org_field_registration_no}}

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

1. Introduction and Purpose

{{org_field_name}} is committed to ensuring the health, safety, and well-being of all service users. This policy outlines the procedures for requesting medical support from General Practitioners (GPs), paramedics, and specialist services when a service user’s health condition requires professional medical intervention. It ensures compliance with the Health and Social Care Act 2008, the Care Act 2014, and CQC regulations regarding safe care and treatment.

This policy supports compliance with the Health and Social Care Act 2008, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, the Care Quality Commission (Registration) Regulations 2009, the Care Act 2014, the Mental Capacity Act 2005, the Human Rights Act 1998, the Equality Act 2010, the Data Protection Act 2018 and UK GDPR. It should be read alongside the organisation’s policies on Safeguarding Adults, Medication Management, Mental Capacity and Consent, Duty of Candour, Incident Reporting, Infection Prevention and Control, Record Keeping, Confidentiality and Data Protection, Complaints, End of Life Care and Business Continuity.

The policy reflects the CQC Fundamental Standards and the CQC Single Assessment Framework, including the key questions of whether care is safe, effective, caring, responsive and well-led. It is particularly relevant to Regulation 9, person-centred care; Regulation 10, dignity and respect; Regulation 11, need for consent; Regulation 12, safe care and treatment; Regulation 13, safeguarding service users from abuse and improper treatment; Regulation 16, receiving and acting on complaints; Regulation 17, good governance; Regulation 18, staffing; Regulation 19, fit and proper persons employed; and Regulation 20, duty of candour.

2. Scope of the Policy

This policy applies to all staff involved in the provision, management or oversight of domiciliary care services, including care workers, senior care workers, supervisors, coordinators, office staff, on-call staff, agency workers, volunteers, the registered manager, nominated individual and provider representatives.

It applies whenever a service user appears to require medical advice, review, assessment, emergency treatment, specialist referral or follow-up from a healthcare professional. This includes support requested from GPs, NHS 111, out-of-hours GP services, community nursing teams, paramedics, ambulance services, mental health crisis teams, palliative care teams, pharmacists, specialist clinics, hospital discharge teams and other health or social care professionals.

This policy applies in the service user’s own home, supported living environments, community settings and any other location where staff are providing care or support on behalf of {{org_field_name}}.

2.1 Key Principles

Staff must act promptly, proportionately and in the best interests of the service user when a health concern is identified. Staff must not attempt to diagnose medical conditions, but they must recognise signs of deterioration, seek appropriate medical advice, escalate concerns and follow instructions from healthcare professionals.

Staff must always consider whether the situation is an emergency, urgent but not immediately life-threatening, or non-urgent. Where there is any doubt about immediate risk to life, serious injury, stroke, heart attack, severe breathing difficulty, sepsis, severe allergic reaction, uncontrolled bleeding, sudden collapse or any other serious deterioration, staff must call 999 without delay.

Care must be person-centred and must take account of the service user’s known health conditions, communication needs, mental capacity, wishes, preferences, advance decisions, ReSPECT plan, DNACPR decision, end of life care plan, cultural needs and any reasonable adjustments required because of disability, autism, learning disability, sensory impairment or language needs.

Staff must record all concerns, decisions, contacts, advice received, actions taken, outcomes and follow-up requirements in the service user’s care record as soon as practicable and before the end of the shift unless an emergency prevents this.

3. Identifying the Need for Medical Support

Staff are trained to identify and respond to early signs of health deterioration, including but not limited to:

breathing difficulties, shortness of breath, wheezing, choking, aspiration risk or blue lips;
chest pain, palpitations, suspected heart attack or sudden severe pain;
possible stroke symptoms, including facial drooping, arm weakness, speech difficulty, sudden confusion, loss of balance or sudden visual changes;
signs of sepsis or serious infection, including high or low temperature, shivering, clammy or mottled skin, new confusion, rapid breathing, reduced urine output, severe pain or feeling very unwell;
falls, head injury, suspected fracture, loss of consciousness, new mobility problems or unexplained bruising;
sudden or significant changes in mental state, including confusion, agitation, delirium, hallucinations, withdrawal or unusual behaviour;
mental health crisis, suicidal thoughts, self-neglect, severe anxiety, psychosis or risk of harm to self or others;
medication concerns, including missed doses, overdose, adverse reactions, side effects, allergy, incorrect administration or concerns about controlled drugs;
diabetes-related concerns, including suspected hypoglycaemia, hyperglycaemia, excessive thirst, drowsiness, confusion or changes in blood glucose readings where monitoring is part of the care plan;
dehydration, poor food or fluid intake, vomiting, diarrhoea, constipation, swallowing difficulties or sudden weight loss;
skin deterioration, pressure damage, infected wounds, cellulitis, leg ulcers or concerns about dressings;
catheter, stoma or continence concerns, including blocked catheter, reduced urine output, blood in urine or signs of urinary tract infection;
end of life deterioration, uncontrolled pain, breathlessness, agitation, distress or concerns raised by family or palliative care professionals;
any concern raised by the service user, family, unpaid carer, advocate, staff member or visiting professional that suggests the person’s health may be deteriorating

Staff are encouraged to act promptly and escalate concerns when they arise. Regular training ensures that staff can recognise subtle changes that may indicate an underlying health issue.

Staff must use the service user’s care plan, risk assessments, medication records, hospital discharge information, emergency information sheet and known baseline presentation to identify whether the person’s condition has changed. Where available and within the staff member’s training and role, observations such as temperature, pulse, blood pressure, oxygen saturation, respiratory rate, blood glucose, pain score or level of consciousness may be recorded and shared with healthcare professionals. Staff must not undertake clinical observations unless they have been trained and authorised to do so.

3.1 Deciding the Correct Route for Medical Support

Staff must use the following escalation route:

Call 999 immediately where there is an immediate risk to life, serious injury, suspected stroke, suspected heart attack, severe breathing difficulty, severe allergic reaction, uncontrolled bleeding, sudden collapse, suspected sepsis, serious head injury, severe burns, choking, unconsciousness, seizure, or any situation where urgent emergency treatment is required.
Contact the GP or out-of-hours GP service where the concern is medically important but not immediately life-threatening, such as suspected infection, pain, wound deterioration, medication side effects, reduced mobility, constipation, continence concerns, worsening long-term condition or general deterioration.
Contact NHS 111 or NHS 111 online where urgent clinical advice is needed and the GP is unavailable, the concern occurs outside GP opening hours, or staff are unsure which service is most appropriate.
Contact specialist services where the service user is already known to a specialist team and the concern relates to that area of care, for example community nursing, diabetes, mental health crisis, palliative care, falls service, respiratory team, tissue viability, speech and language therapy or occupational therapy.
Escalate to the office, on-call manager or registered manager whenever medical support is requested, refused, delayed, unavailable, or where staff remain concerned despite advice received.

Staff must not delay calling 999 while seeking permission from managers, family members or other professionals where emergency support is required.

4. Requesting GP Support

GP support must be requested when a service user presents with a non-emergency health concern that requires medical advice, review, prescription, referral or monitoring. This may include suspected infection, pain, constipation, deterioration in a long-term condition, medication side effects, reduced appetite or fluid intake, skin deterioration, continence concerns, sleep disturbance, increased confusion or general health decline.

Staff must obtain the service user’s consent before contacting the GP unless the person lacks capacity to make the specific decision or there is an immediate risk that requires urgent action. Where the person may lack capacity, staff must follow the Mental Capacity Act 2005 and the organisation’s Mental Capacity and Consent Policy. The decision, capacity considerations, best-interest rationale and any consultation with family, attorneys, deputies or professionals must be recorded.

When contacting the GP practice, staff must provide clear and relevant information, including:

the service user’s full name, date of birth, address and NHS number if available;
the reason for the request and the specific concern;
when symptoms started and whether they are getting worse;
relevant medical history and known risks from the care plan;
current medication and any recent changes or missed doses;
allergies;
observations taken, where staff are trained and authorised to take them;
changes from the person’s normal presentation;
whether the person has fallen, sustained an injury or been admitted to hospital recently;
any ReSPECT plan, advance decision, DNACPR decision or end of life care plan known to staff;
what support the organisation is requesting, such as call back, appointment, home visit, prescription, referral or urgent review.

Staff must document the date, time, method of contact, name and role of the person spoken to, information provided, advice received, agreed actions, expected timescales and any follow-up required.

If the GP practice advises that the concern should be managed through NHS 111, urgent treatment centre, emergency department, community service or 999, staff must follow that advice and inform the office, on-call manager or registered manager.

If the GP practice does not respond within the expected timeframe, or if the service user’s condition deteriorates while waiting, staff must escalate to NHS 111, the out-of-hours GP service, 999 or the registered manager as appropriate. Staff must not leave a service user at risk because a call back or appointment is pending.

Where the GP prescribes medication, changes medication or gives treatment advice, staff must ensure the instruction is recorded, communicated to the office and reflected in the care plan and medication records where applicable. Any medication changes must be managed in line with the organisation’s Medication Management Policy.

5. Requesting Emergency or Paramedic Support

Emergency support must be requested by calling 999 immediately where there is an immediate risk to life, serious injury or significant deterioration. Staff may also use 112, but 999 is the primary emergency number in the UK.

Examples of situations requiring emergency support include:

suspected stroke, including facial drooping, arm weakness, speech difficulty or sudden confusion;
suspected heart attack, severe chest pain or unexplained severe upper body pain;
severe breathing difficulty, choking, blue lips or oxygen concerns;
unconsciousness, collapse, seizure or reduced level of consciousness;
suspected sepsis or serious infection with rapid deterioration;
severe allergic reaction or anaphylaxis;
uncontrolled bleeding;
serious fall, suspected fracture, head injury, spinal injury or severe pain after a fall;
severe burns or scalds;
overdose, poisoning or serious medication error;
suicidal intent, serious self-harm or immediate risk of harm to others;
any situation where staff believe urgent emergency treatment is required.

In an emergency, staff must:

call 999 immediately and provide clear information to the emergency operator;
stay with the service user unless it is unsafe to do so;
follow instructions given by the emergency call handler;
provide first aid only within their training and competence;
avoid moving the service user after a fall or injury unless there is an immediate danger, such as fire, flood or environmental risk;
check the care plan for emergency information, allergies, medication, ReSPECT plan, DNACPR decision, advance decision or end of life care plan and share relevant information with paramedics;
notify the office, on-call manager or registered manager as soon as reasonably practicable;
notify next of kin, representative, attorney or advocate where this is agreed in the care plan or is necessary in the circumstances, unless doing so would place the person at risk;
prepare relevant information for ambulance staff, including medication records, care plan, allergies, baseline presentation, recent changes, known risks and contact details;
record the incident, symptoms, actions taken, advice received, ambulance reference number if available, outcome and whether the service user remained at home or was transferred to hospital.

A DNACPR decision must never be interpreted as a decision not to provide treatment, comfort, care, medical review or hospital transfer unless this is clearly stated in a valid advance care plan or ReSPECT plan. Staff must seek urgent clinical advice if there is any uncertainty.

6. Requesting Specialist Services

Specialist medical or clinical support must be sought when a service user requires assessment, treatment, advice or monitoring beyond the role of domiciliary care staff and beyond routine GP support.

Specialist services may include, but are not limited to:

community nursing services for wound care, injections, catheter care, continence concerns, end of life care or chronic disease support;
tissue viability services for pressure damage, leg ulcers, complex wounds or deterioration in skin integrity;
mental health services, crisis teams or dementia support services for psychological distress, crisis, psychosis, suicidal ideation, severe anxiety, delirium or behavioural changes;
palliative care or hospice teams for pain, symptom control, end of life planning or family support;
diabetes, respiratory, cardiac, neurology or falls services where the service user has a relevant long-term condition or risk;
speech and language therapy for swallowing, choking or communication concerns;
occupational therapy or physiotherapy for mobility, transfers, equipment, falls prevention or rehabilitation;
pharmacy services for medication reviews, side effects, interactions, compliance aids or safe medicines use;
hospital discharge, virtual ward, urgent community response or reablement teams where the person is under their care.

Staff must follow the referral route set out in the care plan or local procedure. This may include contacting the GP for referral, contacting a specialist team directly where the service user is already open to that team, or escalating through NHS 111, the local authority, integrated care services or the registered manager.

Staff must ensure the service user understands the reason for the referral and gives consent wherever they have capacity to do so. Where the person lacks capacity, the Mental Capacity Act 2005 must be followed and any best-interest decision must be recorded.

Staff must record the referral request, information provided, consent or best-interest decision, expected response time, advice received, appointments arranged, transport or access support required, and outcome. Care plans and risk assessments must be updated following specialist advice.

7. Communication, Confidentiality and Documentation

Effective communication and accurate documentation are essential to safe care and treatment. Staff must ensure that all requests for medical support are recorded clearly, accurately, securely and contemporaneously in the service user’s care record.

Records must include:

date and time the concern was identified;
who identified or reported the concern;
symptoms, observations and changes from the person’s normal presentation;
relevant risks, medical history, allergies and current medication;
whether consent was obtained or whether a Mental Capacity Act assessment or best-interest decision was required;
who was contacted, including name, role, organisation, telephone number or service route where available;
time and method of contact;
advice or instructions received;
action taken by staff;
whether family, representative, advocate, attorney, deputy, manager or other professionals were informed;
whether a safeguarding concern, statutory notification, incident report or Duty of Candour response was required;
outcome, follow-up actions and any changes required to the care plan or risk assessment.

Staff must share information with healthcare professionals where this is necessary for the provision of safe care and treatment. Information must be shared securely and in accordance with UK GDPR, the Data Protection Act 2018, the Caldicott Principles where applicable, and the organisation’s Confidentiality and Data Protection Policy.

Staff must not use personal phones, unapproved messaging applications or insecure communication channels to share confidential health information unless this has been authorised by the organisation and appropriate safeguards are in place.

The office, senior staff or registered manager must ensure that care plans, risk assessments, medication records and visit notes are updated after any medical advice, hospital attendance, medication change, specialist referral or significant change in the service user’s condition.

8. Follow-Up and Monitoring

After medical support has been requested or provided, staff must continue to monitor the service user in line with the advice received and the care plan. Staff must report any deterioration, new symptoms, missed call backs, delayed appointments, failure of prescribed treatment, medication concerns or unresolved risks to the office, on-call manager or registered manager.

Where a healthcare professional gives advice, staff must confirm whether any action is required by care staff, family, the GP, pharmacy, community nurse, specialist service or emergency service. The responsible person for each action and the expected timescale must be recorded.

If the service user is admitted or transferred to hospital, staff must notify the office or on-call manager as soon as reasonably practicable. The office must consider whether family, representatives, commissioners, social workers or other professionals need to be informed. Relevant care records must be updated to show that the person is in hospital and visits must be amended or suspended safely.

When the service user returns from hospital or urgent care, the office or senior staff must obtain and review discharge information where available, check for medication changes, update the care plan and risk assessments, inform staff of changes before the next visit and arrange any required follow-up with the GP, pharmacy, community nursing team or specialist service.

If staff remain concerned after medical advice has been received, or if the advice does not appear to address the risk, staff must escalate to a senior member of staff, the registered manager, NHS 111, the GP, specialist service or 999 depending on the level of risk.

9. Training and Staff Competency

All staff must receive training appropriate to their role and responsibilities so that they can recognise deterioration, respond to medical concerns, communicate effectively with healthcare professionals, follow emergency procedures and record actions accurately.

Training and competency checks may include:

recognising deterioration and common signs of serious illness;
emergency response, including when to call 999;
falls response and post-fall escalation;
sepsis awareness, stroke awareness and heart attack awareness;
medication awareness and escalation of medication concerns;
safeguarding adults and escalation of abuse or neglect concerns;
Mental Capacity Act 2005, consent and best-interest decision-making;
communication with GPs, NHS 111, paramedics and specialist services;
record keeping, confidentiality, UK GDPR and information sharing;
infection prevention and control;
end of life care, ReSPECT plans, advance decisions and DNACPR awareness where relevant to the service user group;
Duty of Candour and statutory notification requirements;
learning disability and autism training appropriate to the person’s role and in line with the Oliver McGowan Code of Practice.

Staff must not undertake clinical observations, first aid tasks, medication-related tasks or specialist interventions unless they have been trained, assessed as competent and authorised to do so by the organisation.

The registered manager must ensure that training records, competency assessments, supervision notes and refresher training are maintained and reviewed. Where a staff member fails to follow this policy or lacks confidence or competence, additional supervision, retraining or competency assessment must be arranged.

10. Quality Assurance and Continuous Improvement

The registered manager will monitor the effectiveness of this policy through governance systems that assess, monitor and improve the quality and safety of care. This supports CQC Regulation 17, good governance, and the CQC Single Assessment Framework.

Quality assurance activities may include:

audits of medical support requests, GP contacts, 999 calls, NHS 111 contacts and specialist referrals;
review of care records to ensure documentation is accurate, complete, contemporaneous and secure;
review of incidents, accidents, hospital admissions, medication concerns, safeguarding concerns and complaints linked to medical support;
checks that care plans and risk assessments are updated following medical advice, hospital discharge or change in condition;
review of whether CQC statutory notifications were submitted where required;
review of whether Duty of Candour was considered and completed where applicable;
analysis of themes, trends, delays, missed escalation opportunities and learning;
feedback from service users, family members, staff, commissioners and healthcare professionals;
supervision, spot checks and competency reviews where practice concerns are identified.

Learning from audits, incidents, complaints, safeguarding concerns, professional feedback and service user feedback must be shared with staff and used to improve practice. Action plans must identify the responsible person, timescale for completion and evidence of completion.

11. Safeguarding and Escalation

A health concern may also be a safeguarding concern where there is suspected abuse, neglect, self-neglect, acts of omission, medication mismanagement, pressure damage linked to poor care, refusal or obstruction of necessary medical treatment, unexplained injury, repeated avoidable deterioration, failure to seek timely medical support, or any concern that the service user is at risk of harm.

Staff must report safeguarding concerns immediately to the office, on-call manager or registered manager and follow the organisation’s Safeguarding Adults Policy. The registered manager or delegated senior person must consider whether a referral is required to the local authority safeguarding team, commissioner, police, healthcare professional or other relevant agency.

Staff must escalate immediately if:

a service user refuses medical support and appears to lack capacity to understand the risk;
a family member, representative or other person prevents access to necessary medical care;
a health professional’s advice is unclear, delayed or appears insufficient to manage the risk;
the service user deteriorates while waiting for a call back, appointment or visit;
staff believe the person is at immediate risk of serious harm.

Where an incident meets CQC statutory notification criteria, the registered manager must ensure that CQC is notified in accordance with the Care Quality Commission (Registration) Regulations 2009. This may include serious injury, abuse or allegations of abuse, police involvement, events that stop the service running safely and properly, or death of a person using the service.

Where an unintended or unexpected incident occurs during the provision of regulated activity and meets the definition of a notifiable safety incident, the registered person must follow the Duty of Candour procedure, including acting openly and transparently, informing the relevant person as soon as reasonably practicable, providing a truthful account, offering an apology, explaining further enquiries, keeping a written record and providing written follow-up.

12. Duty of Candour

{{org_field_name}} will act in an open and transparent way with service users and relevant persons in relation to care and treatment provided. Where a notifiable safety incident occurs, the registered manager or delegated senior person must ensure that the Duty of Candour procedure is followed in line with Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This includes:

identifying whether the incident meets the threshold for Duty of Candour;
notifying the relevant person as soon as reasonably practicable;
providing a truthful account of what is known at the time;
advising what further enquiries or investigations will take place;
offering a sincere apology;
providing reasonable support;
keeping a written record of all communication;
providing written follow-up where required;
ensuring learning is identified and acted upon.

Duty of Candour must be considered after serious medication errors, delayed escalation, avoidable deterioration, falls, injuries, missed care resulting in harm, failure to follow medical advice or any incident connected with care or treatment that may meet the notifiable safety incident criteria.

13. CQC Statutory Notifications

The registered manager is responsible for ensuring that statutory notifications are submitted to CQC where required by the Care Quality Commission (Registration) Regulations 2009. Staff must promptly report incidents to the office, on-call manager or registered manager so that the need for notification can be assessed.

Events that may require CQC notification include, but are not limited to:

death of a service user where notification criteria are met;
serious injury to a service user;
abuse or allegations of abuse;
incidents reported to or investigated by the police;
events that prevent or may prevent the service from running safely and properly;
unauthorised absence where applicable;
other incidents that affect the health, safety and welfare of people using the service.

The incident record must state whether a CQC notification was considered, whether it was submitted, the date submitted, the person responsible and the notification reference where available.

14. Refusal of Medical Support

A service user with capacity has the right to refuse medical support, including GP contact, NHS 111 advice, ambulance attendance, hospital transfer or specialist referral. Staff must respect the person’s decision where they have capacity to make that specific decision, while ensuring they are given clear information about the risks and alternatives.

If a service user refuses medical support, staff must:

encourage the person to explain their reasons;
provide reassurance and information in a way the person can understand;
consider whether family, an advocate, attorney, deputy, GP, NHS 111 or another professional should be contacted with the person’s consent;
assess whether there is reason to doubt the person’s capacity for the specific decision;
record the refusal, information given, capacity considerations, people consulted and actions taken;
inform the office, on-call manager or registered manager.

If the person appears to lack capacity to understand, retain, weigh or communicate the decision, staff must follow the Mental Capacity Act 2005 and escalate immediately. Where there is serious or immediate risk, staff must seek urgent medical advice or call 999.

15. Advance Care Planning, ReSPECT and DNACPR

Staff must check the care plan for any advance care planning documents, ReSPECT plan, advance decision to refuse treatment, lasting power of attorney, court-appointed deputy, end of life care plan or DNACPR decision before sharing information with healthcare professionals, where it is safe and practicable to do so.

Staff must understand that a DNACPR decision applies only to cardiopulmonary resuscitation. It does not mean “do not treat” and must not prevent staff from seeking medical advice, calling 999, providing comfort, requesting symptom control, arranging hospital transfer or escalating concerns unless this is clearly stated in a valid care plan or advance decision.

Where staff are uncertain about the meaning or validity of any advance care planning document, they must seek advice from the registered manager, GP, palliative care team, NHS 111 or 999 depending on the urgency of the situation.

16. Partnership Working

{{org_field_name}} will work collaboratively with GPs, NHS 111, ambulance services, community nursing teams, pharmacists, hospitals, mental health teams, palliative care services, local authorities, commissioners and other relevant professionals to support safe and joined-up care.

Staff must share relevant information promptly and securely where this is necessary to protect the service user’s health, safety or welfare. The registered manager will seek to resolve communication difficulties, repeated delays, unclear responsibilities or barriers to accessing healthcare through escalation to the relevant service, commissioner, safeguarding team or integrated care route where appropriate.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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