Responsible Clinician and Approved Clinician

Roles

Extending entryExtending entry to other professions to other professions

Introduces Introduces formal approval and re-approvalformal approval and re-approval based based on specific competenceson specific competences

Responsible clinician role distinct from authority to Responsible clinician role distinct from authority to admit for detentionadmit for detention

Significant changesSignificant changes

New rolesNew roles

Responsible Clinicians replace RMOsResponsible Clinicians replace RMOs RCs have overall responsibility after detentionRCs have overall responsibility after detention In order to be a RC must be first an Approved ClinicianIn order to be a RC must be first an Approved Clinician ACs can be medical or non medicalACs can be medical or non medical Non medical AC can come from Psychology, Non medical AC can come from Psychology,

Nursing and OT Nursing and OT To be an AC must have satisfied To be an AC must have satisfied

competency testscompetency tests RCs can come from non medical AC RCs can come from non medical AC

groupgroup Whether a non medical AC should become the RC will depend on Whether a non medical AC should become the RC will depend on ‘the most appropriate expertise is needed to meet the patient’s main ‘the most appropriate expertise is needed to meet the patient’s main treatment needs’ treatment needs’

Authorisation &Training Requirements for Approved Clinicians

Role Training Required

Medic

Professional Qualification + Sec 12

Medic + ApprovedClinician

Professional Qualification + Sec 12 + AC

Non-MedicProfessional Qualification + AC

Initial MedicalAssessment for

Detention

Authorised for

Appointed asResponsible

Clinician

MedicProfessional Qualification

(GP, FME)

Before detention :Only a doctor can assess

and recommend a patient for detention

After detention ; Doctors who are approved clinician

may become the RCOr another professional may take on that role

Functions and Responsibilities of Functions and Responsibilities of Approved CliniciansApproved Clinicians

• Lead responsibilityLead responsibility for patient’s care and for patient’s care and treatmenttreatment

• Only an Only an AC who is section 12 ApprovedAC who is section 12 Approved can can make recommendations for detention in make recommendations for detention in hospital under Sections 2,3,4 hospital under Sections 2,3,4

The Competences of the The Competences of the Approved ClinicianApproved Clinician

Assessment (including assessment and management of Assessment (including assessment and management of risk)risk)Effective communicationEffective communicationImprove quality, equity and cultural diversityImprove quality, equity and cultural diversityCare PlanningCare PlanningLeadership in multidisciplinary team workingLeadership in multidisciplinary team workingTreatmentTreatment

In their application of all the above areas of competence, the In their application of all the above areas of competence, the AC should be influenced and guided by the “Guiding AC should be influenced and guided by the “Guiding Principles”Principles”

Functions and Responsibilities of Functions and Responsibilities of Approved Clinicians re SCTApproved Clinicians re SCT

Recommend and place a patient on Supervised Community Recommend and place a patient on Supervised Community Treatment once satisfied that the relevant criteria are metTreatment once satisfied that the relevant criteria are met(in conjunction with agreement from an AMHP)(in conjunction with agreement from an AMHP)

Renew SCT within the prescribed time scalesRenew SCT within the prescribed time scales

In agreement with an AMHP the RC can impose other conditions In agreement with an AMHP the RC can impose other conditions that are agreed to be necessary or appropriatethat are agreed to be necessary or appropriate

Have the power to recall the patient subject to SCT to hospital if Have the power to recall the patient subject to SCT to hospital if deemed necessarydeemed necessary

Discharge the Community Treatment OrderDischarge the Community Treatment Order

The role is to have overall responsibility for an individual’s care and treatment:

“Every patient must be allocated a responsible clinician, who is the approved clinician with overall responsibility for the patient’s case. Hospital managers should have local protocols in place for allocating responsible clinicians to patients. This is particularly important when patients move between hospitals. A patient’s responsible clinician should be the available approved clinician with the most appropriate expertise to meet the patient’s main treatment needs” (DH, 2007).

Responsible ClinicianResponsible Clinician

Functions and Responsibilities of Functions and Responsibilities of Responsible CliniciansResponsible Clinicians

Responsible Clinician can :Responsible Clinician can :

renew S 3renew S 3

discharge S 3discharge S 3

grant leave for patients subject to section 3grant leave for patients subject to section 3

Hospital Managers Duties in Hospital Managers Duties in respect of Responsible Cliniciansrespect of Responsible Clinicians

• RCs are appointed by Hospital Managers at point of admission to hospital following detention under the MHA

• The suitability of the RC is kept under review by the hospital managers

• Hospital Managers must keep an up to date list of ACs available from which RCs can be appointed to a patient’s care

The following three groups of section 12 doctors will be approved as ACs from 3 November under the provisions of Part 3 of the Directions.

Group 1 Section 12 doctors who have carried out the functions of an RMO in

the 12 month immediately prior to 3 November

• Approval as AC under the transitional arrangements will run until the end of the current section 12 approval. If this is less than 12 months after 3 November, then approval will last 12 months from 3 November.

Transitional arrangementsTransitional arrangements

Group 2

who have been in overall charge of the medical treatment for mental disorder of a person in the 12 months prior to 3 November. Will be approved until Nov 2009

……..expected to complete a course for the initial training of approved clinicians (see paragraph 81) in the first year after 3 November 2008. If the course is completed the doctor will be approved to be an AC under transitional arrangements for a further 2 years from 3 November 2009.

After this further 2 years doctors in this group will need to apply for approval under the general approval arrangements (see paragraph 81). They will not have to complete a course for the initial training of ACs again. They will, of course, have to meet the other requirements of the general approval arrangements(see paragraph 81).

If the course is not completed by 2 November 2009, approval will not be extended under the transitional provisions and will end on 2 November 2009. Doctors in this group who have not completed the training by 2 November 2009 will have to apply to the SHA to be approved as ACs through general approval arrangements (see paragraph 81). They will have to complete a course for the initial training of approved clinicians to be approved under general arrangements as they will not be treated as being an AC in this period. (Direction 14(b) applies)

Group 3

Section 12 doctors who do not fall within groups 1 or 2, but who have been appointed to the post of consultant psychiatrist within the period of 18 months ending on 2 November 2009 (that is 6 months before 3 November 2008 and 1 year after – 3 may 2008 to 3 nov 2009)

Examples

A section 12 approved doctor takes up his first post as a consultant psychiatrist responsible for the care of a patient subject to the provisions of the MH Act in January 2009. He will be treated as approved as an AC until 2 November 2009 without having to have completed a course for the initial training of ACs.

A section 12 approved doctor takes up his first post as a consultant psychiatrist in October 2008, but does not meet the requirements to be treated as an AC under Group 1 or Group 2 because he has not:

• had overall charge of a patient’s care; or • undertake any responsibilities that would fall to an RMO to make;

will be treated as approved as an AC until 2 November 2009 without having to have completed a course for the initial training of ACs.

‘ The Directions (Part 2) directs SHAs to exercise the function of approving persons to act as ACs…….. An SHA shall only approve a person to act as an AC under general approval arrangements if they are satisfied that the person:

• fulfils the professional requirements; • possesses relevant competencies; and • has completed a course for the initial training of ACs in

the 12 months before approval, or, has been approved (or treated as approved under transitional arrangements as they have acted as an RMO) in the past 5 years.