Duty of care: what is reasonable?

Within our profession we come across the term ‘duty of care’ all too often. But, do we know what it really means and do we think about it enough to really understand what is a reasonable standard of care?

Duty of Care

Acceptability within duty of care 

Within our CSP guidance, duty of care is explained as ‘a legal duty to provide a reasonable standard of care to your patients and to act in ways that protect their safety. A duty of care exists when it could reasonably be expected that a person’s actions, or failure to act, might cause injury to another person’. 

What is reasonable and what is not?  

A duty of care is created once a patient or client is accepted, or a referral is accepted by the physiotherapist. This cannot be delegated to another professional and therefore if a reasonable standard of care has not been met by the professional, this would be deemed as a breach of duty of care. But what is meant by a reasonable standard of care?  A reasonable standard of care is defined as ‘care that would be accepted as proper by a responsible body of practitioners’.

Physiotherapists work in a variety of settings so the accepted reasonable standard of care will vary depend on the clinical speciality and context of care. It will also vary depending on an individual’s skills, job role and responsibilities. There must be an evidence base to support the care provided. This does not need to be large, but it does need to withstand logical analysis.

Similarly, we should also be using our professional judgement to identify, and call out, when this standard of care cannot be offered, regardless of the reason. There should be the ability to communicate any concerns regarding poor practice, service restrictions, re-design or excessive workloads because of the potential risk to patients, employees or the public. 

In the current climate, there have been member concerns regarding the inability to treat all the referred patients or provide the best possible care, due to factors such as workforce shortages and staff sickness. The law doesn’t require ‘the best’ care to be provided but it does require a ‘reasonable standard’ at all times. It is therefore important to escalate concerns through your organisations’ reporting channels if you are not able to offer a reasonable standard of care and keep a record of the concerns raised. 

Raising concerns

As a profession, we are well placed to take the lead in discussions about what a reasonable standard of care should look like, regardless of our role or level of practice. What care we offer, to which patients, should not be dictated to us but based on clinical need, service specification and evidence base. We have the freedom to raise concerns and potentially escalate issues which are putting our ability to deliver reasonable standards of care to our patients at risk. 

Our call to action 

The current healthcare landscape and the associated challenges faced by members across sectors, specialities, regions and countries are widespread. With rapid changes in national recommendations for physiotherapy provision and workforce challenges, our profession is continually being asked to provide more for less. At times, this will feel as if we may be compromising patient care. These challenging circumstances must not affect our responsibilities as autonomous practitioners to use our professional skills and judgement to provide a reasonable standard of care. We remain accountable for our actions and omissions with patients. Remember, duty of care cannot be absolved or delegated.

With this in mind, ask yourself the following:

  • should we accept being told what patients to see (or not to see), when, and how? 
  • or should we stand up, start by understanding the underlying problems and start conversations about alternative solutions to maintain and raise standards of care.  

    Professional Advice team

    The CSP’s Professional Advice Service gives advice and support to members on complex and specialist enquiries about physiotherapy practice, including professional practice issues, standards, values and behaviours, international working, service design and commissioning, and policy in practice.

    Rachael Wadlow and Julie Blackburn are CSP professional advisers

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