It is your legal duty as a physiotherapist, support worker or student to provide a ‘reasonable’ standard of care to patients and to protect their safety.
In the same way as the HCPC and CSP code and standards are applicable in all settings, so too are the principles of duty of care. It is important that CSP members understand the principles of duty of care and how they can meet their own duty of care obligations.
Duty of care FAQ
What is meant by duty of care?
A duty of care is a legal duty to provide a reasonable standard of care to your patients. 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. A duty of care is owed by all healthcare professionals and is not optional.
When is a duty of care created?
In the context of physiotherapy, a duty of care is created as soon as a referral is accepted for advice and/or treatment. This may be when a referral is individually triaged before placing on a waiting list, when an appointment is created or a patient and therapist commence one-to-one contact, either in person or virtually.
Can I use a disclaimer to avoid being held accountable?
No. A duty of care is not optional. Your professional obligation requires the use of reasonable skill in providing advice and/or treatment to patients and you cannot deflect this responsibility. Patients cannot be asked to participate in treatment programmes ‘at their own risk’; nor can you delegate your duty of care to another person.
Does this mean I must provide the best evidence-based intervention at all times?
No. The law does not require 'the best' care to be provided. A reasonable standard can be described as the standard expected of an individual according to their skills, job role and responsibilities. What would be deemed reasonable for an experienced staff member would therefore, be different to that of a less experienced practitioner.
We have a very long waiting list, do I have a duty of care to those on the waiting list?
The organisation you work for has a duty of care toward all those it has accepted for care, including those on a waiting list. The law acknowledges that services can only be provided within the limits of available resources. Excessively long patient waits for treatment may constitute a breach of the organisation’s duty of care, especially if the delay causes an exacerbation or deterioration in the patient’s condition. Robust referral and monitoring pathways should be in place to assure the screening, triage, prioritisation and management of referrals.
We screen our referrals and prioritise accordingly. When does my duty of care start?
On receipt of a referral, whether self-referral, from another clinician, or via a ward-based blanket referral system, a physiotherapist has a duty of care to assess the priority and suitability of the referral. If the referral is deemed appropriate, then the duty to provide a reasonable standard of care commences, including not waiting an excessively long period for assessment and treatment.
If the received referral has insufficient information to allow waiting list and prioritisation decisions to be made, the physiotherapist is responsible for seeking additional information.
If a triage system is not in operation and a referral is accepted and placed directly onto a waiting list, the organisation holds a duty of care for the patient until individual physiotherapy care is commenced.
If I contact a patient during triage to seek clarity and I provide advice prior to adding the patient to the waiting list, do I have a duty of care?
Yes. If a triage physiotherapist contacts a patient to ask further information about the patient’s condition, a duty of care is created between the patient and the physiotherapist. The duty would be maintained by the triage physiotherapist until the patient is transferred to another physiotherapist for assessment and further care.
We have patient information leaflets on our website and in our waiting rooms. If a patient follows this advice do I create a duty of care?
Where information is provided to a person that is freely accessible via website or books and it is not added to in any way as a result of an individual assessment, then a duty of care is not likely to have been established. The advice must be reviewed regularly to ensure that it is accurate and up to date and a statement advising that there is no intention for this general advice to be a substitute for additional professional advice given as part of individualised and tailored care.
Rather than fully discharge a patient I may leave it open for them to contact me, should they need. Could this be a problem?
Yes. During this period, the physiotherapist still retains a duty of care to the patient.
It may be unwise to keep a patient’s case open for longer than is clinically indicated. Once an active problem has been managed according to the initial plan, the patient should be discharged and communication provided to the referrer and patient relating to local procedures for referral.