Care or responsibility? The role of a GP supervisor

Jul 9, 2018

As a supervisor, am I legally liable if my registrar makes a mistake?

While modern medicine may be a team sport, it’s also important that each of us understand our roles and responsibilities in delivering patient care. Unfortunately the question of responsibility also comes to the fore when something goes wrong. The much-discussed case involving Dr Bawa-Garba prompted comment about the responsibility and liability that should attach to a trainee’s supervisor in that situation.

Being a GP supervisor is a wonderful opportunity to contribute to the development of competent GP registrars who are equipped to provide safe and appropriate patient care. Providing effective supervision is also one of the best ways of protecting both you and your registrar against things going wrong.

Leading by example

It is important to set up a learning environment from the start. GP registrars need to feel comfortable discussing any matters of concern with their supervisors at the practice. You can encourage them to do this by making it clear your practice is one where all the doctors in the practice share their concerns and seek help from each other with the difficult situations GPs face frequently.

Making time for and encouraging them to ask questions, as well as reviewing records regularly to help registrars learn what matters require discussion are important steps towards establishing an open learning environment.

You may need to spell out that ‘no question is too silly and we would rather you ask, than guess’. You may also need to be clear that you want to hear about the complex or emotionally charged consultations, even if they would rather forget about them and move on.

As a supervisor you can make it clear that asking good questions is a skill in itself. By teaching the registrars to think and frame their questions carefully to ensure the key issues of uncertainty are identified, you can help them to develop this skill, and improve the quality of your supervision sessions.

This is a learning zone

It is in the best interests of practices and their doctors to inform patients that GP registrars are training and under supervision at their practice, so they can make a conscious decision about who they see for treatment. Signage indicating the practice is an accredited training practice and who the GP registrars are, is one way of informing patients of this. It can also be noted in practice brochures, online booking tool, or on the practice’s website or Facebook page.

It is also a good idea to let patients know that if they are unhappy with the advice or care they have received from a registrar, they can contact one of the GPs at the practice to review the matter. This is an opportunity for the GP to provide the registrar with constructive feedback and address any patient care issues before they escalate into a formal complaint or claim.

Being an effective supervisor

To ensure you are effectively supervising and supporting your registrars, here are some other tips from Avant’s senior medical advisors:

  • don’t assume GP registrars know and understand common GP tasks and skills
  • assess your GP registrar’s skills and experience early into their term and often throughout it
  • identify procedures they can and cannot perform
  • implement a level of supervision commensurate with their skills and experience
  • put in place an individualised learning plan, regularly assess their progress and provide feedback
  • have a system in place to identify and address errors – inform GP registrars of this system and encourage open disclosure
  • keep good records of the training provided and address any gaps immediately.

What if something goes wrong?

Registrars have substantial autonomy and are expected to exercise their judgement in determining the best course of management for patients. GP supervisors play an important role in assessing a registrar’s level of competence, setting appropriate boundaries, and ensuring an environment where the registrar is comfortable to seek advice when an issue is beyond their experience or expertise.

GP registrars usually see and advise patients independently and, to a degree, determine when they seek assistance from a supervisor. Therefore, GP supervisors cannot be responsible or liable for every decision a registrar makes.

However, the practice is required to provide an adequate standard of care to patients and this extends to the supervision and training of GP registrars.

A GP supervisor (or the practice) may be brought into a claim or complaint if:

  • the registrar sought clinical advice from their supervisor and relied on it, to the patient’s detriment – in this case the supervisor is responsible for his/her contribution to the patient’s care in the same way as if they had treated the patient
  • the patient or registrar alleged the supervisor or practice provided insufficient training or support for the registrar.

Liability may extend to any doctor in the practice who supervised the GP registrar (to the extent they relied upon the doctor’s advice to treat the patient), not just the formally appointed supervisor. Although it is more likely that formal supervisors will be involved in a claim or complaint as they have regular contact with the registrar.

If a complaint or claim does arise and you believe you may be brought into it, contact our Medico-legal Advisory Service at nca@avant.org.au or call 1800 128 268 for expert advice, 24/7 in emergencies.

Key learnings


  • Be aware of your responsibilities as a GP supervisor and take action to address these responsibilities.
  • Provide support and supervision commensurate to your registrar’s level of experience and skills, and establish a tailored learning plan to facilitate the registrar’s professional development.
  • Foster an open communication environment and provide frequent, constructive feedback.
  • Make sure you inform patients that registrars are training at your practice.

Resources

Complete our webinar, Clinical supervision at the point of care:issues and insights, for more insights about supervising trainees and guidance on how to manage potential issues that may arise.

http://gpsupervisorsaustralia.org.au/frequently-asked-questions-more/

http://www.agpt.com.au/GP-supervisors