Topic: How to respond when things go wrong
Noted key themes from this chapter in the Professional Practice Guidelines:
- Managing conflict in teams
- Managing conflict with a client
- Supporting a colleague when a complaint has been made
- Transparency and Duty of Candour
- What to do when the client remains unhappy
- Working in multi-professional/multi-agency contexts
The group had wide ranging discussion.
There is a professional ethical standard to “do no harm”. We need to be aware about how to protect vulnerable clients of our services.
We noted that Professor Glenys Parry had developed a toolkit regarding the potential negative consequences of psychological treatment. This may include clients feeling worse (temporarily) in sessions or at the end of treatment. This may lead to complaints.
Issues were raised about variable access to supervision. Everyone had clinical supervision but there could be uncertainty about whether one’s supervisor would “stand up to be counted” in a conflictual or litigious situation. We noted that in independent practice, there was generally little or no access to the formal management and complaint investigation processes which would be present in public or private sector corporate bodies.
Discussants noted that details of the complaint against the practitioner appear publicly on the HCPC website and only removed if the complaint is not upheld.
Some independent practitioners undertake agency work, and again the liabilities and procedures can be unclear or potentially unfair to practitioners.
Independent practitioners may over-claim their expertise and this led to some discussion about psychologist not being a protected title and confusion about this by the general public. There is a duty to colleagues and the public to act on issues regarding fitness to practise and to address limits to expertise.
In terms of fitness to practise, recognition of burnout, illness and stress issues may be less transparent and more complex to address for independent practitioners.
A colleague noted that the Supreme Court (Montgomery v. Lanarkshire) 2015 had ruled recently in terms of the requirement to obtain informed consent for any treatment. This includes information about potential risk of harm from intervention and information about alternative approaches, enabling an individual to make an informed decision. This overrides the Bolam Test of “what any competent practitioner in one’s profession might do/have done”. Delegates were unaware of this and it underscored the need to remain vigilant regarding developing case law in this area.
Discussants felt there was a lack of expert clinicians as an independent reference group and the perception that medical practitioners had an effective trade union in the British Medical Association, which was lacking for psychologists. Some felt there may be a role for the BPS or the ACP (Association of Clinical Psychologists) or similar bodies for other applied psychologists to provide some scrutiny or external validation of practice issues. The HCPC could not fulfil this function as it is a regulatory body. It was important that practice was evaluated by someone from the same professional background and who understood all the complex issues.
We noted that independent practitioners should have a clear statement regarding complaints procedure within their terms and conditions and there were legal obligations set by the Information Commissioners Office (ICO) e.g. regarding GDPR and information governance.
Independent practitioners could be encouraged to share their policies, Ts & Cs etc.
One discussant mentioned a mediation offer where his organisation would undertake to fund 50% of mediation costs where a client was unhappy with the service.
Routine use of client feedback can be useful in identifying issues before they become complaints and can be positive in shaping best practice.
Provision of leaflets/information about client’s rights to complain and details of the professional body /accreditations etc is an ICO requirement.
We need to be careful regarding record keeping and recognise that there has been a recent increase in investigation of historical abuse wherein legal processes may request access to old notes etc.
It was not always clear how independent practitioners can access child or adult safeguarding teams, usually led by the Local Authority and/or NHS Trusts. It can be hard to know who to go to for advice.
When complaints are made there can be complex issues for the practitioner being complained against of shame or lack of trust that the complaint will be fairly heard or understood by HCPC/regulatory bodies. This could be attenuated if investigation is conducted by a competent person from one’s own profession.
More could be done within the independent practitioner network to support colleagues who are subject to a complaint.
Supervisors can provide ethical advice but this might be variable – particularly within the independent sector.
People generally had had favourable experiences with lawyers funded via their professional insurance, although complaints could be protracted before reaching resolution and the process was highly stressful.
- Billing data – for tax purposes (7 yrs)
- Client data
- Hard to keep short/simple
- ICO has toolkit online
- IP in organisation – who is responsible for data?
- Keep up to date? – data maintenance
- Keep summary report for minimum time
- PRVIACY NOTICE – Rationale for keeping
- Retention and destruction
- Securely disposed of
- Potential legal action within 7 years
- Register as data controller (implications)
Topic: Representation and Status of Psychologists and their Qualifications
- Choice for PUBLIC – how do different applied psychologists describe themselves and where?
- Following a recognised training route – issues and time
- “Formal” websites; informal discussions
- Wanting to practice and recognised pathways to the BPS Applied Psychology routes – to the HCPC; also becoming HCPC registered
- What does status mean and to whom?
- The use of the word “Consultant” – meaning in the NHS and not in the NHS
- The use of the word “expert” – criteria for this in legal settings