28 March 2014
Section 230 (1) states that as soon as is reasonably practicable
after the occurrence of an appropriate act in relation to a
patient, the relevant managers shall appoint an approved medical
practitioner (AMP - see below) to be the patient's RMO.
The relevant managers mean the managers of the hospital in which
the patient is detained. Usually the function of allocating the RMO
is delegated to medical records managers. If in doubt about who is
the manager, the clinician should consult with their clinical lead
or medical director.
Section 230 (3a) allows the relevant managers to appoint another
AMP in place of the existing RMO which for example covers leave and
on call rotas.
Section 230 (3b) allows the relevant managers to authorise an
approved AMP to act (whether for a particular purpose or in
particular circumstances) in place of the patient's responsible
medical officer. This could apply where a patient age under 18 has
been placed in an adult ward and the RMO is not a child specialist.
Another RMO from the specialist CAMHS service could be appointed to
issue any T2 required.
Issues that have come to our attention
- Consultants/RMOs should note that they do not have the
authority to delegate RMO functions to speciality doctors or senior
trainees even if they are AMPs. It is hospital managers who have
the authority to delegate these functions. This delegation should
be in writing and agreed with medical managers.
- There is always an RMO. Records departments should have a
scheme of delegation if the patient's own RMO is unavailable. This
is likely to be a cross-covering colleague and, failing that, the
duty approved medical practitioner.
- Sometimes there are separate RMOs for hospital and community
care. Records departments should have a clear record of who is the
RMO at any one time. If a patient from the community is readmitted
and the community consultant agrees with the inpatient consultant
they should keep RMO responsibility they should ensure the medical
records dept or relevant mangers are aware of this proposal.
- Specialty doctors and specialty trainees who are AMPs are
advised to ensure they have in writing from hospital managers that
they have the authority to act as an RMO before doing so. Many
non-consultant staff do undertake important RMO duties as a
consequence of their seniority or as an essential part of senior
training. This is perfectly appropriate but they must ensure they
have the legal authority to do so.
Certain functions must be carried out by the patient's RMO and
cannot be delegated to an AMP who is not an RMO.
Failure to observe this advice could lead to actions being
declared unlawful. The following have led to particular
- Extension of CTOs/COs We found situations where the extension
certificate was signed (i.e. "granted" under the Act) by an AMP who
was not the RMO. This could make the order challengeable. Another
AMP can conduct the examination but cannot sign the certificate
unless given the authority to do so by hospital managers.
- T2 certificatesmust be issued by the RMO. If authorised by
hospital managers, this can be delegate to a speciality doctor or
senior trainee who is an AMP. It cannot be delegated to a trainee
who is not an AMP.
- T2 certificates for individuals under the age of 18In this
case, the RMO must be a child specialist. If the individual is on
an adult ward and the RMO is not a child specialist, hospital
managers can delegate this function to a child specialist AMP.
- Recall of patient under section 113. This must be done by the
RMO (noting the above arrangements for deputising when the
individual's own RMO is unavailable). A different AMP they may
undertake an examination of the patient on behalf of the RMO for a
section 114 certificate. See our thematic advice note on admission
of individuals subject to community compulsion for more on
Approved Medical Practitioner
This term was introduced in the 2003 Act in Section 22. To act
as an AMP a psychiatrist must have the required
qualifications and experienceandbeapproved by a Health Board as
having special experience in the diagnosis and treatment of mental
Those who have retired and subsequently take on locum work, and
those moving posts or taking up locum work in general are advised
to personally check they are on a board list before acting as an
AMP. There have been examples of RMOs being removed in error from
board lists, and having this drawn to their attention at a tribunal
by a patients solicitor.
The AMP list is also available on the Scottish Government
website in the public domain. Every month, the Scottish Government
produces an updated list of AMPs.
To access this list you can go to the SHOW website at:
health on the web publications
In the keyword box, you need to insert the word "approved", hit
"go" and then a link to the list will appear underneath.