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Walk-in Clinics

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Approved by Council: September 2019

Companion Resource: Advice to the Profession

 

Policies of the College of Physicians and Surgeons of Ontario (the “College”) set out expectations for the professional conduct of physicians practising in Ontario. Together with the Practice Guide and relevant legislation and case law, they will be used by the College and its Committees when considering physician practice or conduct.

Within policies, the terms ‘must’ and ‘advised’ are used to articulate the College’s expectations. When ‘advised’ is used, it indicates that physicians can use reasonable discretion when applying this expectation to practice.

 

Definitions

Walk-in Clinic: Medical practices that provide care to patients where there may be no existing association between the patient and the practice, where there may be no requirement to book appointments, and where the care provided is generally, although not always, episodic in nature. This includes urgent care centres, but does not include hospital-based emergency departments.

 

Policy

This policy does not provide an exhaustive catalogue of all physician expectations that apply in the walk-in clinic practice setting and other College policies set out expectations for physicians that apply in this setting as well.1

Supporting Patients

  1. Physicians practising in a walk-in clinic must use their professional judgement to determine whether it would be appropriate to sensitively remind patients:
    1. That there are differences between episodic care and care that is provided as part of a sustained physician-patient relationship2;
    2. About the benefits of seeing their primary care provider, if they have one, for care within their physician’s scope of practice; and/or
    3. About the benefits of having a primary care provider and encouraging them to seek one out, if they don’t already have one.
  2. Physicians practising in a walk-in clinic who are asked for assistance in finding a primary care provider must be as helpful as possible in supporting the patient.3

Meeting the Standard of Practice

  1. Physicians practising in a walk-in clinic must meet the standard of practice of the profession, which applies regardless of whether care is being provided in a sustained or episodic manner.
    1. For example, physicians practising in a walk-in clinic must conduct any assessments, tests, or investigations that are required in order for them to appropriately provide treatment and must provide or arrange for appropriate follow-up care.4
  2. Physicians practising in a walk-in clinic who limit the care or services they provide due to the episodic nature of walk-in clinic care5 must:
    1. Make decisions to limit the services they provide due to the episodic nature of walk-in clinic care in good faith;
    2. Communicate any limitations to patients in a clear and straightforward manner; and
    3. Communicate appropriate next steps to patients seeking care or services that are not provided, considering factors such as the urgency of the patient’s needs and whether other health-care providers are involved in the patient’s care.

Managing Tests and Referrals

  1. Physicians practising within a walk-in clinic who order tests must:
    1. Comply with the expectations set out in the Managing Tests policy, including providing appropriate follow-up on test results; and
    2. Comply with relevant expectations set out in the Availability and Coverage policy, in particular those relating to coordinating coverage for critical test results.
  2. Physicians practising in a walk-in clinic who make referrals must provide or arrange for the provision of necessary follow-up care, including reviewing consultation reports.
  3. Physicians practising in a walk-in clinic must not rely on the patient’s primary care provider or another health-care provider involved in the patient’s care to provide or coordinate appropriate follow-up for tests they have ordered or referrals they have made, unless the other providers have agreed to assume this responsibility.

Coordinating with Primary Care Providers

  1. Physicians practising in a walk-in clinic must provide the patient’s primary care provider (if there is one) with a record of the encounter6 when:
    1. The patient makes a request to do so; or
    2. In their opinion, one is warranted from a patient safety perspective and the patient has provided consent to do so.
  2. If it is not possible to send the record of the encounter directly to the patient’s primary care provider (e.g., where there is uncertainty regarding their identity or incomplete contact information), physicians practising in a walk-in clinic must provide the patient with the record of the encounter and inform them of the importance of sharing it with their primary care provider.
 

Endnotes

1. For example: Medical Records, Confidentiality of Personal Health Information, Professional Obligations and Human Rights, etc.

2. As defined in the Availability and Coverage policy, a sustained physician-patient relationship is one where care is actively managed over multiple encounters.

3. Examples include directing patients to a colleague who is accepting new patients or to an organization that may be able to assist, such as a Community Health Centre, local hospital or emergency room, or other organization. The College’s Physician and Public Advisory Service (PPAS) may also be able to provide some general tips and advice to patients seeking a new provider. PPAS can be reached toll free at 1-800-268-7096 ext. 603.

4. See, as well, provisions 5 through 7 in this policy.

5. Among other factors, a physician’s practice environment may determine their scope of practice at a particular point in time. This is distinct from limitations that result from a moral or religious objection where specific expectations apply (see the College’s Professional Obligations and Human Rights policy).

6. This may include, for example, a record of any tests ordered, diagnoses reached, any treatment and advice provided, any referrals that were made, and any follow-up care that was arranged or advised, etc.