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Manager Practice


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because of the resource implications of the patient’s care or treatment. There is a clear process to be followed, one which must be fair and reasonable and does not discriminate against the patient. Usually removals are made where the relationship between the practice and the patient has broken down, often as a result of aggressive or violent behaviour. GMC guidance also provides for removal in situations where a patient has “persistently acted inconsiderately or unreasonably,” leading to a breakdown of trust between doctor and patient. Before removal, you should warn the patient of your intentions and do what you can to restore the relationship. If the decision to remove is taken, inform the patient in writing (explaining the reasons why) and note this in their record. Be sure to give the patient information on finding another GP.


INFECTION CONTROL Q A


I have recently started work managing a medical practice and have been checking compliance with infection prevention and control requirements. I notice one of the waiting rooms still has carpeting on the floor. Is this a problem?


Each clinical commissioning group (CCG) or health board area will have its own infection prevention and control policies and you should consult the relevant policy for your area. Generally, carpeting is not recommended in any clinical areas (particularly not treatment rooms) or patient waiting areas due to the risk of body fluid spills. Any other carpeted areas should be well vacuumed and cleaned regularly in line with local policies. This should be set out clearly within the practice’s written cleaning schedule. Practices in England and Wales will have to comply with requirements of their registration with the Care Quality Commission (CQC) while those north of the border are inspected by Healthcare Improvement Scotland.


DRINK PROBLEM Q A


One of our practice staff members has turned up to work recently smelling strongly of alcohol and her appearance is sometimes dishevelled. She has made an increasing number of errors lately and I am concerned she has a drink problem which could impact on patient safety.


If you believe a staff member is under the influence of alcohol then it must be addressed immediately. Ask her about it in a confidential setting, focusing on the workplace performance issues and


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giving clear examples of where errors have been made. If she denies it, then give clear timescales for improvement and offer extra support and training. If she admits to a problem, offer to refer her to a counselling or AA group, as well as focusing on the errors. It should be made clear that being drunk at work will not be tolerated and can be a dismissible offence. Where an employee is clearly drunk at work, consider sending them home on paid leave while the matter is investigated. A clear, up-to-date practice policy on alcohol use is essential. It may also be worth involving occupational health services.


OLD CONSENT Q A


The social worker of a 15-year-old patient, who suffers mental health problems, has contacted the practice seeking access to his medical records in order to update his file. The GP asked for evidence of written consent from the patient and the social worker has sent back a consent form dated almost two years ago. Is this still valid?


It would be reasonable to conclude that a consent form signed so long ago is now so old as to be no longer valid. While there is no official time limit on consent taken in advance of treatment or for other purposes, such as third party disclosure of confidential information, it would be advisable to review it in this case. The GMC encourages decisions about treatment to be reviewed where


“significant time has passed since the initial decision was made” as patients have the right to change their mind at any time. Ask the social worker for an up-to-date consent form before releasing the patient records.


MAKING AMENDS


Q A


A patient has asked to amend their record because they believe the information to be incorrect. Are they allowed to do this?


Under the Data Protection Act 1998, patients have the right to request amendments to their records. This includes correcting simple errors, but can also extend to redacting sensitive details or more complex disagreements over clinical content. In this case, if the doctor agrees with the proposed amendment (that there is, in fact, a mistake/inaccuracy in the patient’s record) then the amendment can be made. A contemporaneous entry should also be made to indicate what has been altered and why. If the doctor does not agree that the record should be amended, an offer can still be made for an additional entry to be made in the records noting the patient’s view/disagreement with the contents. When amending paper records, be sure not to obliterate the piece of information that is being amended. Cross it out with a single line and add the amendment, including an explanation of why the amendment has been made.


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