CALL LOG


Manager Practice


Call log


These cases are based on actual advice calls made to MDDUS advisers and are published here to highlight common challenges within practice management. Details have been changed to maintain confidentiality.


CHAPERONE POLICY Q A


A PM is reviewing the practice’s chaperone policy and has found that, for intimate examinations involving a doctor and patient of the same gender, a chaperone is not routinely offered. The practice is often short-staffed and the manager asks MDDUS if the offer of a chaperone is essential for these same-sex consultations.


MDDUS has handled a number of cases where a patient undergoing an intimate examination with a doctor of the same gender has complained about not being offered a chaperone. Finding a suitable chaperone for intimate examinations can put practice resources under pressure, but GMC guidance clearly states: “When you carry out an intimate examination, you should offer the patient the option of having an impartial observer (a chaperone) present wherever possible. This applies whether or not you are the same gender as the patient.” Chaperones should stay for the whole examination and, where practicable, be able to see what the doctor is doing. The chaperone does not have to be medically qualified but should have received appropri- ate training to understand what constitutes a normal examination and must be respectful of the patient’s dignity and confidentiality.


MISSING RECORDS Q


A dentist suspects his receptionist may have stolen a number of patient records from the practice. Relations between the pair have been strained for several weeks after the receptionist was disciplined, and he has recently made comments about “getting even”. The dentist is unsure of what to do if the records have indeed been stolen.


04 A


The first step is to check if the records have been misfiled, rather than stolen from the practice. If you are sure they have been deliberately and inappropriately removed then ideally the practice would have in place a policy on dealing with a data security breach. This will include informing the patients concerned in writing and alerting the Information Commission- er’s Office. The ICO identifies four key steps in a breach management plan: containment and recovery; assessment of ongoing risk; notification of breach; and evaluation and response. More detailed advice is available from MDDUS and from ico.org.uk.


RIGHTS OF ACCESS Q A


The father of a six-year-old patient wants to access his son’s medical records to check a prescription for a minor infection as the boy is staying for the weekend. The practice manager is aware the man is estranged from the boy’s mother and that she doesn’t want him to access their son’s notes. She asks MDDUS how to proceed.


A key element to consider before allowing access to records is whether


the child’s father has parental responsibility. While all mothers are automatically deemed to have parental responsibility, not all fathers do. A father acquires parental responsibility if married to the mother at the time of birth (or conception in Scotland). An unmarried father only has parental responsibility if it is recorded on the birth certificate at registration (since 1 December 2003 in England or Wales, 15 April 2002 in Northern Ireland and 4 May 2006 in Scot- land). An unmarried father can acquire parental responsibility by legal agreement with the mother or by applying for a court order. The same laws apply to step-parents and civil partners. If the father’s name is not on the birth certificate and he has not been granted parental rights by agreement or by court, then he is not entitled to access the records. If he is entitled, be sure that allowing access is not against the child’s best interests. Any third party information should also be redacted from the notes.


NO VACCINES Q A


The mother of a young girl is refusing consent for her daughter to be given the MMR vaccine, preferring instead a homeopathic treatment. The GP is con- cerned that this would not be in the child’s best interests and also fears being held to account should the girl subsequently fall ill.


Parents have the right to refuse vaccinations for their child and GPs should respect their decision. However, with such an important decision, consider involv- ing both parents in the discussion. Be sure to clearly explain the risks and benefits of immunisation – leaflets or other learning materials may be a useful aid. If the parent(s) cannot be persuaded then make a detailed note of the discussion in the child’s medical record.


PATIENT CONTACTS Q A


A dental nurse volunteers for a local support group for people who suffer from dental phobias and anxiety. She occasionally talks to patients in the practice about it and wants to access the practice database to find their contact details and send out information about the group’s work.


Despite the nurse’s good intentions, accessing the practice’s systems to find patient contact details for this purpose would breach confidentiality. It would also be a breach of the Data Protection Act as personal information should only be used to provide patients with dental care or to inform them of services your practice provides. It should not be used to inform them of non-dental products, meetings or services. Make sure all staff are clear about who can access data and for what purposes.


HOLIDAY CLOSURE Q


The practice will be closed for an upcoming bank holiday weekend and the manager is concerned about the disruption that could be caused to patients, particularly as there were issues with the management of test results during the last holiday closure. She asks MDDUS for advice.


SUMMER 2014  ISSUE 10


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16