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Manager A


Practice


With any holiday closure, planning ahead is key. On the day or two before the practice closes staff should be vigilant in relation to any abnormal result handling. Complaints can often arise in this area, particularly regarding issues like warfarin results or electrolyte abnormalities that may require more urgent attention. Clear, accurate and contemporaneous record keeping is essential, as always. Let your patients know about the closure – via the noticeboard, face-to-face or on the practice’s website/social media pages. Patients on repeat prescriptions should be given a reminder to allow them to pick up any repeats before the long weekend. Prescrip- tion counter slips can also carry a special notice so that patients can make sure they have adequate supplies of repeat medication.


GAMES TIME OFF Q A


A number of practice staff have tickets for the Commonwealth Games and have requested time off to attend. The manager cannot accommodate all the requests and asks MDDUS how to proceed.


Check how many staff want time off and then compare that to the practice’s staffing needs. There is no legal obligation for you to grant all requests, but be sure to follow practice policy and be consistent, fair and transparent. Options for staff include taking annual leave, making up time at a later date, allowing flexible working during the event or granting special paid/unpaid leave. A lottery system of picking names out of a hat could help when you cannot accommodate all requests. When refusing requests, give at least one day’s advance notice for every day of leave requested, i.e. two days’ notice if refusing a request for two days’ holiday. You should also make it clear that unauthorised absence will constitute misconduct and could lead to disciplinary proceedings.


ACCIDENT QUERY Q


A patient explains his car has been hit by a taxi while it was in the practice


car park. He is looking for potential witnesses to support his insurance claim and has requested a list of all patients who attended the practice that day around the time of the accident. The manager wants to help but is conscious of data protection rules. She adds that a disclaimer sign is displayed in the car park, stating that vehicles are left there at their own risk.


A


Under the Data


Protection Act


you cannot reveal the contact details of patients for this purpose. The General Medical Council allows disclosure only where a serious crime has been committed. As with any minor road traffic accident, it would be the driver’s responsi-


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bility to obtain the details of witnesses at the time. If a patient contacts you to say they witnessed the incident then you could invite them to contact the driver directly. You may sympathise with your patient but you are not required to help him with this issue.


ENTITLED TO CARE Q A


A patient has been undergoing cancer treatment for several weeks and her


GP has referred her for hospital treatment. However it has since come to light that she is a failed asylum seeker and, as such, is not entitled to free NHS care. The hospital has contacted the practice manager to confirm that, given the patient’s illegal status, the practice will fund her care.


An MDDUS adviser agrees that it would be unreasonable to expect the practice to fund the patient’s secondary care. The practice should continue providing any immediate necessary treatment and the PM should contact the local clinical commissioning group (CCG) to clarify what this level of treatment would involve. The CCG should also be able to explain who is responsible for the cost of providing the patient’s care. Until this decision is made, the practice should continue to keep the woman on their list and to meet her clinical needs as far as possible under the circumstances. The adviser also cautions the PM that MDDUS has defended cases on behalf of members where refusing or delaying treatment on


CALL LOG


the basis of eligibility has led to claims of negligence.


ABUSIVE PATIENT Q A


A patient has been repeatedly rude and aggressive towards staff in the past few months, on one occasion insisting he only wanted to see a “male white doctor”. He also shouted at reception staff and has been refusing to take his pre- scribed medication. The PM wants to remove him from the practice list and asks MDDUS for advice.


GMC guidance advises that deregistra- tion should be a rare event prompted, for example, by a patient being threatening, abusive or violent, persistently acting inconsiderately or unreasonably, stealing from the premises or making sexual advances towards a doctor/staff member. Before ending your relationship you should warn the patient in writing, highlighting his unacceptable behaviour – citing incident dates and details where appropriate – and advising that he may be deregistered if there are any further incidents. Include only relevant incidents – a failure to comply with treatment is not a valid reason for consider- ing removal. Do what you can to restore the relationship with him and explore alterna- tives before deciding whether to remove him from your list. MDDUS is happy to review a draft letter before you send it to the patient.


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