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.
BROADCAST BLUNDER Q
A patient recently attended our practice to consult with a GP who called him to the consultation room using the tannoy function installed in the new telephone system. However, the doctor failed to switch off the tannoy and the first few minutes of the consultation were broadcast for the whole waiting room to hear. The doctor reassured the patient at the time that he should not worry because no particularly sensitive matters had been discussed. The patient has since made a complaint and, as practice manager, I am unsure how best to proceed.
A
As with all complaint responses, it is important to acknowledge that a mistake was made, to apologise for the distress caused and to offer a full explanation of how things went wrong. You should also take steps to ensure a breach of confidentiality like this does not happen again, and to reassure the patient of this. You should certainly not seek to dismiss their concerns: in this case, it seems unwise to simply tell the patient “not to worry”. Be sure to discover what went wrong with the phone system in this instance and make sure that in future all staff are aware of how to operate it, particularly when a tannoy function is available. MDDUS can assist with the drafting of written responses tailored to each individual complaint and provide further advice and support should the case escalate.
HOLIDAY CHANGES Q 04
A couple of our practice employees regularly work overtime and I have heard them mention that they will soon be entitled to more holiday pay because of a recent employment tribunal ruling. Will the practice have to start paying them more?
A
Yes. The long awaited judgement on the Bear Scotland & ors v Fulton & ors (and related cases) has held that holiday pay calculations should include regular overtime, even non-guaranteed overtime. The judgment only applies however to four weeks under the Working Time Directive and not the additional 1.6 weeks granted in the UK and may be subject to appeal. Any members who have questions on this please contact the MDDUS employment law advice team.
LOST IN TRANSLATION Q
A patient from Poland recently came into the practice for dental treatment but did not speak very good English. One of our nurses is Polish and speaks very good English and it was agreed he would translate what the dentist was saying. The patient has since complained about his finished treatment, claiming he did not expect his teeth to look the way they do. The dentist also did not note any details of the process of translation or consent. How should we proceed in future?
A
When treating patients with limited English, ideally a professionally qualified interpreter should be used. They should be told beforehand that the dentist must hear all information offered by the patient and that everything the dentist says should be translated for the patient. Check the patient is comfortable before proceeding and clearly record in the notes that an interpreter is present, including their name and contact details. It should also be noted that the patient has consented to the arrangement and a clear account given of the information shared during the consultation. Extra care should be taken when using a non-professional interpreter – relatives/friends are often not appropriate as there is no way of knowing their grasp of the language and they could undermine confidentiality. They may also lack objectivity and be unfamiliar with clinical terminology. Take care also when using a practice staff member to translate as they may not be sufficiently skilled for the task. For valid, informed consent, it is vital to
confirm the patient has understood the information given and is happy with the proposed course of treatment.
TACKLING DNAs Q A
A number of our patients frequently do not attend for reviews or monitoring of their medication. To what extent are we expected to keep contacting these patients to encourage them to come in?
It is important to explain to patients the benefits of attending for review and the risks of not doing so, ensuring they have sufficient capacity to understand and make their own decisions on the matter. Be sure to clearly document all attempts to contact the patient and the advice given to them about non-attendance. Practices should have a clear policy on dealing with DNAs, with a system in place to identify patients who fail to attend and a means of dealing with those who cause concern. There should be a prompt investigation of why a patient has not attended as some vulnerable patients may need extra support/advice. It would be for the GP to exercise their clinical judgement as to whether repeat prescriptions should be ended for repeat non-attenders, taking into account the GMC guidance on this issue:
www.gmc-uk.org/ guidance/ethical_guidance/
14325.asp
REASONABLE REMOVAL Q
One of our patients has made a large number of complaints over the past two years about various aspects of his clinical care as well as criticising the practice appointments system and the behaviour of some of our staff members. He has just submitted yet another complaint and I feel it may be better if he was removed from the practice list and encouraged to find another GP.
A
The decision to remove a patient from the practice list must be made very
carefully. Guidance from the RCGP and GMC is clear that you should not end a professional relationship with a patient solely because of a complaint the patient has made about you or your team, or
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