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.
POLICE REQUEST Q A
Two police officers turned up at our medical practice this morning and informed the receptionist that they know a patient is attending an appointment later today and asked if she could confirm this is the case. They would only say that it relates to an investigation into minor thefts in the local area. What should we do?
The decision to comply with police requests for information can be a tricky one and each case has to be assessed on its merits. Generally, confidential patient information should not be released without patient consent, unless in the public interest. That is, does the benefit of disclosure outweigh the general benefit to the public of maintaining confidentiality? In its guidance Confidentiality, the General Medical Council states: “If a patient refuses consent, or if it is not practicable to get their consent, information can still be disclosed if it is required by law or can be justified in the public interest.” If the police can produce a court order or evidence of the patient’s consent, then disclosure can be made. Otherwise, the GMC states that it could be justified in serious cases: “for example, when a disclosure would be likely to assist in the prevention, detection or prosecution of serious crime, especially crimes against the person.” In this case, it would appear that this “serious crime” threshold has not yet been met and you could not justify disclosing the information without consent.
DENTAL TUNES Q 04
Our dentists like to have the radio on in the surgery while they treat patients
and the TV is usually on in the waiting room. Does this mean we need a special music licence?
Whether it’s the radio, TV, CD, MP3 or other formats, any business that plays recorded music in public is legally required to have the relevant licence, including dental (and medical) practices. Licences are required to protect the copyright of those who create, produce and publish the music or performances. Your practice will likely need a licence from both Phonographic Performance Limited (PPL) and the Performing Right Society (PRS for Music). Those who fail to obtain the correct licence face legal proceedings for copyright infringement. More information is available on the PPL and PRS for Music websites.
KEEPING IN TOUCH Q A
One of our receptionists is due to return from maternity leave in a few months and during a recent meeting she explained she was very nervous at the thought of coming back to work, as she had not had much contact from colleagues. While I would be happy to keep employees on leave up-to-date with practice news, I am wary of this being perceived as “harassment”.
The law allows employers to keep in “reasonable contact” with employees on maternity leave. This would certainly include internal matters such as practice organisational changes, staffing issues, promotion opportunities, job vacancies and any planned reorganisations or redundancies. Contact can be maintained informally via email, text, a pre-arranged phone call or even a letter, and notes from staff meetings could be sent. Some organisations use a ‘buddy’ system, where someone in the practice is chosen to keep the employee updated on events and changes. Each employee is different and it is worth agreeing with them in advance about the level of communication they would prefer. A more formal arrangement is by using Keeping in Touch (KIT) days – up to 10 days can be used during an employee’s maternity leave period. KIT days cannot be enforced and must be agreed by both the employee and the practice, as there is no obligation for the employee to work them or for the practice to offer them. KIT days can be used for undertaking work, attending
There are two important elements to clarify. First, what is the nature of the power of attorney held? These can be for financial or welfare decisions, or both. In terms of medical decisions, only a welfare power of attorney is relevant. Secondly, does the patient lack capacity to make decisions regarding the relevant issues? If not, then the power of attorney does not apply and the usual procedure for informed patient consent should be followed. If the patient does lack capacity (and her son has welfare power of attorney) then it may be useful to invite her son to discuss her care and make every attempt to reach a consensus on how best to proceed. If agreement can’t be reached, then consider involving an independent advocate, obtaining a second opinion, holding a case conference or using local mediation services. The Mental Welfare Commission (Scotland) may also assist (law is different elsewhere in the UK). If all of this fails, you may wish to seek legal advice on applying to the appropriate court or statutory body for review or an independent ruling.
SICKNESS SCHEME Q
One of the receptionists has been off sick for three weeks for the second time in six months which is putting a lot of pressure on the rest of the staff. I have heard about the government’s new Fit for Work scheme. Can I make her undergo an assessment to help get her back to work?
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meetings, conferences or training. There is no set rate of pay for such days and this should also be mutually agreed. Discuss with each employee how they would like to proceed. An informal home visit towards the end of leave can also be useful.
POWER TO DECIDE Q
The son of an elderly female patient has complained to a practice (in Scotland) about the the number of visits she is receiving from the district nurse. He believes that his mother requires additional support. The son says he has the right to make this request because he has power of attorney for his mother’s affairs.
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