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refuse treatment. Thus, this would be best framed as a request rather than a condition of re-registering the family.


COPYRIGHT ON PATIENT DATA Q A


A partner in our practice has been requested to complete an army medical form and he wants to include a copy of a CAMHS (Child and Adolescent Mental Health Services) assessment letter – but the letter includes a note stating: “Not to be copied without permission of the author”. Can we copy and send the letter without permission of the author?


Once a document is placed in a patient’s records it becomes available for the patient (or a representative acting with the patient’s consent) to see or allow disclosure upon request. If it contains third-party information or anything the clinician believes could cause serious harm to the patient then this should be redacted. Letters from specialists or other health professionals do not count as third party and therefore anything they have written that is held in the patient records can be disclosed. Thus, it would be reasonable for the GP partner to send a copy of the letter. GMC guidance states that doctors should be honest when writing reports or signing forms and “must not leave out relevant information”.


GP SUPERVISION Q A


Our practice is considering setting up a private clinic to administer travel vaccinations. The plan is to have our practice nurse carry out the injections – would one of the GPs have to be present while she does this?


The key issue to consider when delegating is whether the person who will be carrying out the task is competent to do so. The practice must be confident that the staff member administering the vaccines has the qualifications, experience, knowledge and skills to provide the treatment. For example, would she be competent to deal with a potential anaphylactic reaction to a vaccination? The GMC states clearly that: “Although you will not be accountable for the decisions and actions of those to whom you delegate, you will still be responsible for the overall management of the patient, and accountable for your decision to delegate.” When delegating, doctors must always pass on enough information about the patient and the treatment they need. Ultimately, if the GPs are satisfied these requirements can be met, then they can go ahead with their plans for the nurse to work in the clinic without direct supervision.


PHOTO CONCERN Q


A police officer has contacted the practice following a report from one of our patients who claims she was secretly photographed by another patient while they were both sitting in the waiting room. The officer wants access to the consultation list


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to see who was booked in for an appoint- ment at the time of the alleged incident. When I asked, he said he had not yet secured a court order for the disclosure. Should I give him this information?


A


Whenever police ask for access to confidential patient information there are a number of key issues to confirm. One of these is a court order – if this is in place, then you are required by law to disclose the necessary relevant information. Without such an order, you must exercise your professional judgement. Ideally, no disclosure would be made without first securing consent from the patient(s) concerned, but you should check first with police whether doing so would undermine their investigation. You should also be satisfied that seeking consent would not put you or others at risk of serious harm. Without either a court order or patient consent, you must consider whether disclosing could still be justified. The GMC recognises that there can be a public interest in disclosing information without consent where it is in the public interest “to protect individuals or society from risks of serious harm, such as… serious crime”. Having considered all these factors, if you feel disclosure would not be justified in this case (without consent) then the police would have to seek a court order.


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followed all the necessary steps so far in discussing the issue with the patient and highlighting his legal obligations. As the patient is still driving, it would be advisable for his GP to meet with him again – ideally involving his daughter/another family member – and inform him that if he continues to drive then the doctor will report it to the DVLA in the public interest. Details of the discussion should be noted in the patient’s record and a letter sent to him outlining any action taken. See GMC guidance - Confidentiality: reporting concerns about patients to the DVLA or the DVA.


NEGATIVE FEEDBACK Q A


Our receptionist has informed me that one of our patients has posted a number of negative and derogatory comments about the practice on Facebook. She is not happy about the treatment she has received and she claims our dentists and staff are incompetent. This is very unfair and makes the practice look bad. How should we respond?


Firstly, however unfair this seems and however much the practice wishes to defend itself, you should resist the urge to reply directly (and publicly) to the comments via Facebook. This will not help and will likely make matters worse, as well


DEMENTIA DRIVER Q A


A patient who was recently diagnosed with dementia was seen arriving in the practice car park this morning in his car. He has been told on two occasions he is not fit to drive and that he must inform the DVLA of his diagnosis. His GP has discussed the matter with the patient and his daughter, but to no avail. What should we do next?


All drivers have a legal obligation to alert the DVLA if they suffer from one of a list of conditions, including dementia, cognitive problems and other related conditions. It would appear the practice has


as potentially breaching patient confidentiality. Instead, consider contacting the patient to let her know you are aware she is unhappy about certain aspects of her dental care and invite her to come into the practice to discuss it. Advise her about the practice complaints procedure which could give her a constructive means to air her concerns and allow you to respond accordingly. It is important to make sure that any written communication is carefully composed and should not contain any warnings or threats to deregister her. (It has been known for such letters to also find their way onto Facebook.)


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