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.
DISPUTED RECORDS Q
A disgruntled patient who has decided to leave our practice recently requested a copy of his medical records. We provided these and he has now submitted an angry written complaint over an entry made a year ago in relation to what the patient states is an erroneous diagnosis. He disputes the entry and wants it removed before his records are transferred. How should we respond?
A
Both the Data Protection Act (DPA) and the General Medical Council (GMC) state that a doctor’s clinical opinion should remain in the notes if it was a reasonably held belief at the time and is relevant to the patient’s care. A patient who disagrees with such an entry is entitled to add their own annotation to the records in response. In this case a letter providing the patient clarification of your position on the matter and informing him of his rights in the matter would be reasonble. You should also advise the patient that if dissatisfied with your response he can contact the ombudsman or the Information Commissioner’s Office, which handles compliance with the Data Protection Act.
DENTAL INDEMNITY EXCLUSIONS Q
One of our staff recently saw a notice from the BDA urging dentists to check the small print on their indemnity policies to ensure they are appropriately covered. The warning involved a recent GDC case in which the adequacy of a registrant’s cover was questioned as the policy contained exclusions relating to the transmission of blood-borne diseases. Does your standard indemnity policy include such exclusions?
A 04
We have been contacted by a number of dental members in regard to this issue.
The case apparently led a GDC panel to conclude that the registrant’s policy did not fulfil Standard 1.8 within Standards for the Dental Team: “You must have appropriate arrangements in place for patients to seek compensation if they suffer harm”. Our standard indemnity policies at MDDUS do not include exclusions for specific risks such as failure to prevent the transmission of blood-borne diseases.
FLU JABS Q A
We have a large number of patients due to come in soon for their flu jab. One of our nurses has just gone off sick and is not expected back for a couple of months. Can our healthcare assistant (HCA) step in and help? She has the appropriate training.
Many HCAs are well-trained and competent to administer vaccinations, but it is the prescribing of the vaccine, and the assessment of the patient prior to that, which is the issue. The majority of NHS flu vaccinations provided are prescribed via patient group directives (PGDs). These are written instructions for the supply and/or administration of a named licensed medicine for a defined clinical condition to groups of patients, who may not be individually identified before presentation for treatment. PGDs are not a form of prescribing but provide a legal framework for nurses and certain other registered healthcare professionals to administer a medicine directly to
patients under a specified
criteria, without the need to see a doctor or other qualified prescriber. However, please note that HCAs may not administer drugs or provide treatment under a
PGD. For an HCA to be involved in flu immunisations it must be via a patient specific directive (PSD). A PSD is a written instruction from an independent prescriber (doctor, dentist or independent nurse prescriber) to another healthcare professional, to supply and/or administer a medicine directly to a named patient or to several named patients. PSDs are used once a patient has been assessed by a prescriber. This assessment should be documented and contemporaneous to the administration of the vaccine.
ADVICE FROM ABROAD Q
Our medical practice has been receiving an increasing number of calls from patients while abroad on holiday or business. We operate a triage system so patients are accustomed to telephone advice. Our policy has always been not to offer overseas call-backs on the grounds of cost but now calls to mobiles are no more expensive than those within the UK. However, we are still concerned that in advising patients not currently present in the UK we may be offering a service that is not indemnified. Can you advise?
A
If a patient contacts the surgery for assistance whilst outside the UK, it is important to
understand the associated risks. Administrative requests (such as for a repeat prescription due upon their return or for an appointment) can usually be responded to in the normal manner. But when a patient is requesting medical advice, it is very important to be aware of the obvious risks in being unable to assess the patient properly in order to make a diagnosis – and also the increased risks associated with treating
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