Manager Practice


patients in other countries. MDDUS is a UK- wide indemnity organisation and provides assistance to members for actions raised against them within the UK. Members would NOT be represented if action was taken against them in another country where harm had arisen as a result of their provision of advice. Because of this, we would strongly advise that members do not offer any medical advice in relation to a non-recurrent illness to a patient who is overseas, but that they encourage that patient to see a local medical practitioner.


ACCESSING TWIN RECORDS Q


Our practice has two patients who are twin girls age 12. Mum and Dad are divorced but both share parental responsibility. We have received a request from Dad to come into the practice to view the twins’ medical records. He has since remarried and wants to bring his new wife – a qualified nurse – with him to review the records. Are the twins old enough to consent to this or do we need to contact Mum for permission?


A


All children with “capacity to consent” have the right to allow or prevent access to their medical records. In England there is a presumption of capacity at the age of 16 but children will often have capacity for many decisions before this age. You should first establish if either of the twins has the capacity to decide whether their father and, secondly, their stepmother can have access to their notes. We would suggest you talk to both girls separately to determine whether they understand the nature of the disclosure, its purpose and any possible consequences. A child will have capacity if they are able to understand and retain this information, weigh it up and then communicate their decision. Should each individual girl be judged to have capacity and agree to her notes being disclosed to her father and stepmother then you may do so, subject to redaction of third party or significantly harmful information. Should either girl refuse to consent you should respect her wishes, unless you feel she or someone else would be at risk of serious harm if you did not disclose relevant information. In the latter situation we would recommend seeking further and more specific advice from MDDUS prior to disclosure.


NURSE RECEPTIONIST Q A


Our receptionist is a former dental nurse and, because of her experience and knowledge, she is able to respond to some dental queries from patients. Should she be registered with the General Dental Council?


Registration with the GDC is only required for those who wish to work as a dentist or dental care professional in the UK. This would not normally include the work of practice receptionists. However, you should have clear policies and protocols that detail what she can and cannot say to patients so that she does not stray into what could be classified as the practice of dentistry.


WWW.MDDUS.COM ABUSIVE PATIENTS Q A


Our practice has in recent years seen a rise in incidents involving rude and abusive patients. Could you advise on a standard template letter we could send to such patients setting out our zero tolerance policy and with a warning about possible removal from the patient list?


In recent years, use of the term ‘zero tolerance’ has come under increasing criticism in the NHS, as it does not take into account behaviours that may be explained or mitigated through mental illness and other disorders, challenging behaviours in learning disabilities and other contributory factors. ‘Zero tolerance’ approaches may also fail to consider personal thresholds for unacceptable behaviour. What may be offensive or unacceptable to one member of staff may be viewed as understandable or tolerable by another. What’s important is that organisational policy recognises that it is the individual’s perception of what is acceptable or unacceptable that is important. We would suggest using different terminology in referring to your policy, such as ‘unacceptable behaviour’. In regard to warning letters we would advise that the wording of warning letters needs to be considered on an individual basis depending on the patient and the nature of the inappropriate behaviour. Warning letters should be detailed, setting out the specific issues, incidents and dates involved. It would also be reasonable to acknowledge that there may be some reason for the patient’s behaviour: e.g. “I understand it may be frustrating when you don’t receive the service you would like but…” adding that this cannot justify inappropriate behaviour and that staff have a right to work without being abused, as set out in your practice policy. Be aware that the GMS contract stipulates that a patient should have had a warning in the last 12 months before being removed to give them a chance to change their behaviour. Exceptions to the need for a warning include patients moving out of the practice area or if it is considered that a warning may put the patient or others at risk. The letter should also set out steps for the provision of alternative care in the event of removal from the list. More guidance is available from the GMC.


WRONG PATIENT Q A


A patient came into the practice yesterday to pick up a prescription but later discovered she had been given one belonging to someone else. She has made a complaint about it. What should I do?


The first step would be to draft an appropriate response, including an apology for what is clearly a breach of confidentiality. An MDDUS adviser can offer detailed advice on the wording of the response, but you should explain how the incident occurred and set out the steps the practice will take to ensure it does not happen again. It may be advisable to conduct a significant event analysis to review what happened and highlight any weak points in the practice’s processes that need to be addressed. You should also contact the patient whose prescription was disclosed in error to inform them of the breach, offering a similar apology, explanation and details of how the practice will change. The breach should be recorded through the NHS Digital Toolkit as is required for general practices in England (elsewhere the practice should consider whether the ICO should be notified, based on the seriousness and significance of the breach).


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