Manager Practice A


The GMC states in Good Medical Practice that a doctor may accept unsolicited gifts from patients or relatives but should consider whether by doing so they are altering their relationship with the patient, and also how this may be perceived by the public in general. The regulator provides supplementary guidance in regard to financial and commercial arrangements and potential conflicts of interest, which is available at www.gmc-org.uk. The practice should be satisfied that all actions taken are in accordance with such guidance and must be prepared to explain and justify any decisions made and actions taken. The acceptance of gifts by general practitioners is also subject to statutory and contractual regulations. The General Medical Services Contract Regulations highlight that a register should be kept of gifts received of a value in excess of £100, unless the gift is unconnected with their professional services. This register should include details of the donor and the nature of the gift, including whether it was given to the practice or an individual.


SISTER ON THE LIST Q


Our practice is in a rural area and it has recently come to my attention that the practice nurse has a sister who is registered as a patient. The nurse has assured me that she is aware of the legal requirements in regard to patient confidentiality and that she would never access her sister’s medical records inappropriately. What is the legal/ethical position on having family members of staff registered at the practice?


A


The Nursing and Midwifery Council Code states that nurses should “stay objective and have clear professional boundaries at all times with people in your care”. GMC guidance (Good Medical Practice) is more specific on the treatment of family members, stating that: “Wherever possible, avoid providing medical care to yourself or anyone with whom you have a close personal relationship”. It would be preferable for the sister to be registered elsewhere but if this is not possible then the practice should ensure that the nurse is not providing direct care and also that a strict policy with regard to accessing medical records is adhered to by all employees to ensure confidentiality. Patient systems can also be set up to alert the PM to staff accessing particular records – e.g. those designated as family members at point of registration.


SAFEGUARDING CONCERNS Q


A child from a large family in our practice recently died in an accident. The local child death co-ordinator has now requested that the practice disclose the child’s medical records (including concerns about safeguarding) to the safeguarding team. The team have not obtained parental consent for the release of the records as they are relying on the provisions of the


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Crime and Disorder Act 1998 in order to prevent serious harm to a child or young person. We are aware of no concerns regarding the safety of the other children in the family and are thus unsure why the disclosure is necessary. Can you advise?


A


The GMC states that doctors must co-operate with any investigations regarding the safety or welfare of a child or young person. Perhaps the safeguarding team is investigating factors leading to the child’s death, as well as further concerns for the safety of the other children in the family. In any case it would be helpful for the practice to have more information. A data controller is entitled to request this in order to be satisfied that disclosure in the absence of consent from a personal representative of the deceased is appropriate. You should reassure the safeguarding team of your willingness to co-operate in the investigation but state that you also require sufficient details to determine what information sharing is appropriate. If the safeguarding team believes that parental consent is not required they would need to explain why consent has not been sought. Should you judge that disclosure of the information requested is in the public interest, this disclosure should be of the minimum necessary and relevant to the purpose. Your local Caldicott Guardian may be able to advise you with any further concerns.


EXTREME SPORT Q A


A 52-year-old patient has been in touch with the practice asking for one of the GPs to fill in a medical certificate. She plans to take part in a charity challenge which includes cycling over rough terrain for several days and needs to be certified fit. We are worried about being held liable should anything go wrong.


Doctors must be cautious when completing fitness certificates. Even if the patient has been thoroughly examined, appears healthy and has no history of health problems that would cause concern, this is no guarantee of future fitness. The GP must be sure to act within their expertise and knowledge and be able to justify what they have written should they later be questioned. It may be advisable to make a broad statement along the


lines of: “Based on the information available in the patient’s medical notes, there appears to be no contraindication to exercise but, given the nature of the event, a sport medicine specialist with knowledge of the event would be better placed to comment on the specific query raised”.


REFUSING TO PAY Q


We have a patient who is dissatisfied with her upper partial denture after having consented to treatment and costings. She is now refusing to pay though seems happy enough to keep the denture. Our experience in chasing such patients has been singularly unsuccessful and I have advised the dentist to let it go but he is adamant we pursue the debt. Would it be wise to chase and how can we prevent this from happening in future?


A


Pursuance of outstanding payments can be a long and frustrating business but writing off such debts is equally disappointing. You might consider contacting the patient again to offer a further review to discuss any problems and make adjustments. You could also instigate the normal practice protocol of reminder letters before consideration of forwarding to a debt collection agency for recovery of the money. To prevent this happening in the future you might consider instigating staged payments each time the patient attends for treatment, thus making sure that a significant amount is paid before treatment is completed.


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