These cases are based on actual calls made to MDDUS advisers and are published here to highlight common challenges within general practice. Details have been changed to maintain confidentiality.
Employee and patient?
Q. We’re interviewing for a new receptionist and one of the candidates is also a patient. Should we discount her from the process for that reason, or does she have the right to be both a patient and a member of the practice staff?
If an employee is also a patient at the practice where they are employed, it can cause a myriad of problems. However, it would not be fair to simply reject her application for this reason. We would advise you to inform all prospective employees at the interview stage that the successful candidate would be required to register as a patient at another practice. The only exemption to this would be if your practice was in a remote setting and there were no viable alternatives available. As part of the conditions of employment, this information should be included as a policy in your employee handbook. There are potential conflicts of interest that can arise if an employee is a patient at the practice. The doctor-patient relationship should be kept separate and it is in the best interests of all patients to have access to independent and objective care.
Private clinic ads
Q. We have rented a room in the practice to a private provider of aesthetic treatments. They have asked if we could put up some posters in the waiting room and public areas highlighting their service. Is this allowed?
Putting up posters to advertise this service is not a conflict of interest per se, but you should approach this with caution. If it appears that the practice is in some way recommending the clinic’s treatments, and if the practice benefits financially from patients attending, then this could create difficulties. You should refer to the General Medical Council’s guidance, Good medical practice, specifically the parts on acting with honesty and integrity. At par 70, it states that when advertising your services you must make sure the information you publish is factual and can be checked and does not exploit patients’ vulnerability or lack of medical knowledge. Pars 77 and 80 may also be relevant, in particular: “You must not allow any interests you have to affect the way you prescribe for, treat, refer or commission services for patients.”
Q. One of our longest-attending patients, Miss C, has come into the practice with four bottles of champagne as Christmas gifts for the practice GPs. Each bottle is worth around £35. The patient said she simply wanted to show her appreciation after such a tough year. Can we accept these gifts?
The General Medical Council states in Good medical practice that a doctor “must not ask for or accept – from patients, colleagues or others – any inducement, gift or hospitality that may affect or be seen to affect the way you prescribe for, treat or refer patients or commission services for patients”. The regulator also provides supplementary guidance in regard to financial and commercial arrangements and potential conflicts of interest. This states 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. Doctors should therefore proceed cautiously when considering accepting a gift. 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.
Q. A patient, Mr G, has been coming in for regular treatment over the past few months, mostly with our nurse, Ms L. On his last visit he told the nurse he had developed romantic feelings for her and asked her personal questions. Ms L felt very uncomfortable and advised him she was not interested and that his behaviour was inappropriate. The practice is concerned about this behaviour – what should we do?
This is a difficult situation, however the practice has a duty to protect its staff and some action should be taken. One option would be to invite Mr G in for a meeting with the practice manager and GP partner to discuss the event. During this meeting, it should be made clear to Mr G in a very gentle way that this type of behaviour is unacceptable and that he has put Ms L in a very difficult position. The patient should be advised that he is not to see Ms L and warned that if any behaviour of this type is repeated, you would have no option but to remove him from the practice list. Make it clear to Mr G that you are prepared to continue treating him, but if he feels uncomfortable then he has the right to find another GP practice.
Responsibility for repeat prescribing
Q. I am a partner at a group practice and, in order to reduce workloads, we are planning to move to a system where a duty GP signs all repeat prescriptions (rather than each GP signing their own individual scripts). Would this be acceptable?
The General Medical Council’s guidance on prescribing has a specific section on repeat prescribing that would be a useful reference for you. It states: “You are responsible for any prescription you sign, including repeat prescriptions for medicines initiated by colleagues, so you must make sure that any repeat prescription you sign is safe and appropriate. You should consider the benefits of prescribing with repeats and, where possible, reduce repeat prescribing.” Therefore, should any medical mishap arise from the medication you prescribed you may be held to be at least partly responsible. You must therefore be prepared to explain and justify your decisions and actions when prescribing, administering and managing medicines. Under your proposed new system, responsibility would fall not only to the initial clinician (who instigated the medication and authorised it to be a repeat), but also to the clinician who then signs and authorises the actual repeat prescription. The duty doctor should be aware of this when signing the repeat prescriptions and take care to ensure the prescription is safe and appropriate.
Q. Once government restrictions ease, the practice is looking to arrange a small party to thank staff for their hard work. I’ve never arranged anything like this before – are there any pitfalls I should look out for?
Before arranging any kind of social gathering, be sure to check this is compliant with the latest government Covid-19 advice in your part of the UK. Once it is safe to proceed, consider advising staff in advance about acceptable behaviour and boundaries and warn them of the potential consequences of inappropriate behaviour. Remind them that, even though they are at a party, it is still work and every employee has the right to be in an environment free from bullying and harassment. It would be useful to highlight the practice’s bullying and harassment policy and the disciplinary sanctions that could be invoked if rules are breached. Some examples of inappropriate behaviour include:
- excessive alcohol consumption
- making discriminatory or inappropriate sexual comments
- taking illegal substances.
If you plan to provide alcohol, then it may be wise to limit the amount on offer and ensure there are plenty of alcohol-free drinks. Consider also transport home at the end of the night – it may be useful to note down some taxi numbers and basic information on public transport links.