These cases are based on actual advice calls made to MDDUS advisers and are published in the magazine to highlight common challenges within practice management. Details have been changed to maintain confidentiality.
CONFLICT WITH RIVALS
Q There are two practices in a health centre and Practice A have started mailshotting established housing estates in the hope of attracting some of Practice B’s patients. Practice B are angry at this campaign and contact MDDUS to ask if their rivals are acting unethically and can somehow be stopped. They intend to write to Practice A about their actions and ask MDDUS for advice.
A MDDUS agreed with Practice B that common, courteous practice would be to only mailshot new housing estates where residents may not be aware of the existence of particular GP services in the area. However, Practice A are entitled to mailshot any group of potential patients, provided they stick to clear guidelines. These are set out by both the BMA and in the GMC’s Good Medical Practice regarding probity which states: "If you publish information about your medical services, you must make sure the information is factual and verifiable. You must not make unjustifiable claims about the quality or outcomes of your services in any information you provide to patients. It must not offer guarantees of cures, nor exploit patients’ vulnerability or lack of medical knowledge. You must not put pressure on people to use a service, for example by arousing ill-founded fears for their future health." Any correspondence with Practice A must be very carefully worded and avoid unfounded accusations about their actions.
Q A receptionist within a medical practice is having an affair with a patient, Mr B. Mrs B is also a patient at the same practice and is furious when she discovers her husband’s infidelity. Mrs B complains to the practice manager and raises concerns over the confidentiality of her personal details and medical records, to which the receptionist has access. Mrs B demands the receptionist be dismissed or, at the very least, disciplined and denied all access to her personal records. The practice value the receptionist highly and do not want to terminate her employment. They are unsure how to respond to Mrs B’s complaints and what appropriate action, if any, should be taken regarding the staff member.
A An MDDUS adviser spoke to the practice manager and advised her to assess whether limiting the receptionist’s access to Mrs B’s records would be practically possible. If so, the practice should write to Mrs B suggesting this course of action. If this wasn’t possible, Mrs B should be advised of this along with her right to register with another practice. Disciplining the receptionist would have to be undertaken in line with the terms and conditions stated in her contract of employment. Dismissing the worker would only be an option if her behaviour amounted to ‘gross misconduct’ as defined in her contract.
A MATTER OF DATA PROTECTION
Q A practice is asked by a patient, Mr G, for access to his medical records. The patient is adopted - and is aware of his adoption - but his records detail significant third party information with regards to this. The practice ask MDDUS how to deal with Mr G’s request and how they should handle the sensitive information.
A We advised the practice that they are bound to comply with the Data Protection Act which means any third party information in Mr G’s file must be removed or redacted before he is allowed access. Particular care must be taken if sending an electronic copy of records to the patient as these may be difficult or even impossible to redact. MDDUS advised the practice to print off the records, redact or remove the third party information and then invite Mr G to come to the practice to collect his records. A GP could then go through the records with Mr G to discuss any sensitive issues, medical terminology or other matters arising. Should Mr G question why parts of his records are redacted, the practice should explain they have done so to comply with the Data Protection Act. If the patient is still unhappy, or believes information has been held back inappropriately, he can be referred to the Information Commissioner’s Office at www.ico.gov.uk for further advice.
Q A patient is found to have forged a sick note to his employer claiming to be from Dr J at the patient’s medical practice. The practice have asked MDDUS how to handle this deception and whether they are entitled to remove him from the practice list.
A An MDDUS advisor discussed the matter with the practice manager and advised that she consult the RCGP’s guidance, Removal of Patients from GPs’ Lists. The RCGP states that "unacceptable behaviour such as… crime and deception such as lying to a doctor to obtain a service” is grounds for removal. Patients must always be given a reason for their removal from a practice, except in "very exceptional circumstances". The practice’s contract also requires patients are sent a written warning if they are about to be removed or if they face the risk of removal, should the inappropriate behaviour be repeated. MDDUS advised the practice to use their judgement as to whether to remove the patient in this instance or simply warn him of the consequences of any repeat behaviour. The GMC’s Good Medical Practice also advises doctors to make a "fair" and justifiable decision. If a patient is removed, the doctor must make prompt arrangements for the patient’s continuing care by contacting the PCT or health board in the usual way.