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.
Q The police have asked a practice manager to help them trace a missing person who is a patient at the practice. The officer told the manager that the young woman has been missing for two weeks and her family are desperate to get in touch with her. The manager has since heard that the missing woman has made contact with a practice five miles away, who have never treated her before. The practice manager asks MDDUS if she should alert the police.
A In general, the police would only be entitled to access confidential patient information in the prevention or detection of a serious crime. In this case, however, there may be a public interest in the practice alerting the police about the missing woman. An MDDUS adviser explains this to the manager and recommends contact is made with the other medical practice and that the practice use their clinical judgement in deciding whether or not to inform the police. The GMC guidance Confidentiality also covers this subject.
CLINICAL RECORDS ONLY
Q A practice is being sued for damages by a patient who alleges medical negligence against one of its GPs. Solicitors acting for the patient request copies of all relevant medical records. The practice manager sends full copies of the record but only later notices that included among the documents is correspondence between the GP and a medico-legal adviser from MDDUS which refers to the original patient complaint and the likelihood of a negligence claim. The practice manager is worried about his mistake and calls MDDUS for advice about how to store such documents in future.
A It is essential that a patient’s medical or dental records are used to keep clinically relevant information only. Storing non-clinical information here risks improper disclosure of non-relevant information or breaching third party confidentiality. Documents like medical reports for insurance companies, DWP reports, case conference meeting minutes regarding issues of child protection or a vulnerable adult and correspondence relating to patient complaints should be maintained in a separate patient file. If the patient leaves the practice then this separate file can be sent, where appropriate, in a separate envelope or folder clearly marked as ‘non-clinical’ or ‘medico-legal information’.
A SIMPLE DISCLOSURE
Q A GP is contacted by the headteacher of the village primary school who asks about one of her patients, an eight-year-old boy. The teacher wants the GP to confirm where the child lives and explains that he suspects the boy’s parents are using a bogus address in order to get him into the school. The GP believes the family do not actually live in the school catchment area and wonders if there is any harm in confirming the headteacher’s suspicions.
A An MDDUS adviser told the GP that even confirming whether or not the address held by the school was the same as the one held by the practice would violate patient confidentiality. The GP would need consent from the child’s parents before releasing any information – even if she knew the headteacher’s suspicions were well-founded. Only if the disclosure was made in the public interest, in accordance with GMC guidance Confidentiality, could a doctor consider disclosing without consent.
COURT ORDER FOR RECORDS
Q A general practice in Scotland contacts MDDUS in regard to a court order to surrender a patient’s records for use in criminal proceedings. The question is whether the practice has to provide the original documents or would a photocopy be sufficient?
A It is often assumed that police require original documents for evidential purposes but this means that a practice may be deprived of an original patient record for months or even years in some criminal cases. An MDDUS adviser is able to provide the practice with a copy of a document setting out an agreement between NHS Scotland and the Crown (via the Procurator Fiscal Service) that states that in the first instance “clearly authenticated copy medical records” can be provided in all cases unless the patient is deceased. The Crown reserves the right to request originals in certain circumstances (e.g. where the writing is difficult to read or there are concerns that the record may be incomplete). The document also provides a template for a certificate of authorisation which must be completed and attached to the record copy. Access at www.tinyurl.com/2u8eloe
HOME VISIT DEMAND
Q A mother phones a general medical practice in regard to her child who has been vomiting all night and may be dehydrated. The mother lives relatively nearby but refuses to bring the child into the practice and insists on a home visit. The practice is extremely busy at the time and the practice manager phones MDDUS to ask if the mother can be refused a home visit and compelled to bring the child in.
A A medical adviser speaks with the manager and first clarifies that MDDUS cannot provide specific clinical advice on the case. But she points out that the practice has a duty of care to its patients and obligations as part of the General Medical Services contract, and the doctor on call will have individual responsibility as set out by the GMC in Good Medical Practice. Should the mother not be persuaded to bring the child into the practice it would be wiser on risk grounds that the practice accommodate her request for a home visit. In the end it is a matter of clinical judgment but better safe now than sorry later.