Q A mother phones up her GP practice and asks for her five-year-old daughter’s surname to be changed to her own on the child’s medical records. She tells the practice manager she’d rather not involve the girl’s father. The manager is concerned about proceeding without first speaking to both parents.
A An MDDUS adviser explains that if the child’s father has parental responsibilities, then his consent would be required before the child’s name is changed on the records. A father holds parental responsibility if he is married to the child’s mother (either when the child is born or at a later date), or if he is registered on the birth certificate as the father (in England and Wales since December 2003, in Northern Ireland since April 2002 and in Scotland since May 2006). An unmarried father can also acquire parental responsibility by court order or having a Parental Responsibility Agreement with the mother (for which there is a formal procedure). If the mother can’t provide evidence of the father’s consent then the child’s name should not be changed.
Q A practice manager notices that a number of patients have been leaving the practice in recent months and is concerned by the trend. She would like to contact some of them to ask their reason for leaving but is worried about breaching the Data Protection Act (DPA) and calls MDDUS for advice.
A The manager is advised to proceed carefully in this case as confidential patient details should only be accessed for sound clinical reasons. In addition, accessing the records of patients who are no longer with the practice risks breaching the DPA. Rather than contacting the individual patients who have left, the MDDUS adviser tells the manager to consider inviting current patients to complete a questionnaire asking for their views on the services provided. This may offer a more effective means of finding out if patients are satisfied with the services provided by the practice. A questionnaire would also be less intrusive than making direct contact with former patients.
Q A deaf patient has sent a bill to his dental practice requesting payment for the sign language interpreter who accompanies him during his consultations. The interpreter was previously free but recently decided to charge the patient. The patient did not consult the practice before arranging this particular interpreter. The practice manager believes the hourly rate charged is too high and objects to the request. The manager tells an MDDUS adviser that she has tried to come to an agreement with the patient over the costs, but the patient insists that if the practice does not pay for the interpreter then that amounts to discrimination under the Disability Discrimination Act (DDA).
A The DDA requires practitioners to make “reasonable adjustments” for disabled patients, such as providing clearer signage and induction loops. The Act explains that, although they are not required to anticipate the needs of every individual, they are required to take reasonable steps to overcome any features that may impede disabled people. The manager is advised to look for a suitable alternative to the expensive interpreter, such as approaching charities to enquire about the availability of free, or more reasonably priced, interpreting services. If a suitable alternative is found that meets the needs of the disabled patient then the patient would be unable to refuse under the terms of the Act.
Q A refused asylum seeker from Somalia tries to register at a GP practice and is seeking treatment for a skin infection. After making checks, the practice manager discovers she is in the country illegally and has no right to NHS funding. He calls MDDUS and asks whether he should register the woman considering he may not be able to secure NHS funding for her. He also wants to know whether he should alert the authorities about the woman because of her residency status.
A The manager is advised that the Somali woman should be given any immediate necessary care and that GPs in England, Wales and Scotland have the discretion to register any patient irrespective of residency status. Once registered with a GP, asylum seekers and refused asylum seekers are entitled to free primary care services, although some statutory charges, such as those for prescriptions, may still apply. Practices are not required to check the identity or immigration status of prospective patients and patients are not obliged to provide evidence in this regard. Refused asylum seekers have the same right to confidentiality as other patients and the manager must not disclose confidential information to a third party without patient consent. More information is available in the BMA guidance document Access to health care for asylum seekers and refused asylum seekers.
Q A practice manager wants to cut down on the amount of hard copy letters sent out and is considering making contact with some patients via their private email addresses. She feels this would be a more efficient way of keeping in touch with patients but is concerned about data security.
A Practices should not send confidential information to patients’ private email addresses without their prior consent to avoid the risk of a third party accessing the message. Disclosing sensitive information in this way could breach the Data Protection Act and practices could face stiff penalties. Where possible, use more secure NHS email accounts, double-check you are sending to the correct recipient and only include the minimum amount of information necessary for the purpose of the disclosure. If you are concerned that email may not be suitably secure, use another means of communication.