Q Two police officers turned up at our medical practice this morning and informed the receptionist that they know a patient is attending an appointment later today and asked if she could confirm this is the case. They would only say that it relates to an investigation into minor thefts in the local area. What should we do?
A The decision to comply with police requests for information can be a tricky one and each case has to be assessed on its merits. Generally, confidential patient information should not be released without patient consent, unless in the public interest. That is, does the benefit of disclosure outweigh the general benefit to the public of maintaining confidentiality? In its guidance Confidentiality, the General Medical Council states: “If a patient refuses consent, or if it is not practicable to get their consent, information can still be disclosed if it is required by law or can be justified in the public interest.” If the police can produce a court order or evidence of the patient’s consent, then disclosure can be made. Otherwise, the GMC states that it could be justified in serious cases: “for example, when a disclosure would be likely to assist in the prevention, detection or prosecution of serious crime, especially crimes against the person.” In this case, it would appear that this “serious crime” threshold has not yet been met and you could not justify disclosing the information without consent.
Q Our dentists like to have the radio on in the surgery while they treat patients and the TV is usually on in the waiting room. Does this mean we need a special music licence?
A Whether it’s the radio, TV, CD, MP3 or other formats, any business that plays recorded music in public is legally required to have the relevant licence, including dental (and medical) practices. Licences are required to protect the copyright of those who create, produce and publish the music or performances. Your practice will likely need a licence from both Phonographic Performance Limited (PPL) and the Performing Right Society (PRS for Music). Those who fail to obtain the correct licence face legal proceedings for copyright infringement. More information is available on the PPL and PRS for Music websites.
KEEPING IN TOUCH
Q One of our receptionists is due to return from maternity leave in a few months and during a recent meeting she explained she was very nervous at the thought of coming back to work, as she had not had much contact from colleagues. While I would be happy to keep employees on leave up-to-date with practice news, I am wary of this being perceived as "harassment".
A The law allows employers to keep in “reasonable contact” with employees on maternity leave. This would certainly include internal matters such as practice organisational changes, staffing issues, promotion opportunities, job vacancies and any planned reorganisations or redundancies. Contact can be maintained informally via email, text, a pre-arranged phone call or even a letter, and notes from staff meetings could be sent. Some organisations use a ‘buddy’ system, where someone in the practice is chosen to keep the employee updated on events and changes. Each employee is different and it is worth agreeing with them in advance about the level of communication they would prefer. A more formal arrangement is by using Keeping in Touch (KIT) days – up to 10 days can be used during an employee’s maternity leave period. KIT days cannot be enforced and must be agreed by both the employee and the practice, as there is no obligation for the employee to work them or for the practice to offer them. KIT days can be used for undertaking work, attending meetings, conferences or training. There is no set rate of pay for such days and this should also be mutually agreed. Discuss with each employee how they would like to proceed. An informal home visit towards the end of leave can also be useful.
POWER TO DECIDE
Q The son of an elderly female patient has complained to a practice (in Scotland) about the the number of visits she is receiving from the district nurse. He believes that his mother requires additional support. The son says he has the right to make this request because he has power of attorney for his mother’s affairs.
A There are two important elements to clarify. First, what is the nature of the power of attorney held? These can be for financial or welfare decisions, or both. In terms of medical decisions, only a welfare power of attorney is relevant. Secondly, does the patient lack capacity to make decisions regarding the relevant issues? If not, then the power of attorney does not apply and the usual procedure for informed patient consent should be followed. If the patient does lack capacity (and her son has welfare power of attorney) then it may be useful to invite her son to discuss her care and make every attempt to reach a consensus on how best to proceed. If agreement can’t be reached, then consider involving an independent advocate, obtaining a second opinion, holding a case conference or using local mediation services. The Mental Welfare Commission (Scotland) may also assist (law is different elsewhere in the UK). If all of this fails, you may wish to seek legal advice on applying to the appropriate court or statutory body for review or an independent ruling.
Q One of the receptionists has been off sick for three weeks for the second time in six months which is putting a lot of pressure on the rest of the staff. I have heard about the government’s new Fit for Work scheme. Can I make her undergo an assessment to help get her back to work?
A The Fit for Work scheme, funded by the Department for Work and Pensions, is being rolled out across the UK and should be fully operational in Scotland, England and Wales later in 2015. It provides an occupational health assessment and general health and work advice to employees, employers and GPs with the aim of helping individuals stay in or return to work. Crucially, employees must give their consent to take part in the scheme, so you can’t “make” your receptionist participate. Under the scheme, once the employee reaches four weeks of sickness absence, they can be referred by their GP for an occupational health assessment to examine the issues preventing their return to work. Fit for Work will then create a return-to-work plan including recommendations to help them get back to work and information on where to find further advice. Free advice is also available to employers, employees and GPs by phone or on the Fit for Work and Fit for Work Scotland websites. It would be advisable to update your practice sickness policy to reflect the new scheme.
Q One of our dental patients owed the practice £500 following private treatment to root treat and place a crown on one of his teeth. We have sent out several written reminders in recent months but only a third has so far been paid. A few days ago the dentist left a message on the patient’s home answering machine asking him to call the practice about the unpaid bill. The patient has since complained about a breach of confidentiality because his wife heard the message and did not know about the debt.
A Patients should only be contacted by phone if they have given their express consent for you to do so. Even then, sensitive patient information should never be disclosed in telephone messages due to the potential for a third party to intercept them. In this case, confidentiality has been breached and the patient should be sent a written apology acknowledging the mistake and offering reassurances that it will not be repeated. Practice systems regarding confidentiality should be reviewed and details of how procedures have been improved should also be outlined in writing to the patient. It would be worth considering waiving the outstanding debt in recognition of the distress caused.
AN APPROPRIATE GIFT
Q A long-standing patient who is recovering from cancer has recently come into the practice to give her GP a large bottle of malt whisky and an expensive box of chocolates to thank him for the care he has provided over the past few months. The patient insists it is nothing more than a sign of appreciation for all that the doctor has done, but I am unsure whether it is appropriate to accept such a gift.
A The issue of accepting or refusing a patient gift is a difficult one. Sometimes there may be no harm in accepting a small token of gratitude, but other gifts may represent something more. The GMC’s Good Medical Practice advises doctors not to “ask for or accept any inducement, gift or hospitality which may affect or be seen to affect your judgement,” adding that doctors “must not encourage patients to give, lend or bequeath money or gifts that will directly or indirectly benefit you.” A strict “no gifts” policy may be difficult to enforce but you must consider whether accepting a gift could be seen to influence the doctor’s decision-making, and you should be able to demonstrate that it hasn’t. Consider discussing the offer of a gift with the patient and make it clear that their gesture will not have any impact on the care they receive. There is often concern about insulting or upsetting a patient by not accepting a gift but you should respectfully refuse/return anything that you feel is inappropriate. A practice gift register may be a helpful way of noting correspondence or conversations surrounding the offer of a gift, as well as reasons for accepting it.
Q I have heard the Information Commissioner’s Office will be carrying out checks on GP practices. Can they come into our practice without asking us first?
A Since February 2015, the ICO has been able to enter premises – including GP practices – without consent to carry out compulsory data protection audits. Consent was previously required for audits within the NHS, but this rule no longer stands. The ICO plans to use its powers to target poor performing parts of the health sector and act before a breach occurs. Practices should have a robust system in place to ensure patient data is stored and shared securely. Ensure your practice has appropriate security arrangements in place and consider the potential for data breaches in all electronic communications involving confidential patient data. Encryption can reduce some risks, identifiable data should never be stored on personal computers, and sufficient IT training and support should be available to staff. The ICO has powers to impose monetary penalties, issue undertakings or even launch criminal proceedings in organisations failing to protect private data.