Q A few of our patients have stated recently that they would prefer to communicate with the practice by email rather than by post. Is this something we are allowed to do? I’m worried about confidentiality.
A Email is a convenient way to keep in touch with people but you rightly raise issues of data security. In the first instance, get in touch with your clinical commissioning group (CCG) or health board and find out if they have a local policy about communicating with patients in this way. It is advisable to proceed with caution. While the practice will likely have robust IT protection in place for their email and computer system, the patient may not. Any message you send to them could, unless encrypted, be intercepted and this should be made clear to the patient. Another risk area would be if an email account is shared/ accessible by a number of family members. A good way to minimise risk generally would be to avoid including very sensitive information in email exchanges – perhaps limiting it to matters such as appointment scheduling. Fully explain all these issues and ensure the patient also knows email should not be used to request urgent medical attention. This can be emphasised via an automated email acknowledgement. Similarly, ensure all relevant email accounts are monitored during staff absences.
Q One of our admin staff recently asked about flexible working and whether she could vary her working hours slightly. I’m not sure this would fit with what the practice needs. She’s only been with us for eight months and doesn’t have children to look after. Can I just tell her no?
A Since 2014, all employees who have worked in an organisation for more than 26 weeks have had the right to request flexible working under the Children and Families Act. Previously this right only applied to people with children or caring responsibilities. ACAS has published guidance which states employers are obliged to consider requests in a reasonable manner and meetings should take place as soon as possible. Ask your employee to put her request in writing, stating what changes she would like to make to her working arrangements. She can make one request in any 12 month period and you have three months from receipt to give a decision. Be aware that you must have a sound business reason for rejecting her request – this includes issues such as the burden of additional costs, an inability to reorganise work amongst existing staff, a detrimental impact on quality or performance, or a planned structural change to the business. More detailed guidance is available on the ACAS website and you can access an MDDUS employment law factsheet on our website.
Q We are based in the north of England and one of our male patients has been transitioning to female over the past year, with support from the practice GPs. He has now called up asking for his personal details to be changed on his medical record to reflect his new name and change of gender. Can we do this at his request or should he provide some kind of formal certificate or authorisation first?
A You should ask the patient to submit a signed request in writing. He is not required to provide a Gender Recognition Certificate or updated birth certificate in order to have his record amended (this applies in Scotland too). You should then inform your CCG of the new name and gender (with the patient’s consent). If the patient wishes to be issued with a new NHS number then this can be taken care of by the CCG who will ensure his records are transferred to his new identity. You should explain to the patient he may not be contacted for current or future screening programmes associated with his sex at birth and explain the implications of this. Decisions about screening should be made in the same way as any other decisions about his health (ensuring informed consent is in place). Don’t forget to change the gender marker, pronouns and names on all the patient information that you hold. The GMC have published guidance on trans healthcare on their website which contains further information including the process for changing name, title or NHS number across the UK. Note that it is a criminal offence to share knowledge of a gender reassignment without the subject’s consent.
Q I’ve heard about the recent changes the General Dental Council have introduced about declaring indemnity for our dentists and dental care professionals. Is this a new requirement we need to worry about?
A The GDC has made it clear that this is not a new requirement as dental professionals have always been required to have appropriate indemnity in place. All that has changed is that dentists and DCPs will be asked to “declare” this indemnity when they register/renew their registration. Dentists will make the declaration during the annual renewal period (deadline December 31) which can be done on the eGDC portal. The same applies to DCPs but their deadline is July 31. In relation to dental nurses’ declarations, your employing principal should reassure the employed nurses that they have access to adequate and appropriate indemnity vicariously through the employing principal’s membership with MDDUS. This applies to employed dental nurses only (not locums) where the employing principal is an MDDUS member. The nurses must also ensure they act within their skill set and competence and under the direction of a dentist. More detailed information is available on the GDC website.
Q A patient has submitted a request under the Freedom of Information (Scotland) Act asking for various pieces of information about how the practice works, including how it manages its budget. Is this something we are obliged to give him?
A The 2002 Act gives members of the public the right to access information held by public authorities, including GP surgeries. (The Freedom of Information Act 2000 applies in England, Wales and Northern Ireland and differs slightly from that north of the border). The practice should already have a publication scheme in place which can be a useful means of displaying (often on the practice website) the types of information the practice holds and how it can be requested. Typical publication schemes may include details of the practice’s contract, the services it provides, policies/procedures, the names of the doctors practising there and any costs associated with FOI responses. The scheme should also detail the types of information that the GP holds but cannot make available, and why. The issue raised regarding budgetary management might need a specific answer as disclosing practice finances can be sensitive and may indirectly contravene data protection rights of employees and partners. Data protection rules would apply to any FOI request and the practice must not release any personal or clinical information that the recipient is not entitled to. Patients seeking personal information about themselves can do so via a written subject access request under the terms of the Data Protection Act 1998. FOI requests should be in writing and the practice has 20 working days from receipt of the request to respond. More detailed information can be found on the Information Commissioner’s Office website.
Q We are an English general medical practice and in the past we have not been strict about patients remaining on our list after moving outside practice boundaries. But in recent years our list size has nearly doubled and we are now struggling to meet demand. Consequently we have begun to request that patients living outside practice boundaries register with another GP closer to their home. One patient who has been registered with the practice over 10 years has now written to complain that this will jeopardise his continuity of care. Are we within our rights to ask this patient to register elsewhere?
A It is normal practice to ask a patient who moves out of the practice area to re-register with their local GP. NHS regulations state that a patient may be removed from a practice list if they have moved out of the area but have not deregistered. The patient should be allowed 30 days to make alternative arrangements. In this specific case we advise that the patient should be written to with an explanation behind the decision. Should there be further objection it would be up to the practice to judge whether deregistering without permission would be in this individual patient’s best interests – but such decisions should be consistent to avoid any claim of discrimination.
REMOVING CLINICAL DETAILS
Q A patient at our practice recently had breast augmentation surgery at a private clinic and requested that the hospital not send correspondence to us regarding the procedure – but we had already received a letter regarding the treatment. The patient is now insisting this be removed from her records. What should we do?
A This is relevant clinical information and as such should not be removed from the patient’s records. It might be reasonable to code it as low priority so that it would not appear on referrals. The information might also be marked confidential to ensure it would not be revealed to any other party who may have consent to access her records. Should the clinician judge that this information would be relevant to a specific referral this should be discussed first with the patient.
READ CODE CHANGES
Q A practice nurse has discovered that some of the IT read codes in one particular patient’s records are incorrect and do not reflect his medical condition. Is there any legal risk in just correcting these?
A It would be appropriate to amend the read codes as information within the patient’s records should be accurate. However, we would advise that there is a clear audit trail in relation to this change, including when/why the information was amended and by whom. You may want to contact the providers of your IT clinical system for advice on how this is best achieved. For more guidance see our RCGP-accredited interactive module on good record keeping for GPs.
BUDDY SYSTEM UNPOPULAR
Q Our practice is reconsidering the system we use for managing incoming blood results. It is obviously impractical for the requester to take sole responsibility for their own results as this does not allow for sickness or holiday leave. Currently our GPs use a “buddy system” but this is not popular. What do you suggest?
A An alternate solution would be for all blood results to be dealt with by the duty doctor of the day – or to distribute results equally among all the clinicians with immediate and urgent prescriptions dealt with by the duty doctor. Any protocol will have positives and negatives but it is important to ensure that whichever one is adopted is documented and explained fully to practice staff so that no test results are left waiting for a clinician to return from leave. See our risk checklist on record keeping and workflow processes.