These cases are based on actual advice calls made to MDDUS advisers and are published here to highlight common challenges within practice management. Details have been changed to maintain confidentiality.
Q Can you advise whether our practice can charge for photocopying patient records that have been requested by court order but via a solicitor’s office?
A A practice complying with a court order to supply copies of patient records is not allowed to charge a fee for photocopying. This applies irrespective of whether the order is received directly from the court or via a solicitor. However, the solicitor is obliged to supply the practice with a copy of the court order so you should make sure you are in receipt of this before sending the photocopied records.
ACCESSING DECEASED RECORDS
Q The daughter of a deceased patient has written to the practice requesting a copy of all notes relating to her mother’s care during the final 12 months of her life. We are unaware of any instructions from the patient with regard to access to her records after death and she had not appointed a personal representative. We have discussed the request with the patient’s two other daughters and they have no objections. Should we comply?
AIt would be advisable to consult the General Medical Council’s guidance on Confidentiality regarding disclosing information after a patient has died. The guidance advises that in these circumstances you should consider whether disclosing such information would likely cause distress to the patient’s partner or family and whether there are any concerns over a breach of third-party confidentiality. Among the circumstances in which the GMC states you should usually disclose relevant information about a deceased patient is when “someone close to an adult patient asks for information about the circumstances of that patient’s death and you have no reason to believe the patient would have objected to such a disclosure”. This may apply in this particular case, and consideration should be given to which records might be relevant to disclose.
QWe have received a request from the Nursing and Midwifery Council (NMC) for access to the full records of two patients. They say they need the files as part of an investigation into the conduct of a nurse who worked at the practice up until six months ago. Am I allowed to hand over the records without asking the patients’ consent?
A Ordinarily, before disclosing identifiable information you would be expected to first seek express patient consent. In this case, the NMC has a statutory power to request information for the purposes of their investigation, so patient consent is not strictly necessary if the NMC states that they are relying on these powers. That said, the GMC’s Confidentiality guidance states that, whenever practicable, you should inform patients about such disclosures unless that would undermine the purpose, even if their consent is not required. It also states that disclosures should be kept to a minimum so it is worth confirming with the NMC whether the full patient records are required, or if specific information can be supplied.
Q The sister of one of our patients has attended the practice asking one of our GPs to fill in a travel insurance form on behalf of her brother, Mr B. She wants to claim back the cost of a holiday that he was forced to miss due to ill health. Mr B no longer has capacity to make decisions for himself and is unable to
A The first thing to do is to clarify whether Mr B has appointed a power of attorney (POA) or deputy to make health and welfare decisions on his behalf. If the sister has the relevant POA then this would permit your GP to complete the travel insurance form on Mr B’s behalf. In addition to this, you should check whether there is anything in Mr B’s records to indicate that he would not want this information disclosed. If there is POA in place, be sure to comply with relevant capacity legislation and act in the patient’s best interests. If you do decide to complete the form, be sure to disclose only the minimum amount of information necessary.
Q The mother of a five-year-old patient has called up asking if we can confirm that her estranged husband attended with their son for his dental check-up this morning. We know she has parental responsibility and isn’t on speaking terms with the dad. Are we allowed to confirm this information for her?
A Dealing with the estranged parents of a child patient can be a difficult situation for practices as emotions often run high. In this instance, it may be best to phone the mum to discuss her request and any concerns she may have about her son’s ongoing care. As she has parental responsibility and if it is in the child’s best interests, she would be entitled to know whether or not her child attended for his appointment. You may wish to consider reaching an agreement regarding the child’s dental care arrangements in the future to avoid the practice being placed in a difficult position between two estranged parents.
Q Our practice offers patients an online service for requesting repeat prescriptions but despite promoting this extensively on our home page and with posters and leaflets in the waiting room, uptake remains below 10 per cent. Can we adopt a policy prioritising online repeat prescriptions with a five-day notice period for manual requests?
A The answer to your query may depend on your usual practice regarding prescriptions. If you currently require all patients to give five day’s notice for repeat prescriptions then it may be acceptable to process electronic prescriptions quicker than this as an incentive, but you should consider how this may disadvantage some patients. Certainly, if your current policy calls for repeat prescriptions to be returned within 48 hours it could be seen as discriminatory to delay processing of manual prescriptions from patients who may lack access to the internet or the skills/ confidence to use the online service. Practices should seek contractual/policy advice on the issue from their health board or CCG. There is also RCGP guidance on encouraging patients to take up on-line services. Go to www.tinyurl.com/y74sh9nb
Q During a recent spell of severe weather, some members of our practice team were unable to attend work for two days. Some of the team were able to make it in, so it seems unfair that I should have to pay the ones who didn’t. What am I legally allowed to do in this situation?
AThere is no statutory obligation to pay staff if they cannot attend work due to the weather conditions. However, the practice may have contractual obligations or have custom and practice arrangements in place from previous years. You also need to consider health and safety obligations, as you have a duty of care to your employees. Common sense should be applied. Where there is a Met Office warning to avoid travel, then it is not reasonable to be encouraging employees to come to work. Few contracts will include a clause allowing the practice to deduct a day’s pay if an employee cannot make it in and employees also have a statutory right protecting them against unlawful wage deductions. So, if the practice does not have the contractual right to deduct pay and the employee does not consent to the deduction, a complaint could be raised. Therefore, it is important for the practice to be flexible. How such matters are handled can often affect morale and productivity so it is advisable to introduce a bad weather policy that should be clearly communicated to all employees and applied consistently.
DENTIST WITH A SPECIAL INTEREST
Q One of the dentists in our surgery has been undertaking orthodontic cases having worked part-time in a local orthodontic practice for the past three years and also being halfway through an MSc in the subject. She is not on a GDC specialist list and we obviously cannot advertise her as such on our website. Would it be okay to refer to her as a dentist with a special interest in orthodontics?
A The General Dental Council states in its Standards for the Dental Team that “you must make sure that any advertising, promotional material or other information that you produce is accurate and not misleading and complies with the GDC’s Guidance on Ethical Advertising”. The regulator is very strict when it comes to misusing the term ‘specialist’. This is reserved only for dentists who have completed a GDC-approved specialist training programme and have been awarded a certificate of completion of specialist training (CCST), and who are listed on one of the GDC specialist lists. However, given the historic evidence of the dentist’s commitment to orthodontic practice and her additional training and experience, it would be fair to describe her as a dentist with a special interest in orthodontics.
MEDICAL REPORT BACKLOG
Q We are currently dealing with a backlog of insurance reports in our medical practice and recently an insurance company wrote to inform us that should something dire happen to a patient without life insurance then the practice would be legally at fault. Is this true?
A Receipt of a medical report can be an obvious rate-limiting step in securing insurance and a patient and their family could be left seriously compromised if such a report is not provided in a timely manner. Were a complaint or claim to be made on such a matter, the outcome would depend very much on the extent of and reasons behind the delay but the practice could be at risk of breach of duty of care. It is hard to be more precise in this matter but with any undue delay it is best to inform the requesting organisation so that they are on notice that a report may take some time to complete (see case study on p. 14).
EXEMPTION FROM JURY DUTY
Q A patient in our Glasgow medical practice has been called up for jury duty. She suffers with moderate to severe multiple sclerosis and is requesting an exemption on the basis of her condition. What are our responsibilities and how do we process such a request?
A Potential jurors who are too ill to attend court must provide the clerk of court with a medical certificate. In general a medical certificate should set out the date on which a medical practitioner last examined the patient, the exact nature of the patient’s condition and (if not selfevident) why this would make attendance at court difficult. Note that medical certificates which are requested from GPs for the purpose of jury service are exempt from payment as set out in the terms of The National Health Service (General Medical Services Contracts) (Scotland) Regulations 2004. In England patients wishing an exemption from jury duty are directed to write to the Jury Central Summoning Bureau including evidence in the form of a “letter from your doctor”. Certificates to establish unfitness for jury duty must also be supplied free of charge under GMS Regulations.