Most practices will have a number of patients travelling overseas at any one point in time – some may be on long-term trips or holiday, some may be travelling home to see family they have left behind upon making the UK their home.
When reviewing MDDUS cases, it is evident that patients overseas may contact their practice or GP for a number of reasons. These can include:
• an urgent request for faxed medical records due to an emergency admission
• a deterioration in an ongoing condition
• the contraction of an illness whilst abroad
• a request to change an appointment time which has been scheduled – perhaps their trip has been delayed
• a request for a repeat prescription to be prepared in time for their return – perhaps they are due to run out.
If patients contact the surgery whilst outside the UK, it is important to understand the risks associated with responding to requests for medical advice.
For urgent requests for information where the patient is able to consent, it is reasonable to fax or email relevant information. The decision on what information to share should be made by a clinician who has spoken to the patient, or another clinician treating the patient overseas.
You should take some steps to try to minimise the risks associated with the transfer of information, such as double-checking any fax numbers or email addresses provided. You should also take steps to be reassured that the information will be received by an appropriate individual and confirm that it has been received by that individual.
Where the patient cannot consent, it is important that the GP is reassured that the transfer of relevant information is in the patient’s best interest, based on the information available to them.
Therefore, where consent has not been obtained, the practice must take into account the provisions of the Data Protection Act 1998, specifically in relation to the eighth data protection principle which states: “Personal data shall not be transferred to a country or territory outside the EEA unless that country or territory ensures an adequate level of protection for the rights and freedoms of data subjects in relation to the processing of personal data”.
The Information Commissioner provides guidance to data controllers on assessing adequacy of non-EEA countries, and these should be considered before any decision to transfer personal data is made.
There are exemptions to the principle, the main one being where consent has been obtained from the patient. However, the same general consent rules apply in that it must have been given freely and clearly, and that it may also be withdrawn at any time. Consent will also not be considered valid if the individual has no choice but to give their consent.
Other specific exemptions include arguments about substantial public interest or protecting any “vital interests” of the data subject, which relate to matters of life and death.
Where the request is administrative, such as for a repeat prescription due upon their return or for an appointment, there is no reason why a practice cannot respond to this in the normal manner, subject to the above provisions.
In circumstances where a patient is requesting medical advice, it is very important to be aware that along with the risks associated with not being able to assess the patient properly in order to make a proper diagnosis, there are increased risks associated with treating patients in other countries. MDDUS is a UK-wide indemnity organisation and provides assistance to members for actions raised against them within the UK. Members would NOT be represented if action was taken against them in another country where harm had arisen as a result of their provision of advice.
Because of this, we would strongly advise that members do not offer any medical advice to a patient who is overseas but that they encourage that patient to see a local medical practitioner.
ACTION: Carefully consider any contacts from patients overseas. Any non-urgent requests for medical advice should be responded to by explaining that the GP is unable to give advice and that the patient should seek medical attention locally.