The scene

A salaried GP called the MDU advice line after a patient had sent a written complaint to the GP practice after a phone consultation. The GP was upset because this was her first complaint and she did not know how to reply.

A 65-year old male patient had phoned the GP practice from Spain, having developed a cough while visiting relatives there. He had requested antibiotics because he was feeling short of breath and thought he had developed a chest infection. The GP had explained she was unable to provide treatment to overseas patients and encouraged him to seek medical attention from a GP or hospital in Spain.

In the complaint letter the patient had criticised the GP for her uncaring attitude, questioning her refusal to provide treatment by phone when many GP consultations are now conducted in this way. He also requested compensation for the private consultation and medicines that he now needed to pay for overseas.

MDU advice

The MDU's medico-legal adviser was sympathetic to the GP's feelings of frustration. He supported both her decision not to provide acute medical management of a new illness for a registered GP patient when they were outside the UK, and her advice that the patient should seek assessment and treatment in Spain.

The adviser offered to send the GP a copy of the MDU's guide to the NHS complaints procedure, which would help her draft a response to the complaint. He explained the requirement for a prompt acknowledgement of the complaint and outlined the details of the complaints process. He also offered the GP the opportunity to send in an anonymised copy of the complaint and draft reply to the MDU's advisory department, for further support and advice.

The adviser clarified that MDU membership requires both the doctor and patient to be in the UK when the patient is advised or treated. Although there may be some discretion in relation to enquiries about a longstanding condition, for advice about a new condition that arose while they were abroad (and potentially needed managing abroad, as in this case), it would be prudent for the UK-based GP to advise they seek local assessment and management.

Registered practice patients who are only abroad for a short while are clearly unlikely to make a later claim in that foreign jurisdiction, but attempting to provide remote management of conditions presenting abroad raises issues relating to medical registration, professional responsibility and jurisdiction, as well as indemnity.

With the help of the MDU's advice, the GP drafted a thorough reply to the patient, giving a clear chronology, explaining any misunderstanding, and outlining her reasoning. She sympathised with the patient for the expenses incurred while abroad and suggested the option of contacting his travel insurers if he wished to seek reimbursement, explaining that the local resolution phase of the NHS complaints procedure does not provide financial compensation.

She also apologised for the patient's perception of an uncaring attitude, and had a significant event analysis meeting with her colleagues at the surgery, as well as reflecting on the complaint in her subsequent appraisal.

The outcome

After receiving a copy of the complaint response, the patient asked for a complaint meeting to be held at the surgery but subsequently cancelled it, saying he didn't wish to pursue the complaint further.

The GP explained to the MDU adviser that while it had been upsetting and time-consuming to receive her first complaint and respond to the patient's allegations, she was relieved it had been fully resolved and that she now had a better understanding of the NHS complaints procedure. She was also grateful to her colleagues for the support they had given her during the process.

This dilemma is fictional but based on members' experiences and the types of calls we receive to our advice line.

Overseas treatment

Related articles

Membership in your pocket