Festive dilemmas - how would you respond?

Volunteering at a Christmas day swim

A GP asked the MDU what he needed to consider before volunteering to provide medical cover at a festive outdoor swim.

The medico-legal adviser explained that it was important for the GP to reassure himself that he had the appropriate qualifications, skills, experience, equipment, and support to cover the event. The GMC's Good medical practice guidance says that "you must recognise and work within the limits of your competence".

Also, it would be a good idea to check what was expected and whether any medical equipment would be provided or if he was expected to bring equipment. Chances are he would only need to treat minor injuries but he should be prepared for something more serious such as a cardiac arrest.

There is an ethical duty and a statutory requirement to ensure doctors have indemnity or insurance before they offer medical services. If the organising body wasn't providing this, the adviser suggested the member spoke to the MDU's membership department in advance to check on indemnity for such events. Volunteering work can often be undertaken at no extra cost.

Hopefully the day would go off swimmingly! But if there was a medical problem during the event, it would still be important for the GP to gain patient consent, to maintain confidentiality, and to keep notes of any incidents and the medical care provided.

A generous gift

A practice manager opened a Christmas card to find a cheque written to her personally for £1,000 from a grateful patient. The practice manager had liaised with the GP over the patient's urgent referral to hospital after discovering a suspicious lump. The patient had since been given the all clear. The practice manager was worried how it would be perceived to accept the money for doing her job and contacted us for advice.

The MDU adviser agreed, that while it was gratifying to be appreciated, accepting gifts from patients can be misinterpreted. In this instance, the gift could be viewed as excessive for a token of appreciation and there was a danger that the practice manager could be accused of taking advantage of the patient's position.

In guidance for doctors, the GMC states they must not accept gifts from patients or colleagues if it is an inducement, gift or hospitality that may affect or be seen to affect the way that person is treated.

Practices will usually have their own guidance on accepting gifts. In England, the General Medical Services contract stipulates that GPs who are given gifts worth £100 or more must enter these onto a register, and equivalent sets of regulations are in place in Scotland, Wales and Northern Ireland.

NHS England guidance on managing conflicts of interest also advises that gifts valued over £50 should be treated with caution, and should only be accepted on behalf of an organisation, and not by individual NHS staff. They should also be declared.

The practice manager discussed this with the GP involved in the patient's care and they both agreed to return the cheque to the patient explaining that the practice manager couldn't accept the generous gift. The patient later contacted the practice offering to make a small donation to a charity of the practice's choice instead, which was accepted with thanks.

Prescribing medication for a visiting family member

A respiratory physician contacted the MDU advice line on Boxing Day to ask whether it would be appropriate to prescribe steroid cream for his nephew who was visiting from overseas and appeared to have eczema. He felt this would be more convenient than having to call 111 or to try to be seen in an emergency.

The MDU adviser explained that although it must be distressing to see the child suffering, it was best to avoid prescribing for friends or relations because doctors may not be as objective as when seeing a patient. The GMC advises in Good Medical Practice that when providing clinical care you must "wherever possible, avoid prescribing medical care to yourself or anyone with whom you have a close personal relationship."

In this case, the physician conceded that he didn't have a great deal of expertise in treating eczema or full knowledge of the nephew's medical history or medications. In addition, the MDU adviser pointed out that he wouldn't have access to the relevant medical notes to make a comprehensive record of what information was provided, what the assessment entailed, any discussion about treatment options along with risks and benefits, and the treatment given. Doctors in this situation also need to consider how their relationship may be affected if a problem arises.

Following the discussion, the doctor suggested the child's family arrange to speak to their own GP. The parents reported back that they did so the next day and were able to get an electronic prescription.

This page was correct at publication on 30/11/2021. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.