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27 November 2018
Dr Beverley Ward
The festive period is a busy time of year for GPs, due to a combination of increased demand from patients, higher-than-normal levels of staff leave, and a run of bank holidays resulting in the practice being open for fewer sessions than normal. Here are some tips to help with the medico-legal issues that might arise.
Appreciative patients may want to give you a gift. In most cases gifts can be accepted, although the GMC makes it clear that patients must not be encouraged to give money or gifts that will directly or indirectly benefit you.
GMC guidance also dictates that gifts from patients or relatives cannot affect, or appear to affect the way you prescribe for, treat, or provide services for patients. You should refuse gifts that could be perceived as an abuse of trust.
Practices are required to keep a register of all gifts of more than £100 in value, and this must be available to NHS England if requested. The MDU believes it is worth recording gifts, even those of low value, in case concerns are raised in future.
Guidance from NHS England on conflicts of interest states gifts with a value of over £50 should only be accepted on behalf of an organisation and be declared. Gifts from suppliers or contractors doing business with or likely to do business with the organisation should be declined, but low cost branded promotional aids can be accepted if valued under £6.
The guidance applies to CCGs and NHS trusts, but not to general practices, however NHS England has invited GPs to implement the guidance to ensure conflicts of interest are managed effectively.
Patients celebrating the festivities may be more tempted to drive while under the influence of drugs or alcohol.
The police may ask you to release confidential information about a patient suspected of driving under the influence and this should usually be accompanied by a consent form signed by the patient. If this is not provided, you will need to decide whether disclosure without consent is justifiable in the public interest.
The GMC's confidentiality guidance explains that disclosing personal information may be justified in the public interest if failure to do so may expose others to a risk of death or serious harm. Examples include the prevention, detection or prosecution of serious crime, especially crimes against the person, or if a patient is not fit to drive. Check with your medical defence organisation before releasing confidential information to the police without consent.
It is illegal to drive with levels of some therapeutic medicines in the blood, including benzodiazepines, methadone and morphine. However the law allows for a 'medical defence' for people who have been prescribed medications, and are taking them in accordance with the prescriber's advice. The police can prosecute under existing road traffic offences for driving while impaired through drugs, for which there is no medical defence available.
The MDU advises that you clearly document advice you give to patients about their medications, including advice about factors which may impact fitness to drive. This is in line with GMC advice requiring doctors to keep accurate and contemporaneous records.
With many staff taking annual leave, but with demand from patients remaining high, it can be difficult to ensure you are fully staffed over the holiday period. You have a professional obligation to ensure that your patients are appropriately cared for when you are not available, such as when on annual leave.
The GMC says doctors must share all relevant information with colleagues involved in their patient's care when going off duty, or delegating care. You must also be satisfied that the person providing care has the appropriate qualifications, skills and experience to provide safe care for your patients.
You should therefore check that any locums you employ are appropriately qualified, and that they receive a handover and induction so that they can work effectively.
Patients thinking about an action packed winter break may ask you to certify them fit to take part in skiing, snowboarding or another adventurous activity. This can be a challenge if you are unfamiliar with the activity concerned and patients may be put at risk if you make assumptions about the level of fitness required.
If you believe you are being asked to give an opinion which is outside your field of expertise, explain to the patient why you are unable to sign the form, and suggest that he or she gets an opinion from a suitably qualified doctor such as someone with experience of sports medicine.
If you feel able to sign a certificate the MDU's advice is to ensure the wording reflects your competence.
Provide a factual report detailing relevant information about the patient's health conditions and explain that you 'know of no reason why the patient should not be fit for' the particular activity. Carefully document this as you may be asked to justify your statement at a later date.
Staff parties can be a great way to celebrate your achievements and hard work over the last year. Many staff will want to share their celebrations with friends and colleagues on social media.
Before the festivities get into full swing, check and update your social media policy to ensure your team are aware of the clear ethical and professional boundaries in place. Your practice policy can cover areas such as protecting confidentiality, maintaining boundaries with patients and avoiding reputational damage.
This piece was first published in GPonline in 2017.
Beverley is a former GP and has been a medico-legal adviser at the MDU since 2008. She provides advice and assistance to members of all specialties on ethical and legal matters arising from their care of patients.
This guidance was correct at publication 27/11/2018. It 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.
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