GPs have an unusual relationship with their patients. Together, you might well share moments that are deeply emotional and come to learn details that they’ve shared with no-one else, not even their closest.
That’s part of the job – but it also presents a challenge to GPs. There’s a need for doctors to be able to protect patients – but there are other situations where sharing information might be necessary.
The General Medical Council has drawn up useful guidance for such scenarios. In this post, we take a look at some of the GMC’s advice to give you an understand
GP confidentiality: What the GMC says
There are six key areas highlighted by the GMC when it comes to doctor/patient confidentiality and data.
Education and training
Patients’ data should anonymised for this purpose. If it’s not possible to do so, medical professionals should ask for the patient’s consent. When obtaining this consent, you should be clear about what the information is set to be used for and who will be using it. Patients have to have the opportunity to say no – and shouldn’t feel obliged to take part.
GPs might be asked for information by someone’s employer. Similarly, data on the health of an individual might be requested by an insurance company or sports team. You should only comply with such requests if:
- you’re happy that the patient knows what is being requested and how it’ll be used
- you have seen written consent from the patient
- you only provide factual information that is relevant to the matter
- you offer to show the patient your report or send them a copy
Spread of serious disease
There are some circumstances in which the ‘public interest’ means that health information must be disclosed. The GMC outlines that this could be the case when it comes to ‘serious communicable diseases’. It states: “If you consider that failure to disclose the information would leave individuals or society exposed to a risk so serious that it outweighs the patient’s and the public interest in maintaining confidentiality, you should disclose relevant information promptly to an appropriate person or authority.”
The above scenario demonstrates that doctors have a duty to protect and promote the health of the public as well as their patients. This can also collide with doctor/patient confidentiality when it comes to driving. A driver has a legal responsibility to tell the DVLA if they have a condition or treatment that means they are unfit to drive. Doctors should tell them if they have such conditions and make clear that driving is something that isn’t safe in these circumstances (and, legally, should be reported). However, if they continue to drive when unfit a GP may feel it’s in the public interest to reveal this to the DVLA. Even then, GPs should alert patients that they feel this is necessary and let them know when they have contacted the DVLA.
Gunshot and knife wounds
It’s clearly in the public interest for the police to investigate serious crimes such as those involving gunshot or knife wounds – but doctors need to be careful not to deter patients from coming forward when they need medical assistance too. Again, this is a balancing act. If you feel that your patient and/or others are at a serious risk, you should disclose this to the authorities in a sensitive and appropriate manner.
Some patients choose to publicly criticise their GPs in the media. This can be stressful and frustrating – especially if you feel the details they have given to the press are inaccurate or misleading. However, it’s important to note that this alone doesn’t relieve you of your duty to maintain confidentiality. A public row can undermine a GP’s standing in the eyes of other patients and prolong the issue. GPs are advised to avoid commenting – or sticking to general remarks about their practice.
Any GP who is concerned about confidentiality – whether that’s maintaining this or balancing it against the public interest – should seek support. Contact us if you have a query on confidentiality or any other matter relating to your work as a GP.
The importance of looking after our GPs has never been more vital as more surgeries close, along with a sustained fall in UK GP numbers. What this means, is that highly skilled professionals in our industry are under pressure to see and treat more patients in an already long working day.
Law firm Slater and Gordon took a survey of 200 family doctors and discovered that 80% of these GPs felt they didn’t have sufficient time to properly diagnose patients. 35% of those who took part in the survey admitted they had missed symptoms, while 37% believed they may have prescribed the incorrect course of treatment.
Clinical negligence expert Parm Sahota, from Slater and Gordon, told the Telegraph: “Working in this area of law I already knew GPs were stretched, but the timeframes they are expected to practice within are suffocating.”
Royal College of GPs: ’10-minute appointment not fit for purpose’
Chair of the Royal College of GPs, Professor Helen Stokes-Lampard has responded to this research. Here’s her full statement:
“It has been clear for some time that the standard 10-minute appointment is no longer fit for purpose. As GPs, we want to be able to deliver truly holistic care to our patients after considering all the physical, psychological and social factors potentially impacting on their health.
“But when you consider that very few patients now come to us with just one health-related condition, and that we are increasingly up against the clock in consultations, this is simply not possible and in some cases it could be unsafe.
“We know that GPs and our teams are working under intense resource and workforce pressures and as a result, hard-working, experienced family doctors are burning out, and leaving the profession earlier than they would have done. These must be addressed, not just to keep general practice – and the wider NHS – sustainable, but for our patients’ safety.
“We have called for 15-minute appointments as a standard, with longer for those patients with complex health needs who need it. But with GP workload soaring, falling numbers of family doctors, and patients waiting longer for appointments, we need more resources and an expanded workforce to make these longer consultations feasible – otherwise it will only add to pressures and serve to undermine patients’ ability to access the care that they need.”
Measures regarding longer appointment times are absolutely required to help GPs and it’s important to make it clear that the knowledge and skill of GPs is appreciated by patients across the UK. In response to this research, an NHS spokesperson told the Telegraph:
“The recent GP Patient Survey showed that more than nine in 10 patients trusted their GP, and more than eight in 10 people described their experience at their GP practice as good or better.”
Action needed to help GPs
It’s clearly important to look after our GPs in order for them to look after the health of the community. The call for longer appointment times as standard have been around for some time, but the action required to address this is becoming increasingly urgent. With the previously mentioned surgery closures and fall in GP numbers in the UK, there’s increasing pressure on family doctors across the country.
MDS CEO Rohan Simon said: “As an MDO set up by GPs for GPs, we’re acutely aware that some members of our profession feel under pressure. We’re keen to make sure that GPs get help in these instances and are able to access the correct support if they do make an error.
“If any GP does have a concern, we’d encourage them to contact us. As a nation, we need to look after our GPs so that we keep our skilled professionals in their roles and that they have the help they need to do their jobs to the best standard.”
There’s help at hand if you feel under pressure in your GP role. If you feel you need support, don’t hesitate to get in touch with us by calling 020 8938 3631, or alternatively contact us online here.
GPs are highly skilled professionals but they’re also human beings and that means mistakes in their jobs are possible.
As an MDO set up by GPs for GPs we understand and appreciate this as well as anyone – but we also know the importance of reacting appropriately when something has gone wrong.
In this guide, we’ll take a top-level look at the rules around duty of candour and what they say about the need to act after an error have been made.
What is duty of candour and why was it introduced?
Duty of candour is the legal requirement placed on GPs to be open and honest with patients and their families when something goes wrong that either does or could have caused significant harm. Under this, patients should be told of a ‘notifiable safety incident’ as soon as possible.
Duty of candour was introduced in November 2014 and then extended to GPs the following April and forms regulation 20 of the Health and Social Care Act 2008.
The new regulation came as a response to the Francis Inquiry, which looked into the care given by Mid Staffordshire NHS Foundation Trust. During the inquiry, it emerged that patients had not always been given a thorough explanation by the trust when their care had gone wrong.
The duty of candour was proposed by Sir Robert Francis and later accepted by then health secretary Jeremy Hunt. This is over and above a GP’s professional and ethical duty to be open and honest with a patient.
Duty of candour law: What you need to know
When considering duty of candour, it’s important to understand what is meant by a notifiable safety incident – and what the General Medical Council’s guidance says about reacting to this.
For GPs, a notifiable safety incident is something that, according to the ‘reasonable opinion of the health professional’ either did or could have caused:
• Death (outside of the natural course of an illness)
• Reduced sensory, motor or intellectual function (for 28 days or more)
• Amputation or other changes to the structure of the body
• Psychological harm (for 28 days or more)
• Shortened life expectancy
• Treatment to prevent death or any of the other above outcomes
In Scotland, the process is similar but the ‘reasonable opinion’ needs to come from a healthcare professional who isn’t involved in the incident. Scottish duty of candour comes under the Health (Tobacco, Nicotine and Care etc.) (Scotland) Act 2016.
In England, patients should be notified of the above as soon as possible. In Scotland, the government’s guidance suggests this should be within ten days.
GPs should arrange to meet in person with their patient to share any necessary information and, importantly, to apologise.
An apology is not an admission of guilt
At this point, it’s very important to stress that an apology is not the same as an admission of guilt. GPs should not feel as though they cannot apologise because it will end up costing them in future litigation. Indeed, the NHS Litigation authority states it ‘will never withhold cover for a claim because an apology or explanation has been given’.
GPs aren’t obliged to accept personal responsibility for things that were outside of their control such as a system error. However, the patient does have the right to an apology from the most appropriate team member, regardless of the source of responsibility.
The General Medical Council outlines three clear parts to an apology issued under duty of candour. It should outline:
• What has happened
• What can be done to deal with any immediate harm caused
• What will be done to prevent a repeat in the future
A GP’s apology should be genuine and relies on the individual to judge their own situation. However, the GMC suggests to bear the following in mind:
• Give patients information in a way they’ll understand
• Speak to patients at an appropriate time
• Be considerate with distressing details
• Be personal and properly apologise
• Tell the patient who to contact if they have further concerns
• Record details in a patient’s clinical record
Seek support with duty of candour matters
Hopefully this guide has filled you in on some of the key points to remember about duty of candour. However, if you do find yourself involved in a ‘notifiable safety incident’ then it’s important to remember that you should seek support.
With the Medical Defense Society you have access to our medico-legal advisory team and help with, for example, understanding how to handle an apology in one of the cases outlined above.
If you want to discuss duty of candour or if you wish to find out more about joining MDS, contact us today.
The Government has moved to clarify the rules over travel vaccinations – and has stressed that GPs do need separate indemnity cover for this work.
NHS Resolution’s website had originally stated that the administration of travel vaccines and immunisations in which the patient is charged were in the scope of the new state-backed indemnity scheme.
The NHS Resolution’s information about the clinical negligence scheme for GPs (CNSGP) has now been updated to clarify that this is not the case.
GPs and travel vaccines
The situation regarding travel vaccines and immunisations is as follows:
- Those listed as NHS-funded in the GMS Contract Guidance are covered by CNSGP
- Those not listed and that require the patient to pay, such as yellow fever or rabies, are classes as private services. The CNSGP does not cover private services offered by GPs so separate indemnity cover is needed for this.
- Advice on vaccinations – whether they are paid for or not – is covered by the CNSGP.
In recognition of the confusion, the Department of Health and Social Care has said it will provide assistance for any claim for clinical negligence made against anyone who administered travel vaccinations between 1st April 2019 and 31st July 2019. GPs should contact NHS Resolution for claims made within this specific period.
After this period – and in light of this clarification – GPs will need separate cover for this work.
Medical Defense Society CEO Rohan Simon said: “This is just one example of the importance of GPs retaining indemnity cover for the aspects of their role that fall outside of the state-backed scheme.
“We’re keen to ensure GPs have the support they need to do their jobs with peace of mind.”
If you have any queries about immunisations or any other aspects of GP work and indemnity, get in touch with us today.
Figures showing the alarming rate of surgery closures prove why it’s vital for the UK to look after its GPs, according to the Medical Defense Society.
A recent Pulse investigation showed that GP surgeries are shutting at a record rate, with further analysis of the data showing how coastal and rural areas are worst affected.
Pulse found that 138 GP practices closed their doors in 2018, affecting half a million patients. For context, there were just 18 closures in 2013. The rate of closures looks to have continued in 2019 too, with 12 in the first month alone, compared to eight at the same time in 2018.
The closures come on the back of a sustained fall in GP numbers as the profession faces challenges with recruitment and resourcing. Many practices are also merging, with smaller surgeries becoming part of larger practices.
‘It’s crucial that we look after our GPs’
MDS CEO Rohan Simon said: “These figures are alarming and should further serve to highlight how crucial it is that the UK looks after its existing GPs.
“No-one wants to see surgeries close, especially not in such high numbers, and one important way to do that is to ensure the skilled people employed in our profession have the support they need.
“MDS was set up in by GPs in order to cater for the specific needs of GPs and we’re acutely aware of the pressures they face and the support they need to be able to do their jobs.
“We’re constantly working with our members to ensure their needs are met and we’d support any efforts to reverse this trend. We’re also prepared to work with surgeries to help with their recruitment and retention challenges.”
Mergers contribute to GP closure figures
NHS England said there were fewer practice closures and patient dispersals in the 2017/18 financial year compared to 2016/17. It said it supports GPs through the resilience programme.
In 2017/18, 62% of GP contract closures were due to mergers and the rest due to practice closures. Smaller surgeries were the most likely to close in 2018 – with practices serving 5,000 or fewer patients accounting for 86% of closures.
Royal College of GPs chair Prof Helen Stokes-Lampard told The Guardian: “GPs and our teams are working to our absolute limits to provide safe, high-quality care, while general practice is under intense pressure, and this is resulting in some GPs leaving the profession, and in other cases forcing them to close their surgery doors.
“In some areas, practice closures are the result of surgeries merging or joining federations in order to pool their resources and provide additional services in the best interests of their patient population.”
GP issues in coastal and rural areas
Further analysis of the results suggests that coastal and rural communities have felt the impact of the loss of GP surgeries most keenly.
It emerged that 1,946 villages are now at least three miles away from their nearest GP practice. That’s 162 more than two years ago – with some patients now 14 miles away from a GP in rural areas.
The issues with recruitment are exacerbated in rural areas – with someone younger doctors less likely to want to relocate away from towns and cities.
Prof Stokes-Lampard explained: “Rural, coastal and deprived areas always struggle the most to attract GPs, but with a national shortage, they are being hardest hit. They are the canary in the mine for a problem across the country.”
Looking after the nation’s GPs
MDS is keen to hear from GPs who feel that their existing indemnity costs are prohibitively high. We can work with GP surgeries to see how we can support recruitment and retention in rural and coastal areas.
MDS is determined to look after the interests of all GPs and provides indemnity that has their specific needs in mind, with a clear mission statement to defend GPs’ interests.
If you wish to find out more about how we can provide the cover and support you need as a GP, contact us today.
Medical Defense Society membership numbers have jumped 70% during a strong period of growth in 2018/19.
The rise in members for the year to April can be revealed as MDS gets ready to celebrate its second anniversary in July and starts to become a recognised alternative to the existing MDOs.
Membership numbers grew steadily throughout the year, with a particular spike during the traditional renewal period of the summer as well as in December and April.
GPs buying into vision
CEO Rohan Simon said: “It’s clear that GPs like the fact that there’s an MDO out there that was created by fellow GPs and keeps their interests at the forefront of its thinking at all times.
“This was the vision we had for the company from the very start and it’s heartening to see so many GPs buying into that.
“We see this strong growth as a huge vote of confidence from GPs and we’re keen to repay that faith by continuing to provide the very best service for our members.”
The topic of GP indemnity has been highlighted in 2019, with the Government introducing a state-backed scheme to cover some of the work carried out by GPs.
However, with this scheme not covering several key aspects of a GP’s work – such as support for proceedings and inquiries with the General Medical Council and representation at inquests – it’s vital that they select an indemnity provider that can look after their needs.
Exciting plans for growth
Mr Simon added: “We have exciting plans in place for the rest of 2019 and beyond and we look forward to sharing those soon as we continue to grow the MDS family.
“We know how important it is for GPs to retain their MDO membership to cover the parts of their jobs that aren’t included in the Government scheme and we’re confident that we can give them the support they need to be able to go about their jobs with support, security and peace of mind.”
MDS members can save money on their indemnity through our new referral scheme. If they refer a new GP to MDS then both parties get 5% discount. The discount applies for up to four referrals, meaning members can earn up to 20% off their membership costs.
Want to find out more about what MDS has to offer? Get in touch.