Medico-legal: 5 tips for a smooth summer

The summer months can present a number of medico-legal challenges for GPs - from an increase in temporary patients to Good Samaritan acts. The MDU's Dr Oliver Lord offers some advice.

The summer months can bring different challenges to the rest of the year, with higher numbers of clinical staff on leave, patients visiting from other countries or local patients returning from their own holidays.

With this in mind, here are some tips that should help you get through the summer smoothly.

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This article is funded by the MDU for GP Connect

1. Countersigning passport applications

Many doctors have acted as counter-signatories for their patients on passport applications. This is not a service provided by the NHS and so can attract a fee payable by the patient.

However, the UK passport office no longer recommends that doctors act as counter-signatories, unless the doctor states they have known the applicant in a personal capacity and can recognise the applicant easily from their photo. This is in addition to the standard requirement for a counter-signatory to have known the applicant for at least two years, is not related by birth or marriage to the applicant and has a British or Irish passport.

It is a criminal offence to make a false declaration on a passport application, and any conviction would need to be declared to the GMC, resulting in possible risk to a doctor’s registration. Find out more here.

2. Consider unusual differential diagnoses

At this time of year, many people will be travelling overseas and may not volunteer information about their recent trip to a GP or A&E department. If you don’t ask, then you may miss a diagnosis relevant to their recent travel, such as malaria or cholera.

The NHS advises the public to seek advice from their GP or travel clinic before travelling, so it is important that you are up to date and familiar with what advice to give. NHS Choices provides information about travelling abroad and vaccinations and TravelHealthPro is a website that brings together resources from the National Travel Health Network and Centre (NaTHNaC).  

3. Temporary patients

Depending on the location of your practice, you may find you have an influx of temporary patients in the summer months. This can bring challenges, including the fact that you will not have access to their medical records, allergy or drug history, so careful assessment and record keeping is essential.

You should have a low threshold for contacting a patient’s own GP for further information, particularly, if you are considering prescribing medication. You should also pass a copy of your records to the patient’s own GP after your consultation.

You might also have concerns about whether the patient is entitled to NHS treatment. The DH advises that GPs can exercise their discretion to accept any person, including overseas visitors, to be fully registered, or as a temporary resident if they are to be in an area between 24 hours and three months, but that does not necessarily entitle that person to free NHS hospital treatment.

With this in mind, if a doctor feels it is necessary to refer a temporary patient for hospital treatment, the doctor should explain this to the patient, and make it clear in the referral letter that they believe the patient is visiting from overseas so that the relevant NHS body can check their entitlement.

GPs can refuse to treat temporary patients provided they have ‘reasonable grounds for doing so that do not relate to the applicant’s race, gender, gender reassignment, social class, age, religion, sexual orientation, appearance, marriage, pregnancy,  disability or medical condition’ (Standard GMS contract - Schedule 3, Part 2, Section 21).

However, GPs have a contractual duty to provide immediate necessary treatment and an ethical duty to treat in an emergency. If a patient is refused an appointment, you should make detailed notes with the reasons in case you are asked to justify this decision at a later date.

4. Good Samaritan acts

You could be called on to provide help in an emergency while you are off duty or on holiday, and although there is no legal obligation to do so, the GMC’s guidelines state that doctors should offer help in an emergency.

If you are ever called upon to help, you should take into account:

  • Your safety - don't put yourself at unnecessary risk
  • Your competence - don't try to work outside your abilities
  • The availability of other options - are more qualified or able people on the scene?

Where possible, you should also:

  • Make a detailed record of the incident and your involvement
  • Obtain consent from the patient
  • Explain your actions and treatment to the patient

If you don't have a licence to practise - for example, if you've retired or you're a student - you can still offer assistance in an emergency. The GMC advises that not having a licence or registration shouldn't stop doctors from helping in emergencies.

Non-licensed doctors must, however, be clear about their GMC status. It is a criminal offence to inaccurately present yourself as registered with or without a licence.

The MDU provides worldwide medical indemnity for Good Samaritan acts to all its members, but thankfully the risk to doctors of being sued after they have helped in an emergency is very low.

5. Ensure proper cover and handover when you go on holiday

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.

  • Dr Lord is a medico-legal adviser at the MDU

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