GP dilemma: How should I deal with a patient requesting the hepatitis B vaccine?

Practices have been removed from the hepatitis B vaccine supply chain until further notice. Medical Protection's Dr Marika Davies explains the medico-legal implications.

The dilemma: A patient is insisting that I give them a Hepatitis B vaccine as a preventive measure. Due to shortages, GPs have been told to refer patients to hospital or the NHS occupational health services until further notice. Where do I stand from a medicolegal point of view?

In response to the global shortage of Hepatitis B vaccines, Public Health England (PHE) has issued temporary recommendations which prioritise the vaccine for those at highest, immediate need.

GP practices will not be able to order any adult hepatitis B vaccine stock, and will not provide the service until further notice to help preserve supplies.

Patients cannot demand a particular treatment. In its guidance Good Medical Practice the GMC says that you must give priority to patients on the basis of their clinical need if these decisions are within your power.

It also says that you must make good use of the resources available to you, and take account of clinical guidelines. ‘You must be familiar with any local and national policies that set out agreed criteria for access to a particular treatment,’ it says.

While the care of patients must be your first concern, the GMC recognises that treatment options that can be offered to patients may be affected by limits on resources.

PHE says that an individual risk assessment is required to assess whether a vaccination should proceed straightaway or whether it could be deferred, and has set out guidance on prioritisation to support decision making. These decisions have been temporarily referred to other providers, which you will need to explain to your patient.

Your patient will be understandably concerned that they may not be able to have the vaccination they feel they need. It will be important to ensure that you provide them with a full explanation, and good communication will be key to avoiding a complaint.

It may be helpful to explain the situation and outline the criteria for prioritisation to the patient yourself. If required you could also and give them the opportunity to seek a second opinion. You should be open and honest with the patient, and offer them details of your complaints process should they remain dissatisfied.

PHE also recommends that patients should be given advice on avoiding exposure to the Hepatitis B infection, and post-exposure vaccination in the event of a specific exposure. There is a patient information leaflet for those whose vaccination is deferred.

The GMC expects you to be prepared to explain and justify your decisions and actions when prescribing, administering and managing medicines. Document the reasons for your decision carefully, as well as details of the discussion you have with your patient. This will be helpful should they decide to pursue a formal complaint.

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