For most people, the easing of travel restrictions introduced during COVID has been welcome. For GPs, it has brought a swathe of new challenges that can be difficult to manage.
With pressure on appointments already causing issues in practices across the country, careful consideration is needed in managing cases where patients seek medical treatment abroad and then present for follow-up once they’ve returned to the UK.
In April this year, an audit by the British Association of Aesthetic Plastic Surgeons found that the number of patients being treated for serious complications following cosmetic surgery abroad in the last four years had increased by 44 per cent in 2021.
What should GPs do when patients present seeking follow-up and support after treatment in another country and there are no specific commissioning arrangements in place?
Clinical monitoring
It is important for any GP, who is the initial contact for a patient returning from treatment overseas, to make sure they continue to act within the field of their competence. That may mean seeking advice from specialists, for example an upper GI surgeon in the case of a patient who has undergone bariatric surgery.
No doctor is obliged to undertake any care which is contrary to their clinical judgement or beyond their expertise. However, given the potential impact of significant medical intervention such as surgery on a patient's health, a GP should consider whether specific clinical monitoring is required to address patient safety.
Prescribing
GPs should also not feel pressured into prescribing unfamiliar drugs when dealing with the aftercare of patients who have received treatment abroad. Some medications may not be licensed in the UK and such requests should be treated in the same way as recommendations from a UK specialist.
The GMC guidance on good practice in prescribing is clear that GPs are required to take responsibility for any prescriptions they issue. They should feel able to explain their decisions and actions in relation to the prescribing of medicines.
Translating treatment records
In the absence of any defined policy, Doctors should be directed by any local arrangements in place for translating medical records in a foreign language. For example, NHS England provides guidance for commissioners in relation to interpreting and translation services in primary care.
From time to time, it may be most appropriate for the patient to be reassessed in the UK. In emergency situations, use of technology such as translation apps may be appropriate.
Key points
- Advise patients of the risks of undertaking treatment abroad, considering factors such as language barriers and follow-up care in the UK.
- When asked to provide follow-up/after care, be careful not to overstep your own expertise, and consider appropriate referrals where necessary.
- Resist pressure to prescribe drugs or provide treatments that are unlicensed or beyond your expertise.
- GPs should make their own assessment of the need and means of obtaining translations of treatment records provided in a foreign language on the merits of each case and follow any relevant local guidance.
If you have any concerns contact your medical defence organisation for advice.
- Dr Naeem Nazem, head of medical at MDDUS
