The dilemma: There have been delays in transferring patient records between practices. How do I manage risks and the patient’s expectations when this happens? And when do I need to report the delay in receiving the record?
GPs are understandably concerned about delays in the transferring of medical records between practices.
Common scenarios when this may occur include a new patient attending part-way through a series of diagnostic procedures for a complex clinical picture. It is unlikely that the patient will be able to provide a detailed and accurate account of the tests and results unless they have brought documentation from their previous GP.
Similarly, if a patient with cognitive impairment and complex clinical needs moves to a nearby care home without records you might be unable to advise definitively on the treatment and care they need.
Another example may be a new patient presenting with a request for a further prescription of drugs of dependence, such as opiates or benzodiazepines. Without access to the full GP records you might not be able to differentiate easily between a genuine clinical need and higher risk behaviours.
While these scenarios might occur more commonly at initial registration, and there will always be some difficulties before sufficient information is received, the risks and problems are compounded if there is any further delay in receiving the full records.
Medical Protection is often asked about how to manage any potential risks to patients and how to go about reporting these issues.
What does the GMC say?
While it is tempting to discard certain steps when your workload continues to increase, any assessment, diagnosis or treatment of patients must begin with you knowing their medical history.
GMC guidance in Good Medical Practice (paragraph 15) states that: ‘You must provide a good standard of practice and care. If you assess, diagnose or treat patients, you must: adequately assess the patient’s conditions, taking account of their history (including the symptoms and psychological, spiritual, social and cultural factors), their views and values; where necessary, examine the patient...’
Paragraph 16 specifies that as part of the duty to perform due diligence when providing clinical care, you must: ‘Prescribe drugs or treatment, including repeat prescriptions, only when you have adequate knowledge of the patient’s health’ and ‘check that the care or treatment you provide for each patient is compatible with any other treatments the patient is receiving’.
The reason for this guidance is obvious as there would be a risk of harm to the patient if the wrong diagnosis is made or if the patient is put at high risk of having an adverse reaction to a drug or treatment.
The guidance in this matter is strict – the word ‘must’ rather than ‘may’ is used. Breaching the guidance therefore not only puts the patient at risk of harm, but also you, the doctor, at risk of censure.
The GMC recognises that in situations where the full clinical record is not available to the GP, there might be increased risk of harm to the patient by withholding care until the records are available. They would accept the use of a reasonable interim management plan that minimises the risk to the patient.
For example, it might be reasonable to provide the patient requesting benzodiazepines with a stop-gap prescription for a short duration. However, if receipt of the full records is seriously delayed, a GP might be criticised for passively accepting the delay, and continuing interim treatments for inordinately long periods.
If the clinical records are delayed, there may sometimes be a need and the expectation for you to bypass the usual system and communicate directly with the patient’s previous clinicians, with the patient’s consent.
It might also be reasonable to ask for electronic copies of GP records and hospital letters. The previous GP should be happy to provide you with sufficient information by telephone or other immediate communication, for you to record.
If a system is not functioning such that your patients might be put at risk, you have an obligation, according to Good Medical Practice, to report those concerns to a body that can remedy the problem.
In England, NHS England is responsible for the transfer of records, and your local area team may have a specific incident reporting form that you can use.
Providing you have taken reasonable steps to mitigate the aforementioned risks, along with raising any concerns about patient safety, the GMC should accept that you have fulfilled your professional duty.
If you have any concerns about your medical defence organisation can provide further advice and guidance.
- Dr Kremer is a medico-legal adviser at Medical Protection
Picture: JH Lancy