Call log

These cases are based on actual calls made to MDDUS advisers and are published here to highlight common challenges within general practice. Details have been changed to maintain confidentiality.

WhatsApp with patients

Q. I’m looking to improve communication with our patients and I’m considering giving some of them a mobile number so they can contact me via WhatsApp (during office hours) in case they can’t get through on the main practice phone line. It would be a dedicated mobile phone, rather than a personal device. Is this ok?

MDDUS would advise that you proceed with extreme caution with this plan. It is generally advised that patients should use official points of contact, such as the practice main telephone number or practice email address. Professional boundaries can become blurred when using more informal channels, such as text messaging (even if a dedicated business phone is being used). It is also an approach that could leave you open to criticism in the event of any formal complaint or regulatory investigations. Read more in this MDDUS advice article.

Suspicious police request

Q.  We’ve received an email that appears to be from a police officer, requesting a copy of a patient’s medical records in relation to a serious assault investigation. It has a signed patient mandate attached, but there is a discrepancy between the email and the mandate in terms of the patient’s date of birth. I’m worried the email is not genuine. Should I respond?

It is a concern to see an error in a key piece of information such as date of birth and so it would not be appropriate to release the patient’s records without first confirming the request and consent are valid. It may be advisable to contact the police force separately, obtaining contact details via their website. You could then verify with them the name of the officer who has made the request. It may also be worth contacting the patient directly to ask if they did in fact sign this mandate, and confirm they are happy for you to release the records.

Instagram request

Q. A 17-year-old patient recently tried to friend one of our young GPs on Instagram. He has been treating her for a number of symptoms related to anxiety. The GP blocked her on his account and carefully explained to her why such contact was not appropriate. Is there more we should do, including encouraging the patient to see a different GP in the practice?

In this case, the GP acted entirely appropriately in blocking such contact and explaining why to the patient in a sensitive manner. The GMC provides guidance in such cases in Maintaining a professional boundary between you and your patient. Should the young patient persist in trying to make contact outside of the clinical relationship it would be appropriate for the practice to write to her to reinforce the importance of maintaining professional boundaries and to highlight her unacceptable behaviour. It would be at the discretion of the practice as to whether the patient should see a different GP within the practice. There is no “right or wrong” answer here; it very much depends upon the conduct of the patient going forward and how comfortable the young GP feels seeing the patient in future.

Fit to undertake some work?

Q. I’m a GP and have recently undergone surgery and been signed off work with a Med3. Our practice is currently experiencing staffing problems and in discussion with the partners I have offered to undertake some remote consulting and other limited administrative duties, such as results handling. Would this be possible with my current indemnity?

MDDUS would recommend that you act in accordance with medical advice. In line with your GMC obligations, it is important that you ensure that you are fit to undertake any work you agree to do. You should liaise with the partners (or your employer), occupational health and your own doctor in deciding this. If you have been on deferred membership whilst you have been signed off, you should inform our membership department when you return to work. Should you have any specific queries it would be best to contact our membership department directly at membership@mddus.com.

Redacting info from SAR

Q. Our practice recently had a request from a patient to forward her full medical record to her place of work. She provided a signed consent but requested to view the documentation before it was posted. In doing so she advised us that there is some information which is not relevant to her job and therefore should not be released to her employer. Can we remove this information without advising the employer?

It would be helpful to review the information your patient feels is not relevant and assess whether, despite the patient’s own views, it might pose a significant health issue to her, her colleagues or customers/service users. Should such an issue be identified, the GP would then have a duty to discuss this with the patient and explain the importance of informing her employer. However, if the patient still refuses to share this information, the practice should only disclose what has been consented to but with the proviso (made clear to the patient) that the employer will be informed that redactions have been made at the patient’s request. Should there be information within the records that the GP considers may expose others to a risk of death or serious harm in the context of the patient’s employment, then the GP may wish to consider if it would be justifiable to release this to the employer in the public interest, without consent of the patient. GMC guidance provides examples of situations where it may be appropriate to disclose information in this way, despite the patient’s wishes.

Flexible working request

Q. One of our receptionists has asked to reduce her days in the practice from five to three to allow her more time to care for her elderly mother. The partners thought that only employees with childcare issues were eligible to request a change of hours, but I don’t think this is the case. I have looked at the rota and we could manage if she changed to three days – but just not the specific days she is asking for.

Any employee – not just those with childcare issues – is entitled to make a flexible working request under the Employment Act 2003, provided they have been employed for more than 26 weeks and have not made a previous application in the last 12 months. A flexible working request can consist of a reduction in hours, a change of days, compressed hours, working from home, and job sharing.

A request for flexible working with all the particulars must be submitted in writing, advising that the request is being made under a statutory right. You should then arrange a meeting with your receptionist to discuss the matter further if the practice feels it cannot be accommodated or alternatives need to be offered. The employee has the right to be accompanied at this meeting.

Any request needs to be given serious consideration, taking into account such aspects as the benefits to the employee and the practice and weighing these against any possible adverse impact of implementing the changes. You should also ensure that you do not discriminate unlawfully against the employee. Your decision should be advised in writing to the employee. The practice can choose to either accept the request and set a start date (confirming any compromise or alternatives offered), or reject the request and explain the reasons for this. The eight reasons that a request can be rejected are:

• burden of additional costs
• detrimental effect on ability to meet customer demands
• inability to reorganise work amongst staff
• inability to recruit additional staff
• detrimental impact on quality
• detrimental impact on performance
• insufficient work during periods proposed to work
• planned structural changes.

All requests, including any appeals, must be considered and decided on within a period of three months from first receipt of the request, but this period can be extended through agreement with the employee. Ensure that all requests for flexible working are dealt with fairly and consistently.