NHS staff jumping the queue

IT'S not uncommon for healthcare professionals to be approached by patients in the supermarket or other non-clinical settings asking for advice or looking to bypass systems and gain quicker access to appointments or referrals. However, MDDUS advisers have had calls from members seeking advice in relation to NHS employees using their privileged position to inappropriately obtain contact details for staff at GP practices or hospital departments where they are awaiting appointments and treatment.

Members report being contacted through the official NHSmail platform on various issues. These include individuals divulging detailed clinical symptoms in the hope that this will elicit advice or expedite treatment. Using the NHS directory system inappropriately in such a way could result in disciplinary action and even possible dismissal if an employee is found guilty of gross misconduct.

Physician heal thyself

Given the current pressure on the NHS with workforce challenges and growing patient demand it’s not surprising that staff are experiencing increased work-related illness. The 2022 NHS annual staff survey found that 44.8 per cent reported feeling unwell as the result of work-related stress. The NHS has been identified as having higher than average stress-related sickness absence, compared against all job sectors across the country – and this can be added to expected disease levels among healthcare workers.

Healthcare professionals and their families face the same anxiety as the general public over access to NHS care – with long waiting times for treatment and a “scramble” for appointments. It may be tempting to use inside influence to facilitate quicker access to healthcare services but this can risk consequences on several counts.

Objective care

Being asked to provide healthcare advice or treatment for a friend or colleague can put doctors in a difficult situation. Refusing such a request might seem awkward or overscrupulous but it is important to recognise that personal relationships can potentially inhibit the ability to make clinical decisions objectively.

The GMC is clear on the matter in its guidance Good medical practice, stating (paragraph 16g): "In providing clinical care you must... wherever possible, avoid providing medical care to yourself or anyone with whom you have a close personal relationship."

Making a referral or “expediting” a request could be viewed as offering clinical care in this context and also a misuse of privilege.

Test results

Another example of using privileged access to provide a ‘personal favour’ would be logging into a clinical system to review test results upon request from a friend or colleague. They may be anxious to hear from their doctor and ask if you can check for them.

Refusing such a request may again seem awkward and unsympathetic but it is not appropriate to blur patient-doctor boundaries in this way and it is likely to fall foul of professional duties and organisational policies, including data protection (see below). Our advice is to explain the reasons why they should liaise with their own doctor/clinician.

Data protection concerns

Another important factor to consider is patient confidentiality. A colleague might reach out to you for advice on behalf of a relative or friend you are treating. However, disclosing identifiers or sensitive information without consent from the patient would constitute a breach of patient confidentiality.

There is also the risk that an email might be forwarded to the wrong recipient. Contact details being searched for on the NHS mail directory could result in the selection of the wrong email address, such as selecting someone with a similar or same name.

The GMC offers specific guidance on confidentiality (paragraph 5), stating: “Doctors, like everyone else, must comply with the law when using, accessing or disclosing personal information.”

GMC advice on confidentiality is underpinned by eight principles, including the requirement to: “Make sure any personal information you hold or control is effectively protected at all times against improper access, disclosure or loss.”

Organisational policies

Organisations should maintain policies that set out the legitimate ways in which patients can contact a service for access to advice and treatment. A policy should also be agreed for the benefit of staff and clinicians, setting out protocols for staff being contacted for advice or requests outside of normal channels. This should include circumstances in which high-risk clinical information is disclosed, making sure that the patient and their personal information is protected.

Apart from avoiding regulatory or other difficulties, such policies will help prevent reputational damage to the organisation from complaints of unequal access to services. Responding safely and equitably to requests for advice or access to healthcare should help prevent criticism if a complaint is raised.

Key points

• Act swiftly and refer to organisational policy if you are concerned about a person’s immediate symptoms or welfare.
• Be mindful of regulatory guidance, particularly involving patient confidentiality.
• Contact MDDUS if you are unsure how to manage such circumstances.

Kay Louise Grant is a risk adviser at MDDUS