Employment law: Patients as employees

SHOULD new employees at a GP or dental surgery be asked to register at another practice as part of their job offer or do they have the right to join any practice that they wish? This is a common question put to the employment law advisory service at MDDUS. And what happens if prospective employees are already patients at the practice? Can you ask existing employees to move?

These are interesting questions and not as straightforward as you may think. Employing a staff member who is a patient at the same practice can potentially cause a myriad of problems. There is the obvious conflict of interest when providing care to a patient with health issues while also dealing with them as an employer. Do you use your insight into their health problems to ensure they are kept at work for operational reasons? It might be tempting to suppose that a health condition is not genuine or being “over played” while at the same time having the responsibility to provide a fit note to certify absence from work.

INSIDE KNOWLEDGE

In cases where employees are regularly absent with no apparent underlying health conditions, the disciplinary process may be invoked which can be unpleasant all round. A frequent reaction to an employee being challenged at work for absence, performance or conduct is for them to be signed off sick, but you can see the conflict here if the practice is aware of the reason why the employee is being disciplined at work. In some long-term absence cases, it may be necessary to refer the employee to occupational health to gain an objective and independent view so that again the practice is not seen to be “trading on” its inside knowledge as healthcare provider and employer.

There are also important clinical reasons to keep the doctor-patient relationship separate from work. For example, employees may be embarrassed to share essential information or undergo an intimate examination with a doctor at the same practice, or they may worry that health concerns might raise questions of their capacity to do their job.

Doctors treating staff colleagues may also be put in a difficult professional position and patient care can be compromised. GMC guidance states doctors should “wherever possible avoid providing medical care to yourself or anyone with whom you have a close personal relationship.”

BE CLEAR FROM THE START

Our advice is that you should inform prospective employees at interview that a stipulation of any job offer is that they move to another practice – or even flag this up earlier in the application process. This should ensure that it is no surprise when the candidate finds that they are required to register with another practice as a condition of employment. The only exemption to this policy would be if your practice is in a remote setting, such as an island, where there is no alternative primary healthcare provider available for prospective employees to register.

Asking current staff to change practice is not so straightforward as there is no obligation for them to comply. Some patientemployees may feel a strong tie to their practice and to a specific doctor or dentist who is familiar with their clinical history. Discuss fully with staff the reasons behind the request – the potential conflicts of interests and clinical risks – but make it clear that you cannot force them to move. It may be more effective to address the issue with the practice as a whole and then offer individual follow-up meetings for employees who have personal concerns they would like to discuss. Hopefully staff will see that the policy is in their best interests.

Another approach used in some practices is to have one doctor allocated as “staff partner”, who is ultimately responsible for decisions regarding staff but does not routinely see employees in the capacity as patients.

MAKE IT POLICY

To conclude, it is best practice if prospective employees are asked to move to another practice at the point of job offer where possible to avoid any potential conflicts. You can also ask current staff to move although you cannot force them to do so. We would also advise that whatever policy is adopted is added to your employee handbook. Further specific advice and support on this issue is available from the employment law team by calling 0333 043 4444.

Janice Sibbald is an employment law adviser at MDDUS