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 are now starting to see a rise in calls concerning 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 range from requests for a GP callback when struggling to get through to a busy practice by phone, to individuals divulging detailed clinical symptoms in the hope that this will illicit advice or 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 more 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 medical and dental 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 an abuse of privilege.

There is no absolute restriction on dentists providing care to colleagues or family. However, GDC Standard 9.1.4 states that: “You must maintain appropriate boundaries in the relationships you have with patients. You must not take advantage of your position as a dental professional in your relationships with patients.”

A less formal dentist-patient relationship can present risk in providing objective care.

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 organisational policies, including data protection (see below). Our advice is to explain why you cannot access their records and why it is safer for them to await an official review from their doctor.

Data protection concerns

Another serious risk to consider is patient confidentiality. A colleague might reach out for advice on behalf of a relative or friend but this could be problematic without appropriate consent to share personal health details. Disclosing identifiers or sensitive information without consent would constitute a breach of patient confidentiality either by the colleague asking for advice on behalf of their friend or the treating clinician sharing details about the patient with their colleague.

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, with similar or the same names being listed and the contents of the email ending up in the wrong mailbox.

The GMC offers specific guidance on confidentiality, 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.”

The GDC offers similar guidance in its Standards for the dental team, stating: “You must protect the confidentiality of patients’ information and only use it for the purpose for which it was given.”

Continuity of care

What if a colleague contacts you for health advice on a matter of immediate concern? It may seem inadvisable to provide advice in such a context but it is important to recognise when you have a duty to act swiftly.

How such requests are recorded is important. Any kind of advice response from a clinician, even if only to signpost to the most appropriate point of contact, should be recorded contemporaneously and added to the clinical record of the patient to ensure continuity of care, especially any description of symptoms that leads to clinical or dental advice being given.

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 claims of unequal access to services. Responding safely and equitably to requests for advice or access to healthcare should help prevent you or the practice coming under criticism if a complaint is raised.

Key points

• Undertake a risk assessment to determine the best way to redirect individuals who contact you informally for advice.
• 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