In summer, medical professionals may face different challenges to the rest of the year, for example, higher numbers of staff on leave, patients visiting from other countries, or local patients returning from their own holidays. Dr Sally Old, Medico-Legal Adviser at the Medical Defence Union, advises on how best to address these seasonal healthcare issues.
Increasing Number of Temporary Patients
You may find that you have an increase of temporary patients in the summer months. Unfortunately, this may result in you not having access to their medical records, allergy, or drug history, so careful assessment and record-keeping is essential. You should be willing to contact a patient’s own GP for further information, with the patient’s consent, particularly if you are considering prescribing for a temporary patient, who may not provide an accurate or full drug history.
You should also pass a copy of your records to the patient’s own GP after your consultation. You might also have concerns about whether the patient is entitled to NHS treatment. The Department of Health advises that medical professionals can exercise their discretion to accept any person, including overseas visitors, to be fully registered, or as a temporary resident, if they are to be in an area between 24 hours and three months, but that does not necessarily entitle that person to free NHS hospital treatment.
With this in mind, if a doctor feels it is necessary to refer a temporary patient for hospital treatment, the doctor should explain this to the patient, and make it clear in the referral letter that they believe the patient is visiting from overseas so that the relevant NHS body can check their entitlement.
Medical professionals can refuse to treat temporary patients provided they have ‘reasonable grounds for doing so that do not relate to the applicant’s race, gender, social class, age, religion, sexual orientation, appearance, disability, or medical condition’ (standard General Medical Services contract – Schedule 3, Part 2, Section 21).
However, doctors have a duty to provide immediate necessary treatment and an ethical duty to treat in an emergency. If a patient is refused an appointment, you should make detailed notes with the reasons in case you are asked to justify this decision at a later date.
Arranging Cover When you Go on Holiday
It’s your responsibility to ensure that patients are appropriately cared for when you are not available, such as when on annual leave.
The General Medical Council says that doctors must share all relevant information with colleagues involved in their patient’s care when handing over or delegating care. You must also be satisfied that the person providing care has the appropriate qualifications, skills, and experience to provide safe care for your patients.
You should therefore check that any locums that you employ are appropriately qualified, and that they receive a handover and induction so that they can work effectively.
Considering Unusual Diagnoses
In summer time, many people will be traveling on their holidays and may not volunteer or think to share information about their recent travel to a GP or A&E department. It’s always important to ask as if you don’t, you may miss a diagnosis relevant to their recent travel.
The NHS advises the public to seek advice from their GP or travel clinic before traveling, so it is important that you are up-to-date and familiar with what advice to give.
For more information, visit www.nhs.uk/conditions/Travel-immunisation/Pages/Introduction.aspx and www.travelhealthpro.org.uk/countries.
Being a Good Samaritan
You finally get away for your own well-deserved holiday when there is an announcement on the plane, ‘Is there a doctor on-board?’ Although there is no legal obligation to do so, the General Medical Council’s guidelines state that doctors should offer help to an emergency.
If you are ever called upon to help, you should take into account:
• Your safety – don’t put yourself at unnecessary risk
• Your competence – don’t try to work outside your abilities
• The availability of other options – are more qualified or able people on the scene?
Where possible, you should also:
• Make a detailed record of the incident and your involvement
• Obtain consent from the patient
• Explain your actions and
treatment to the patient
• If you don’t have a licence to practice – for example, if you’ve
retired or you’re a student – you can still offer assistance in an emergency. The General Medical Council advises that not having a licence or registration shouldn’t stop doctors from helping in emergencies
• Non-licensed doctors must, however, be clear about their General Medical Council status. It is a criminal offence to inaccurately present yourself as registered with or without a licence