Q&A with an MLA

Editor-in-Chief and MLA (medicolegal adviser) Dr Rachel Birch answers some recent queries from practices.

Read this article to:

• Discover risks involved in setting up patient activity groups.
• Learn whether electronic consent on requests for insurance reports is valid.
• Find out if you have to treat patients presenting with dental problems.

“As a practice, we are considering setting up a weekly walking group. Patients with co-morbidities such as diabetes or hypertension would be accompanied by our HCA. Are there any potential risks to this?”

Clinicians regularly recommend exercise to their patients. Whilst the idea to set up a walking group is an innovative one and may appeal to many patients, it is important to minimise any risk associated with this venture.

Although you may wish to advertise the group, you should not put pressure on patients to take part. If you are recommending the group to individual patients, you should reassure them that their care won’t be any different if they don’t join in.

You should also consider, when recommending the group within the context of a consultation, whether the patient is medically fit enough to take part. You should therefore familiarise yourself with possible routes and the walking speed.

Since your HCA is leading the group, you may wish to ensure that they carry a fully charged mobile phone in case of emergency. You should ensure they receive training regarding what to do if there is an emergency, such as a fractured limb or cardiac arrest. Whilst these situations are unlikely, it is better to be prepared for any eventuality.

The practice would also need to ensure that the walking group is covered by their public liability insurance, as the activity is beyond the scope of Medical Protection membership.

“We have had a request for an insurance report on a patient. There is no signed patient consent, instead the insurance company has stated that consent has been captured electronically. Is this valid?

This is becoming more commonplace with insurance companies and the Information Commissioners Office has produced guidance.1 There is no legal requirement for there to be a “wet ink signature” on a subject access request form and electronic signatures are permitted.

However, practices must still be satisfied that the patient has provided appropriate and fully informed consent and is clear about the extent and scope of the disclosure.

Practices should also check that the insurance company has sufficient procedures in place to ensure that patient consent is being captured adequately and securely. Many insurance companies will enclose details of this with the request, but if in doubt, practices should consider asking to see evidence of this.

If there are any doubts, practices can still ask insurance companies to provide evidence of consent from the patient. However, it may be preferable to contact the patient directly to seek consent for the report. This can also be a good opportunity to double check matters, especially if there is potentially sensitive information within the patient’s medical record. 

 

“Do we have to treat patients presenting with dental problems? Patients sometimes present requesting antibiotics or pain relief for dental abscesses.”

Patients with dental problems are more appropriately seen by dentists but often present to GP practices instead. It is reasonable to suggest that the patient sees their own dentist or accesses the local emergency dental service − however, patients may not be registered with a dentist or may experience problems accessing dental services. Since dental infection is a potentially lifethreatening condition,2 the patient should be assessed by a clinician. This assessment will establish the precise nature of the patient’s care needs. The patient may require analgesia, in which case this should be provided. The clinician should also consider if antibiotics are indicated, and if not, explain to the patient why they are not going to be prescribed. Consideration should be given as to whether emergency admission is necessary and, if so, it should be arranged. The patient should be encouraged to see their dentist as soon as possible. NICE has provided clinical guidance on the management of dental abscesses in primary medical care.3 It highlights that patients should seek dental treatment as they are likely to require prompt dental surgery for abscesses. Although antibiotics are not usually indicated, there may be situations when antibiotics should be prescribed and circumstances where urgent admission is required. GPs and nurse practitioners should familiarise themselves with this guidance. You may wish to raise concerns with local dental practices if patients are having difficulties accessing their services.