We recommend that wherever possible practices should not have members of staff as registered patients. Being both the employer and the GP of a staff member may potentially conflict them in their provision of care and there is a tender balance to strike.
Recently there have been a number of cases discussed at the NHS England Performance Advisory Group which have identified that practice systems and processes may be exposing staff to vulnerabilities in maintaining their professional boundaries for staff and close family members who are registered at the practice.
It is very easy to see how staff could feel pressured to provide treatment or access to services for close family or to think that they may be saving NHS time by doing so but this could result in staff working without expected protocols or professional guidance.
Any health professional in the practice may have access to knowledge about a staff member that could, although shouldn’t, affect decisions that the practice makes about their employment.
Having practice staff as patients could mean there is a risk that staff will consider that an ‘informal’ chat about a medical complaint counts as having seen their GP. It is therefore important to discuss with staff about the moral dilemma of having staff as patients and the difficult situations it can put both parties in.
Corridor conversations may mean the GP, Practice Nurse or Allied Health Professional may not have explored concerns as fully as they would have if they had had a formal consultation and it is unlikely that they would have conducted an examination or documented the relevant information in the medical records.
All patients are entitled to confidential medical care. The fact that staff medical records are kept at their place of work introduces a risk that a colleague will accidentally or purposefully access confidential information that is held about them.
This GPC guidance below also summarises why it is advised against having staff as patients. However, if you do decide to still have staff as patients, ensure it is risk assessed, document clearly the rationale behind this, ensure that your employment contracts and confidentially agreements are up to date, review practice policies and ensure that regular audits regarding IT access are conducted. You will also need to ensure IT blocks are in place to stop staff accessing files they shouldn’t and you must also remind staff that any inappropriate access of a patient’s confidential information is a disciplinary matter.
GMC guidance from April 2013 states:
‘Wherever possible you should avoid providing medical care to anyone with whom you have a close personal relationship’ This principle needs to be carried across into any situation where practice staff could access information on their family or relations. This may be where they accidentally come across information (such as opening a discharge letter) or perhaps when acting on a message received by the practice. To avoid any possible concerns about breaches of confidentiality or inappropriate access practices are asked to review their existing policies and procedures and in doing so to consider the following:
- Whether there should be policy that specifically states that staff should not access family/relations information, even when pursing their legitimate work in the practice.
- Practice should ensure that all staff are aware that inappropriate access is a disciplinary matter.
- Ask staff to register if any of their family/relations are patients at the practice
- Develop a procedure to cover the eventuality of a member of staff inadvertently coming across family/relation’s information e.g., the member of staff should ask a colleague to complete the task and register the event with the designated person e.g. the practice manager or senior partner.
- Remind staff that they are only permitted to view a patient’s confidential information when there is a legitimate work reason to do so, and this applies to family members and relations, unless there are Practice specific rules to adhere to.
- Remind staff when there is not a legitimate work reason they are in the same position as members of the public; they can only legally access a patient’s confidential information where the patient has registered their consent with the practice for them to do so. This applies to family members and relations.
- To be able to act on a patient’s behalf e.g. reordering prescriptions etc., requires a further consent from the patient stating a specific person can act on their behalf and to what capacity and this must registered with the practice this applies to family members and relations.
The website links below also provide helpful hints and tips:
For further advice or assistance, please call the LMC office on 0115 979 6912 or email firstname.lastname@example.org