This site is intended for health professionals only

At the heart of general practice since 1960

Contract boosts job satisfaction

case history

Your excellent male receptionist charms the female patients and gets teased for being quite camp with men. Recently you suspect he has made friends with a vulnerable, depressed 20-year-old man who attends frequently. You have overheard exchanges like 'Okay, see you later' and the practice manager thinks the patient has phoned a few times for personal chats with him.

Neither of you wants to accuse him outright.

One day that patient comes out very upset from counselling. The receptionist takes him into an empty room to calm him down. His front-desk colleague comes to you, accusing him of shirking work, of taking advantage of a vulnerable patient and of being a promiscuous homosexual. What do you do?

'How vulnerable is a 20-year-old?'

This member of staff is being accused of shirking work, of using his position of responsibility to take advantage of a patient, of being homosexual and of being promiscuous. Being homosexual is irrelevant and his actions should be judged in the same way as if a female member of staff had been involved with the patient.

I do not appear to have any evidence to support the accusation that he is promiscuous unless there have been previous complaints about his behaviour? The issue of shirking work should also be looked at over a longer period and previous problems ­ a poor sickness record and personal observations ­ are important.

The issue of taking advantage of a vulnerable patient is quite difficult. How vulnerable is a 20-year-old and what right have we to interfere, as long as this was conducted in a discreet way, off work premises.

The first thing I would do would be to listen carefully to the other receptionist in a quiet, private setting. I would try to find out if there was any substance to the complaint and how much effect this was having on the staff and the running of the practice.

At this stage I would prefer to discuss the issues with my partners and practice manager before taking things any further. Someone then needs to talk to the male receptionist in a non-judgmental way in private, ask him what happened this morning and allow him to disclose as much as he wishes.

If there is a relationship with the patient, I would ask him how it was affecting his work and guide him towards the need for discretion in the same way as I would in the case of a heterosexual relationship. Our staff have a clause in their contract covering behaviour likely to damage the practice's reputation and this could be applied if necessary.

The other issue is the possibility that the other receptionist is being homophobic.

She may need reminding of the practice's obligations as an equal opportunity employer. This may highlight a training need for her and require careful monitoring.

Richard Stokell is a GP in Birkenhead ­ he is also a GP trainer and course organiser

'We have to define some boundaries for the way we interact with staff and patients'

Oh dear! Our hands-off management style seems to have exploded here!

Regardless of what the truth is, we have two very distressed people (the distraught receptionist ­ call him/her B ­ and the patient). We have concerns about our male receptionist (call him A) and we have a counsellor who is possibly dangerous. We also have to define some boundaries, for the ways we interact with our staff and our patients.

The immediate need is to help the distressed ­ receptionist B and the patient. I suggest a GP partner tactfully take over from receptionist A to help the patient. The patient needs a sympathetic ear, some time and some very gentle inquiry about the counselling. Later, that GP needs to talk it over with the counsellor.

The manager or another GP should take a few minutes alone with receptionist A and explain there are some concerns ­ put it in gentle, non-accusatory terms like 'defining boundaries' because nothing has been proved. If he reacts angrily and makes accusations against the other receptionist, tell him there are no preconceptions, everyone will be listened to and he will have his chance to air his own grievances.

Remember, if he is simply being a bit too conscientious, he will be very hurt at being accused wrongly.

Receptionist B needs time to ventilate to a senior person.

A lot could go wrong ­ complaints from the patient and both receptionists, stress leave, accusations of constructive dismissal, harassment cases, just for starters.

Prompt and effective action will minimise all those risks but I would get good advice quickly from my medical defence body, the BMA and maybe the relevant NHS admin body. I would also make notes.

Declan Fox is a freelance physician in Newtown-stewart,

Co. Tyrone

'The pair may know each other from another setting'

There are two main issues. First is whether a member of the team is misusing his position to take advantage of a vulnerable patient. The second is to work out whether his front-desk colleague has problems with him and his sexuality and whether she is right about him shirking his work.

I would tackle the second issue first and speak to the distressed receptionist as soon as possible, with another partner present. The practice manager is not an appropriate choice as she seems to have a similar view. I would tread carefully, confirming that it is important she raises her concerns about the wellbeing of patients.

However, can the practice be certain that the pair do not have prior knowledge of each other in another setting? There are social circumstances where friendships arise between patients and staff, such as having children in the same school, etc.

The more serious problem is the allegation of promiscuity, and possible homophobia in a member of staff. Again it is important to work out what impinges on work and what is supposition or prejudice, which are unacceptable.

I think the health professionals might have had covert or explicit comments from other patients if they were unhappy about the behaviour of a member of staff.

I would then speak with the receptionist concerned. He may well make life easy and be relieved to admit having a relationship with the patient.

I do not know whether it would be prudent to express the concerns with the counsellor. While the counsellor has to maintain confidentiality, I think passing information to them may be seen as acting in the patient's best interest. If the allegation is true the patient may be helped to discuss his feelings and helped to resolve the issue.

The important lesson to be learned is that it is best to act early. At the first mention of the problem the partners should have discussed how to handle the situation and even considered seeking outside help.

Abayomi McEwen has been a GP for more than 20 years and is currently a GP tutor and appraisal lead for Epping Forest PCT and communications skills facilitator for the Eastern deanery

Learning checklist

What does the law say about discrimination at work?

· Indivdual workers/job applicants must not be treated less favourably because of their (perceived) sexual orientation or associates. For example it is unlawful to decide not to employ/ promote/train them, to dismiss them or to give them less favourable terms and conditions.

· Organisations must not have discriminatory selection criteria, policies, benefits, employment rules or any other practices that unjustifiably disadvantage workers of a particular sexual orientation.

· Harassment includes behaviour that is offensive, frightening or in any way distressing, even if it is not intentional.

· Practices may be held responsible for the actions of their staff unless they can show they took reasonable steps to prevent harassment; practices may be also liable to pay compensation. GPs should ensure staff understand that if they harass colleagues, they could be personally liable and may also be liable to pay compensation.

· 'No offence or discrimination was intended' is not a defence.

· Patients may harass staff; practice policy should protect staff.

How should practices avoid falling foul of the law?

· Recruitment ­ advertising should be aimed at a wide audience and personal information should not be sought on application forms or at an interview. The person specification should be based on skills and aptitudes.

· Practices should have a written equality policy that includes sexual orientation, is covered during staff training, and is reviewed regularly.

· Terms and conditions should apply equally, regardless of sexual orientation.

· Personal information about staff should be kept confidential.

· Staff should be informed about what action to take if they feel discriminated against, harassed or victimised, and should feel confident that their complaint will be treated seriously.

· Good records must be kept.

Are practice staff allowed to form relationships with patients?

· Many doctors and their staff form friendships with practice patients. This is not unlawful, but is usually undesirable where patients are vulnerable or dependent.

· Staff are not bound by GMC rules, but GPs may be vicariously liable if a staff member forms an inappropriate relationship with a patient, especially if partly conducted on practice premises or in practice time. Training and contracts should cover this.

· Patients may favour or seek out individual members of staff who they find particularly helpful. Staff should be trained to recognise and report this if it seems inappropriate; they should be supported by the practice.

How should this situation be handled?

· Should a GP speak to the patient about his post-counselling distress?

· Should a GP ask the patient about what the receptionist said in private?

· Did the patient or other patients witness the other receptionist's outburst? How should this be handled?

· What should be discussed with each of the receptionists? Should a GP, the practice manager or both be present? What aspects of employment law pertain? Is legal advice needed?

Melanie Wynne-Jones is a GP in

Marple, Cheshire

Rate this article 

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Have your say