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Dilemma: Lending £10 to patient

A patient attends with an abscess that needs to be seen at the local hospital. It’s not serious enough to need an ambulance, but the patient has no money for a bus or taxi. What should you advise the patient to do?

Suggest an alternative solution, such as using a local volunteer service

Dr Peter Swinyard 1 Charles Milligan

We are often viewed (thank you Daily Mail) as being as rich as Croesus and I have been asked in the past for a loan from a patient.

We are obliged to be absolutely beyond question in our financial dealings with a patient as part of our GMC duties. There is no explicit prohibition in the GMC guidance about lending money to a patient – but I have come across some situations in which GPs have got enmeshed in financial dealings that have led to GMC complaints. You can imagine if the patient were a young woman and an older male doctor lent her money – and she then told her friends that he had paid her for services rendered.

Here we have a much simpler situation where a patient needs an NHS service and has difficulty in gaining access to that service. Calling a blue-light ambulance in this situation would be farcical, so alternatives must be explored. These include local volunteer drivers – the old ambulance car service or its equivalent – or public transport or a commissioned patient transport service.

This is clearly a non-emergency/urgent transport requirement and I would call on the local patient transport service, recently commissioned in my area from Arriva. It may be that transport would have to wait until the next day but this could be clinically appropriate.

But lend him a tenner? Not on your nelly.

Dr Peter Swinyard is chair of the Family Doctor Association and a GP in Swindon

Use an ambulance if you have no alternatives

Dr John Cosgrove

For me, lending money to a patient crosses a line and so this dilemma would prompt me to re-evaluate the patient’s clinical condition. If I saw no alternative to emergency hospital treatment, I would try to arrange ambulance transfer. Otherwise, I might consider aspirating the abscess myself and prescribing oral antibiotics, or, depending upon skills and facilities, lancing it in the surgery.

Lending him the money would come close to infringing the GMC’s ‘Duties of a Doctor’, which warns against accepting or offering gifts which might be seen to affect the way I treat patients. Imagine how I might feel towards him subsequently if he did not pay me back or did not use it on a taxi to hospital.

This man and his community need to find resilient transport solutions. I’d be happy to help them find solutions – perhaps help to set up a charitable hardship fund – but not to provide them.

Working out of hours, I am struck that those patients who argue most passionately for a house call citing lack of transport often reach the centre the quickest! Who knows, just as lending him the cash requires a closer relationship than I might be happy with, succeeding in finding a lift might even help to strengthen ties between him and his obliging neighbour.

GPs have the skills and limited resources to provide medical treatment. We should resist the temptation to try to, or be seen to, provide non-medical interventions. We are poorly placed to judge the financial merits of each case.

Dr John Cosgrove is a GP in Birmingham and a founder member of Grassroots GP campaign group.

Start a slush fund for these patients

Dr Vicky Blackburn - online

I have had situations like this arise in my practice. As a result we have a clear practice policy, and have taken steps to avoid such situations whenever possible. Our policy is that we advise none of our staff to lend money to patients – no matter how plausible their lack of funds, or needy their case. Past experience has shown that it usually results in the lender being permanently out-of-pocket.

In an attempt to avoid such situations, a neighbouring practice had set up a cash reserve fund. This practice has charitable fundraisers and keeps small donations from grateful patients. This money serves as ‘petty cash’, and can be used to ‘lend’ money for taxis in cases such as this.

In my practice, with our policy in place, our patients usually find a friend or relative they can ask to give them a lift, or lend them funds.

Recently, however, when faced with a long wait for an ambulance, a member of my staff did kindly drop a patient at the hospital on their way home.

Thus my answer would be: ‘No, I cannot lend you money’. I do not feel that refusing such a request would impact on the doctor-patient relationship- so long as it is made clear that it is practice policy is being followed, and nothing personal.

It should be made clear that as GPs we do not hold sole responsibility for people’s health needs. Patients must be able to take responsibility for their own health too by making sensible choices (by ensuring they have adequate funds for emergencies or friends who can help at times of need).

If GPs aren’t careful, acts of kindness become expected tasks, and other requests will follow – do you really want to take home the homeless man on your doorstep once the hostels are full?

It is important to seek and provide the best possible care for our patients, but we must not blur our responsibilities, as in so doing we may ‘dilute’

our professional integrity.Dr Vicky Blackburn is a GP in Stonehouse, Gloucestershire.

Readers' comments (8)

  • Rachael Mackay

    I'd be shocked if the majority of patients didn't agree with all your thoughts on this. GPs certainly don't hold sole responsibility for people's health needs and I would hope that the majority of practices have a policy in place so all staff can refer to it if they are put on the spot by patients asking to borrow money. The cash reserve fund is a nice idea but above the call of duty in my humble opinion. I imagine it could easily get abused if not monitored closely. In general, I think Patients need to be better educated regarding the role of the GP, but I'm certainly not suggesting that this should be added to your ever increasing workloads!!!!!!

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  • Goodness that is a challenging situation! The solution raised by all three commentators sounds very much the best as it minimises the chance of abuse - arrange transport with one of the existing patient transport services. They will have procedures in place to make sure that a patient ends up at the place you wanted them to go, and you haven't set a precedent.
    The only issue related to this that we have faced, is where patients can get free transport to A&E but not to their GP surgery, so to save a 200yd walk they go to A&E. But we're trying to find a way around this already

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  • This dilemma takes a different turn when the nearest hospital is on the east coast of the country and we are on the west coast, a 2 hour drive away. There are no buses and no taxis that can take the patient and the community car scheme does not travel outside of the area. We would ask the patient to ring for ambulance transport knowing full well that this does not guarantee they will make their appointment. In the past we have had to threaten to admit via blue light ambulance before sense prevails and transport is arranged, for example for a transfer to an out of area nursing home when the patient's only carer is admitted.

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  • Well nice thoughts. I am not sure of distance. For local bus an officially stamped note from GP will allow him I owe you bus fare to the hospital.

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  • I've driven a patient to hospital before now and Have bought bread and milk for an elderly lady with an empty fridge prior to contacting social services. I would like to think there are people who would have helped me if the situation was reversed. Slush fund a very good idea.

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  • I too have helped with very basic food stuff, lift to hospital, etc

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  • I too have helped with very small amounts for basics in the past and one night in a very poor household fed the electricity meter in order to see to examine the patient ! I was however happily surprised when the patients wife came to reception the very next morning to pay it back.

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  • "Never a borrower or a lender be"

    Ok, a bit simplistic. I don't think it is good practice to lend money to patients. It can sour the relationship if its not paid back. Even if the lender is not bitter about it, the borrower may be ashamed to approach them again.

    I'd deal with this as I would any request to borrow money. If there is no other option for emergency transport, I'd give the tenner, not lend it and make it clear that is what I'm doing. If I get it back, great. If not, theres no harm done.

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