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At the heart of general practice since 1960

Should I report a patient I suspect of benefits fraud?

Three experts advise a GP who suspects a patient is defrauding the welfare system

Dr Matt Burkes - Report the patient openly, not anonymously

Putting aside how enthusiastic you feel about adding state benefit surveillance to your role as a GP, it is not right to make an anonymous tip-off. If you feel you cannot talk to the patient and that it is your civic duty to report them, this should be done through normal channels.

This goes back to GMC guidance that says ‘confidentiality is central to trust between doctors and patients’.1 Any action that jeopardises this should not be taken lightly. The case for maintaining a confidential health service goes beyond the individual patient-doctor relationship and is compelling. Society as a whole clearly benefits - the treatment of communicable disease being the often cited example.

Having said this, confidentiality may be broken in certain circumstances; if ordered by a judge, if the patient consents or if the benefits to the public interest outweigh both the individual’s and society’s interest in maintaining confidentiality. The GMC gives the example of protecting a patient, or society, from serious harm or crime.

In this case, you should ask yourself whether the potential benefit fraud amounts to a serious societal harm or a serious crime? If you feel it doesn’t, then clearly confidentiality should not be broken as the situation does not fulfil the criteria for disclosure.

If, however, you feel it does, then note that the GMC also advises that one should inform the patient of any disclosure made - unless doing so would put you or others at serious risk.

The GMC also advises that you document this in the patient’s notes.

Dr Matt Burkes is a GP in Chichester, West Sussex. He is the co-editor of The Good GP Training Guide (RCGP Press)

 

Dr Toni Hazell - Ignore your suspicions and focus on patient care

GPs often get dragged into discussing non-medical issues - housing, benefits, work-related stress. Some patients are doing their best to navigate a complicated system, but occasionally I have become aware that there is fraud. It’s never clear what to do in response.

GMC advice says that disclosure is justified only to prevent others from death or serious harm, or to prevent or detect a serious crime. It seems unlikely that saving taxpayers’ money would fill those criteria anyhow, and you might have interpreted the situation wrongly.

We’re GPs, not social workers, benefits advisers or fraud investigators. Accusing a (possibly innocent) patient of fraud would fatally undermine the doctor-patient relationship and could lead to a complaint. Decline to write supporting letters for the claim, by all means, but keep your nose out of it and concentrate on treating sick people.

I can’t claim to be an expert in the benefits system and there is a fine line between exploiting loopholes and outright fraud. I don’t think this meets the criteria to break confidentiality.

Dr Toni Hazell is a GP in north London and e-learning development fellow at the RCGP

 

Dr Helen Manson - Discuss your concerns with the patient

It is unlikely that a patient would consent to information about them being passed on in this situation. Nevertheless, discuss your concerns with them in the hope of preventing them from continuing to be fraudulent.

The conversation might prove your suspicions untrue, but if not, the GMC advises that if you decide to contact the police the patient should be informed, unless this is not practical, would put someone at risk of serious harm, or might interfere with the purpose of disclosure. Disclose the minimum information necessary.

Whether or not you’re justified in disclosing their concerns depends on the extent of likely harm of the suspected crime.

Weigh up the damage that disclosure might do to the doctor-patient relationship as well as to trust in the medical profession. Contact your medical defence organisation for advice.

It is in the public interest for patients to trust that their information will be kept confidential. Doctors must generally gain patient consent before disclosing information.

The exceptions to this rule are if the doctor considers it justified in the public interest, if remaining silent may risk death or serious harm to an individual, or if disclosing would assist in the prevention, detection or prosecution of a serious crime.

The GMC considers serious crimes to include those involving ‘substantial financial gain or loss’, but does not define substantial.

Dr Helen Manson is a medicolegal adviser at the Medical Defence Union

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Readers' comments (16)

  • 1. I have a patient who is off sick due to backache for 6 months- MRI normal. Seen by Specialists and referred to Neuropsychiatry. I see him in the evening at a construction site with other workers.
    2. I have another whose children are brought in by male partner who is off sick for a genuine condition. The mother claims benefits due to a back problem, drives his 4x4 and he brings children to Surgery. Seemingly, the couple live together but official address is different in Surgery. I guess this is to cheat the system.

    What do I do? Nothing. Because, we are not here to police patients but to do a job and any involvement may distract us from what we should be doing in the first place.
    As citizens, however, there is a duty which comes into serious conflict with our obligations of care to patients and to abide by GMC regulations.
    Conclusion: Inaction advised as an error of judgment may cost the patient his health and well being while for the health professional it may spell doom. After all the first principle is - Do no harm.

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  • There is always the option of using the confidential fraud reporting line anonymously

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  • One of the problems, it seems to me, is that with all of these issues there's a risk - particularly if something bad happens (no matter how unpredictable) - the GP who [did not] act will be blamed; and that they will be investigated, hauled over the coals, NCAS and the GMC will do a fishing expedition to try to find something to blame them for, and they'll be lucky to escape with their life and sanity, let alone their career. Regardless of how carefully they thing about what they might do.

    (See e.g. [1] below.)

    1. Dyer C. GP should have seen child who was being starved within 48 hours of contact, says tribunal, 2015 (http://www.bmj.com/content/350/bmj.h3255).

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  • Benefit fraud is theft; worse, it is stealing from a fund set up to help the most vulnerable in our society. Pretending that not reporting theft is ethical is at best delusional; you are colluding with theft. It is easy to report anonymously using the benefits hotline.

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  • I made contact with the Police when I realized one of my patients was a victim of 'slavery'. She was brought from Africa to look after kids in a family at the age of 16 and worked 12 hours a day under the false promise of being eligible for UK citizenship. She was paid 100 pounds per month and when it got cold and she asked for a coat, this was deducted from her salary. Her passport had been taken and she was made to work like a mule. Poor thing was stiff with backache as she worked 7 days a week and I had no second thoughts about what needed to be done. She was anxious to return to her country and was afraid the family would find out. Her medication expenses were deducted from her income too.
    I gave her medication from our Surgery store, asked her to go home and not mention that she had been to the GP to discuss issues and assured her that I would get help. The Police were great when I called them and requested anonymity explaining the issues and that the family who had brought this person to the country were my patients. They took care of the person and helped her by removing her from the family and hopefully sending her home.
    I noted she was de-registered from the Surgery within a week of my contact.
    Sometimes there are no options and your heart and head are unanimous. I never had any doubts that this was the right thing to do and never once did the thought cross my mind of what the consequences could be for me as a GP.
    Anonymous post to prevent identification of Surgery/Patients.

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  • Britain is a nation of bums.If you have any ambition and want to succeed then emigrate.

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  • You are busted either way ..that's life as a doctor now

    Yeah and for all the lets all be truthful honest etc actually it dies not work
    And for all those who cite patient will come to harm lets just ask if the patient was a doctor doing this then what would you say ..... ..? And I hope you all say the doctor sorry patient safety paramount etc and you will all treat everyone equally

    After all we are all equal aren't we . ..? Patients that is ( this does include doctors contrary to populous belief )

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  • There is a case to be made that by doing nothing you are conspiring to reduce the funds available to those of your patients in genuine need. I'm now retired but I can't see any downside in raising concerns about benefits abuse; you may be wrong in which case no harm is done or you may be correct in which case Society benefits.

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  • Do you think it is okay to grass someone up for benefit fraud but sit back and say nothing about the billions in tax avoidance by companies we direct patients to running ISTCs and pharmacies and children's services.............?

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  • The answer is No, Benefit fraud is tiny compared to tax fraud, £120B v £1.2b The Government has cut the numbers of Tax cheats to 350, whilst increasing the numbers snooping on potential benefit fraud to 3,500.

    Trust between patient and doctor is a pact, and breaching the trust is the end of patient doctor relationship.

    Perhaps you as a GP could try living on £70 every 2 weeks and ask yourself if you could gain the system would not do it for the benefit of your kids?

    Yo need to walk a mile in a persons shoes....

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