Your patient has asked for a treatment that my consortium has decided not to provide, but you believe it is clinically appropriate. What options are available to you? Dr Nick Clements offers GPs his expert advice
Your responsibility is to your patient, and to provide the best treatment and care that you can, within the constraints and resources available to you. Where resources are unavailable or inadequate, you should base your decision on the underlying principles of efficiency and efficacy, fairness, justice, and a doctor's duty to protect life and health.
The patient should have the position explained clearly to them, in an objective manner. You should be careful not to allow your personal views to lead you into making comments that could be taken to be unfounded or malicious, that may undermine patient trust in the care and treatment they receive, or the judgement of those treating them.
If the consortium offers an appeals process in respect of treatment decisions, you should explain this to the patient, and provide details as well as any support you feel is appropriate. If you believe that patient safety is or may be seriously compromised by the consortium's policy, then you should follow GMC advice in "Raising Concerns About Patient Safety – Guidance for Doctors" (November 2006).
In particular ensure that you concerns are drawn to the attention of the consortium. You should be clear, honest and objective, and keep a record of both your concerns and the steps taken to try to resolve them. If the consortium has a procedure in place for this type of issue, then make sure you follow it.
If you are unable to resolve the matter, you should seek further advice, for example from a senior colleague, your Medical Defence Organisation or other professional association.
Dr Nick Clements is head of Medical Services in Leeds at the Medical Protection Society
