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Surgery websites have come

a long way, but there are medicolegal

issues to consider, warns

Dr John Holden of the MDU

Practice websites have reached a highly sophisticated state. Some now offer their patients the opportunity to request repeat prescriptions and even provide Frequently Asked Questions-style medical and general healthy lifestyle advice. In future, patients may also be able to Choose and Book hospital appointments via practice websites.

But there are numerous medicolegal issues to consider when setting up or adding new services to your website.

Confidentiality is vital, and GPs must be confident in the security of any IT system they use, including the server hosting a practice web page. While no information system can ever be 100 per cent secure, GPs need to demonstrate they have adequate security and have taken steps to try to prevent accidental disclosure of confidential data.

The new contract requires that GPs use approved computer systems and have high-quality security, audit and system management functions.

Practices should consider the requirements of the Disability Discrimination Act 1999. This requires that all organisations, big or small, must take 'reasonable steps' to make their premises accessible to the disabled or provide a reasonable alternative method of accessing the service.

The MDU has received advice that the provision of information and online services via a website falls under the Act. While the Act offers no specific guidance as to what an organisation must do to comply with the legislation, both the RNIB and the Disability Rights Commission offer general advice on web accessibility.

If you offer general medical advice on your site to your patients, you should include a note stating that the advice is only general and should not be used as a substitute for the personal advice patients receive when consulting a GP.

In Good Medical Practice the GMC advises that the information doctors publish about their services must be factual and verifiable and published in accordance with the law and guidance from the Advertising Standards Authority.

It is possible to offer e-mail consultations over a website. If you do it is important to ensure that all such communication is confidential ­ in other words all e-mails must be secure.

In Good Medical Practice the GMC advises that good clinical care must include an assessment of the patient's condition, based on the history, symptoms and if necessary, an examination. It is also important to keep a note in the patient's record of what was discussed and agreed and how you intend to follow up the problem.

The GMC gives specific advice to doctors who are considering prescribing remotely for their patients, in the form of Frequently Asked Questions. The advice says you must ensure you have an appropriate dialogue to:

· establish the patient's current medical conditions, history and concurrent or

recent use of other medications including non-prescription medicines

· carry out an adequate assessment of the patient's condition

· identify the likely cause of the patient's condition, and ensure there is sufficient

justification to supply the medicines/

treatment proposed.

Where appropriate you should discuss other treatment options with the patient. You should ensure the treatment and/or medicine/s are not contraindicated for the patient and make a clear, accurate and legible record of all medicines prescribed. If you cannot satisfy these conditions the GMC advises that you should not use remote means to prescribe for a patient.

John Holden is a medicolegal adviser at the MDU

Case study

· An enterprising patient, on holiday in Portugal and having difficulty finding a local doctor, e-mailed his GP via their website asking if he should increase his dose of asthma inhaler as he had been having difficulty 'getting his breath' in the night. The GP advised him to increase the dose, but later rang the MDU to ask if he should have done so.

· In this case, the GP's clinical advice may well have been correct, but by offering advice you are assuming a duty of care for a patient who you cannot examine or offer to follow up. Also, a body of legal opinion maintains that the consultation occurs where the patient is. As the patient here is in mainland Europe and not in the UK, the GP would need to be registered to practise in that jurisdiction. His indemnity cover may apply only to treating patients in certain countries.

· The patient should be advised to seek local medical assistance with an offer to provide local doctors with further information about previous medical history, should that be required.

· The case mentioned is fictitious, but based on cases from the MDU's files. Doctors with specific concerns are advised to contact their medical defence organisation for medicolegal and risk management advice.

The MDU cannot offer advice on the compliance of websites.

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