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Should practices have a smoking policy?

We are interviewing for a full-time assistant practice manager. Our best candidate, on paper, is a smoker. She tells us she is at peace with her addiction, but that she will need to be able to smoke during the working day and does not think it acceptable that she should have to stand out on the street to do so. Nobody else in the practice smokes, so we have never needed a formal smoking policy. What are our obligations?">

Under the Health and Safety at Work regulations 1992, you are required as employers to protect non-smokers from discomfort caused by exposure to tobacco smoke in rest areas. You are under no obligation to make provision for smokers to indulge their habit during their work time ­ tobacco addiction is not recognised as a disability which employers must try to accommodate.

As almost two in five adults in the UK are smokers, it makes sense to have a written policy on smoking in the workplace. Start by discussing the matter with your existing staff and finding out their views. Look at your premises. Could your assistant practice manager have her own office in which she can smoke while she works? Is there any possibility of creating a designated 'smoking area' separate from the main staff rest area? Or is the consensus that it would be inappropriate for a medical practice to be anything other than completely smoke-free?

Draw up a policy statement, and keep the policy under review. Include measures that you will take to help smokers who want to quit. These might range from giving a quitline contact number through to providing private hypnotherapy.

If your prospective assistant practice manager does not think she can comply with your smoking policy, you should not offer her the job. Even if she only smokes outside the building, it will detract from the image of the practice and will reduce the amount of time she spends working.

Can we dismiss our sick secretary?

Our secretary has recently had casual sickness absence of 15 per cent of her scheduled work time. She has now been off sick for six weeks with back pain, and has no intention of returning until she has had an MRI scan, for which she may have to wait several months. When we appointed her we knew she had recurrent low back pain. Does this mean we cannot dismiss her?

You are not obliged to keep her on when her pre-existing condition makes her incapable of fulfilling her job description, but do take the following steps before dismissing her on grounds of incapacity.

 · Discuss the possibility of adapting her duties to accommodate her disability. Would she be able to do her job if you altered her workstation or even let her do some work at home?

 · Keep in contact without making her feel harassed, spied upon, or pressurised into returning to work or resigning. This is a delicate area, as people on sick leave often feel guilty about being absent from work, and this guilt readily translates into defensiveness and even paranoia.

 · The practice manager or the partner responsible for staff management should write a letter offering to visit her at home ­ and send it by recorded delivery. At this visit, discuss her rehabilitation and ask her to sign a consent form so you can approach her GP for a medical report. Give her a written summary of the content of the meeting afterwards. If she refuses a visit, send the consent form to her with an explanatory letter and an SAE.

 · Request a medical report, specifically seeking an opinion on her prognosis for returning to work and being able to do her job properly, from her own GP. Enclose her signed consent and a copy of her job description.

If you have done all you can and there is no prospect of her returning to work in the foreseeable future, or she remains off sick despite a medical report stating that she is fit, you can dismiss her.

Should our staff register with us?

We are the only practice in our village. Although we insist

that the doctors register with another practice, many of

our staff live locally and are our patients. How big a

problem is this conflict of interest?">

It would be best for everyone if your staff, and their immediate families, registered with another practice. Could you come to an agreement with a practice not too far away to register one another's staff? To compensate staff for the resulting inconvenience, perhaps the agreement could include a degree of extra flexibility with appointment times.

If this is not possible, you do need to take steps to ensure that staff who are also patients receive fair treatment.

 · Keep the medical records of staff and their families in a secure place away from prying eyes. If the senior receptionist finds out that you have prescribed the Pill for her teenage daughter, or the other staff start gossiping about the fertility treatment which the secretary had intended should remain a secret, you must be absolutely certain that the practice cannot be accused of having been the source of the information leak.

 · Encourage staff to consult by appointment in normal surgery instead of being fitted in at odd moments, and don't let staff consult on behalf of spouses and children.

 · Don't allow staff to print a script (even for an OTC drug) for themselves or a family member, or arrange an investigation, without the clinical appropriateness being confirmed by a doctor.

 · Have a protocol for dealing with a staff member who is off sick. The partner who looks after the staff member's health should play no part in employment-related decisions, and should treat the staff member as if she were employed by another agency.

Ultimately, unless you are sure that you could cope with the bizarre scenario of having to write your own practice manager a report on the fitness of your receptionist to do her job, you should not allow your staff to be patients of the practice.

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