Stress at work
Accepting gifts is tricky, but so is refusing them – Dr Melanie Wynne-Jones advises
general practice. Most patients feel strongly entitled to a free NHS, although of course a gift is not the same as paying a fee. Patients do often wish to express gratitude (and other intentions) in the form of a gift, but flowers, alcohol, chocolates and occasionally more personal/unusual gifts are the norm. Extremely personal gifts, such as lingerie, should ring alarm bells. In a case like this, talk to your GP trainer immediately.
Money has different connotations and should be very carefully considered indeed. Is it a gift, a 'payment in advance' for some future service, or even an attempt at a bribe? The amount may also be relevant and high-value gifts fall into the same category as hard cash.
GPs are not currently allowed to charge their own patients for any service provided under the new GP contract. As your GP trainer's employee, neither are you. Whether you are allowed to accept gifts depends on your contract; most GP trainers would not question low-value personal gifts, but would certainly want to know more if you (or they) were offered money.
Legacies from grateful patients are probably the commonest example of money gifts, although they are not actually that common. And since Harold Shipman was discovered to have forged one of his victim's wills, the profession is under greater scrutiny and threatened by inferences that doctors' motives may not be pure.
The GMC's Good Medical Practice says you 'must not encourage your patients to give, lend or bequeath money or gifts which will directly or indirectly benefit you – you must not put pressure on patients or their families to make donations to other people or organisations'1.
Caring for a patient who announces their intention to leave you some money could create ethical problems. In a case like this, tell your GP trainer and seek advice from a solicitor or medical defence society in case relatives later suggest you exerted pressure on them or even harmed them.
You could be particularly vulnerable if there are questions about your clinical care of someone who has given you money. Good record-keeping and sharing clinical decisions where appropriate should protect you, but always be aware of how your actions could be construed.
Being offered money 'to look after the family' raises further ethical issues. Consider what may be asked of you in the future. Will you be expected to offer appointments or visits on demand, prescribe or refer without question, or treat the family more favourably than other patients on your list? You may well prefer to decline the gift (and to record that fact) to avoid an awkward situation. However, declining also requires great tact in order to avoid offending the giver.
Doctors are required to declare gifts over the value of £100 to the PCO2. This probably includes multiple gifts from the same source totalling £100 or more. You must also keep a record of the amount and source of all gifts; the probity section of your appraisal folder is appropriate. If you pass on a gift or donate it to charity, get a receipt. Gifts are not usually taxed, but check with your accountant.
In some practices, all gifts become the property of the partnership, or are put into a fund for providing equipment or extra services for patients. The latter should be transparently administered. Personal lists may have disappeared under the new contract, but the doctor who was actually given the money or provided the bulk of the patient's care may feel morally entitled to keep it.
Partnership agreements and contracts with salaried doctors and other staff must therefore clearly stipulate how gifts are to be treated if conflict is to be avoided. Small sums can generate almost as much resentment as larger amounts.
Melanie Wynne-Jones is a GP in Marple, Cheshire
1 GMC Good Medical Practice 2001
2 Standard General Medical