How do I discipline a member of staff who is also a patient?
Three experts advise a GP facing a conflict of interest with a staff member
A member of admin staff has not been abiding by our staff sickness policy and is therefore being disciplined by the practice. However, they are also a patient at the practice and are making a complaint about their clinical care. How do I deal with this potential conflict of interest?
Dr Fiona Cornish: Look at the two issues together
You will need to look carefully at the details of the patient’s notes and discuss with your practice manager how the staff sickness policy has been abused, to establish how the disciplinary action and clinical complaint are interrelated. Details of the staff sickness policy may include how many days of self-certification are allowed, who you have to inform when you are unable to come to work, and what medical evidence is needed. For example, the GP treating the staff member may have written notes including comments about the expected length of time needed to recover, and the staff member may have taken more time off. On the other hand, the GP might have written very brief, incomplete notes, and not offered the appropriate treatment. Any patient has the right to follow the complaints procedure and this would need to be offered.
Resolution by sensitive handling through a meeting with a GP, and practice manager and the member of staff (patient) would be the goal, but if necessary, consult the BMA for employment advice and your defence organisation for advice on the complaint. You would hope to resolve the situation by a conciliatory meeting, and you could have an observer present who is independent. Suggest that your member of staff changes practice, for their own benefit, so they can receive independent and objective medical care.
In general, it can be negative for a member of staff to be a patient at the practice. Likely difficulties are that the member of staff may not disclose information that is crucial to a diagnosis or management of a condition because they are embarrassed to share that information with their employer. Likewise doctors may fail to ask sensitive questions or carry out intimate examinations, which is ultimately not in the best interest of the patient.
The fact that medical records are kept at their place of work introduces a risk that a colleague will accidentally or purposefully access confidential information that is held about them. If the care of this member of staff involved a sick note, the GP would be aware of the effect their absence would have on the smooth running of the practice, so this may impair their ability to be entirely objective in writing the note.
Dr Fiona Cornish is a GP in Cambridge and a former president of the Medical Women’s Federation
Dr Sarah Jarvis: Deal with the problems separately
Many practices operate a policy that members of staff cannot also be patients, however in this situation, it’s important that the practice keeps the doctor-patient and employer-employee relationship as separate as possible. Different members of the management team should be dealing with the complaint and the employment matter.
The patient is entitled to have her complaint investigated in the same way as any other patient so it’s important that the practice follows its complaints procedure. This will help to avoid any criticism by the patient or the Ombudsman should the complaint be escalated there.
The person dealing with the sickness absence issue needs to bear in mind that while the employee may provide information as part of an occupational health assessment, the practice should be careful not to inadvertently reveal any health details known to them only in the context of the doctor-patient relationship.
To avoid this situation in future, the practice may wish to revisit its policies on having staff as patients. If a decision is taken to ask staff to register elsewhere, this would need to be communicated sensitively and those affected would need to be given time to make alternative arrangements.
Dr Sarah Jarvis is a medicolegal advisor at the medical defence union
Dr Mohammed Saqib Anwar: Follow your policies carefully
This is a situation that needs to be handled very carefully and sensitively, for obvious reasons. It is imperative that the performance issue is kept completely separate from the clinical complaint aspect, and as such each should be dealt with on its own facts. If the situation allows I would ensure that different partners or individuals look at and take responsibility for the differing aspects under question. This will help ensure that there is a clear divide and separation of the matters and less chance of any actual or perceived bias. The practice will hopefully have very clear policies on both the disciplinary and complaints process, so it is essential that these are followed and adhered to. Getting a disciplinary process wrong can have significant consequences especially if matters escalate to an employment tribunal and so I would strongly encourage you to seek specialist HR advice.
Unsurprisingly what this scenario clearly highlights is some of the challenges that having a dual role as employer and doctor can pose. The GMC in its guidance Good Medical Practice states that you should avoid providing medical care to anyone with whom you have a close personal relationship. Even if GPs and members of staff do not consider themselves to have this close personal relationship, in my view it is best practice for members of staff to register at a different practice. You need to think very carefully about having your employees as patients, as it is not ideal for anyone, and so I would also recommend that as soon as the situation allows this is discussed amongst all the partners to help ensure a practice policy on such can be developed.
Dr Mohammed Saqib Anwar is chair of RCGP Leicester and a GP Partner in Oadby