Treating Olympic tourists in general practice
Here are five steps recommended by the Medical Defence Union for coping with an influx of non-registered patients.
The Olympics is almost upon us, and from this Friday an estimated 325,000 extra visitors are expected to descend on the capital's streets during each day of the two-week event. But it's not just London that will be affected – with events taking place in venues as far apart as Glasgow, Coventry and Weymouth, there are many places in the country that can expect to see an influx of visitors.
But what does this mean for GPs in those areas?
By now, many practices in London and other areas where events are taking place, will have already had discussions about how to deal with the impact of the Olympics, including how the extra visitor numbers may lead to an increase in temporary patients who want to see a doctor.
Here are five steps recommended by the Medical Defence Union for coping with an influx of non-registered patients:
1. Prepare for new patients
Providing treatment to temporary patients can be complicated for GPs. When a GP treats a registered patient, they have the patient's records to hand, which they can refer to and update during the consultation. These records act as an important account of any underlying health conditions, allergies or medication regimes. If a patient visits a GP with whom they are not registered, however, the GP will not have access to this record and so will not be familiar with the patient's background. Although the patient may be able to explain much of their own medical history, it can be difficult to recall everything – for example, medication dosages – and this means the GP may not be able to gain a full picture of a patient's health.
2. Get the patient's consent to access their at-home medical records
A GP may wish to ask a patient's permission to contact their GP in order to access the patient's medical records prior to their appointment. If the patient agrees, every attempt should be made to contact the patient's practice before providing treatment.
3. Take notes and pass them back to the patient's normal doctor
Clear and contemporaneous notes should always be made when treating a non-registered patient, and these should be securely passed on to the patient's usual practice after the consultation.
If the patient does not agree for their usual practice to be contacted or if the patient's records can not be accessed for another reason, it is especially important to make sure a detailed history is taken from the patient, including enquiring into whether the patient has any allergies.
4. For referrals, tell the hospital that the patient is an overseas visitor
In addition to the potential problems associated with not having access to a patient's medical records, GPs may also be faced with patients for whom it is not clear if they are entitled to NHS treatment. The Department of Health guidance states that a GP can exercise their discretion to accept any person, including overseas visitors, to be either fully registered as an NHS patient or as a temporary resident if they are to be in an area between 24 hours and three months.
5. Know the exceptions
However, DH guidance also states that being registered with a GP or having an NHS number does not give a person automatic entitlement to access free NHS hospital treatment. With this in mind, if a doctor feels it is necessary to refer a temporary patient for hospital treatment, they should make it clear in the referral letter that they believe the patient is visiting from overseas so the relevant NHS body can check their entitlement.
GPs can refuse to treat temporary patients provided they have ‘reasonable grounds for doing so that do not relate to the applicant's race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition' (clause 181, standard GMS contract).
However, GPs have a contractual duty to provide immediate necessary treatment and an ethical duty to treat in an emergency. Although GPs are not ordinarily obliged to grant non-emergency appointments to non-registered patients, a doctor should be prepared to justify any decision not to provide an appointment at a later date if necessary.
If a practice chooses not to honour a request for an appointment from a non-registered patient, the practice should make detailed notes on its own system in case staff members are questioned later as to why an appointment was not provided and are asked to justify this decision.
Dr Natalie Hayes is a medico-legal adviser at the Medical Defence Union