Your patient has gone to the local paper to complain that they have been denied access to a treatment by your consortium. You are sympathetic to their cause. What should you say if the journalist asks you for comment? Dr Helena McKeown advises
Unfortunately I think it quite likely that a patient who believes they are being unjustly denied a treatment they believe best for them may well contact the local press. GP commissioning with its aim to make better use of the NHS budget is likely to increase the conflicting challenges we face. We are obliged to protect our patients if we have serious concerns about what is happening around us and that patient care may be under threa. The GMC's Good Medical Practice states the following on raising concerns about systemic problems:
If you have good reason to think that patient safety is or may be seriously compromised by inadequate premises, equipment, or other resources, policies or systems, you should put the matter right if that is possible.
Talking about a concern directly to the media is rarely advisable and if I were approached I must first insist that I cannot break patient confidentiality and secondly only comment if I am fully aware of all the facts, who else will be commenting and whether I can see what will be printed as attributed to me before printing. Local papers will have an angle and I may damage my professional relationships with the consortium, potentially doing more harm to the local population where I work than good as advocate for this individual with whom I sympathise. I would be wise to consult the BMA or my defence body first.[1]
I could explain in general terms that GP commissioning encourages us all to make appropriate use of NHS resources, and in secondary care services in particular it should ensure a step-change in the quality of care for local patients, delivering better value for the taxpayer and improving the health of our community.[2]
In looking at the facts, was the decision about this patient's treatment clinically appropriate and was the GP who made the decision financially rewarded for refusing a particular treatment? We will all need to ensure that we do not receive direct payments for clinical decisions or they will not be defensible to the GMC.
Under commissioning arrangements GPs must both continue to refer in the patient's best clinical interests and to ensure that they are seen to be doing so.[3]
Dr Helena McKeown is a member of the GPC Commissioing and Service Development Sub-committee, and GPC member for Wilts and Dorset
Dr Helena McKeown
