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Practice calendar: December

Should you allow practice staff to accept Christmas gifts, or will you be left open to accusations of bribery? Our legal expert advises on this seasonal problem.

The problem

Christmas is nearly upon us – a time when many patients show their appreciation by giving gifts to the practice staff and doctors. Nobody wishes to appear ungrateful or to upset a patient by refusing a gift, but there are times when accepting one can raise a dilemma. What should you do with patients bearing gifts, and when is it appropriate to keep them?

Expert advice

The golden rule is that gifts should not influence or be seen to influence the care a patient receives or a healthcare professional's clinical decision-making. GPs also have a contractual duty to keep a register of certain gifts.

Much will of course depend on the nature of the gift. A dilemma may arise if the gift is of substantial value, such as a large amount of money or a family heirloom. Alternatively, the gift may be inappropriate in some way: for example, lingerie from a patient who has previously made amorous advances.

The GMC and the Nursing and Midwifery Council advise doctors and nurses that they should not accept gifts which affect or may be seen to affect their judgement. The Institute of Healthcare Management issues similar advice to its practice manager members.

If a member of staff decided to accept a gift and this prompted a complaint - perhaps from a disgruntled relative of the patient who gave the gift – he or she would need to be able demonstrate that the patient had not been encouraged to give the gift and that the patient's care had not been affected. For GPs and nurses accepting gifts, they should be able to demonstrate they have not affected their clinical judgement.

If a gift is kept, it will need to be included on the practice gift register. The register applies to all gifts worth more than £100 from patients, relatives and people providing practice services, and the rule applies to all GPs, their employees or locums, and extends to their spouses.

The register should include the name of the donor and either their address or NHS number. It is advisable to warn the patient offering a gift that this information will be kept and may be disclosed to the PCT on request.

It may be also be safer to include even low value gifts on the register, to avoid any future difficulties or criticism. At times it may be wise to discuss whether it's appropriate to accept a gift with the PCT.

Dr Jacqui Phillips, is a medico-legal adviser at the Medical Defence Union

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