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Practice dilemma: Large cheque from a patient

Your practice nurse opens a thank you card from a patient to find a cheque for £500 made out to her personally. What are the rules regarding accepting gifts? Our legal expert gives advice.

The golden rule is that gifts should not influence or be seen to influence the treatment or advice a patient receives.

The Nursing and Midwifery Council advises nurses in its Code of Conduct (2008) that they must refuse any gifts, favours or hospitality that might be interpreted as an attempt to gain preferential treatment.

When deciding whether to accept this relatively large amount of money, it is advisable to ask if it could appear that it had influenced clinical decision-making in any way. If you decide to accept it, you would need to be prepared to demonstrate that it had not. It is important to keep a record of the reasons for accepting or returning the money and any conversations you have with the patient.

If you keep the gift, it will need to be included on the practice gift register which GPs have a contractual duty to keep [1]. The register applies to all gifts worth more than £100 from patients, relatives or people providing practice services. The rule applies to all GPs, their employees or locums, and extends to their partners.

The register should include the name of the donor and either their address or NHS number. The patient would need to be warned that this information will be kept and may be disclosed to the PCT on request.

The MDU advises that it may be safer to include all gifts in the register, irrespective of value, to avoid any future difficulties or criticism.

Dr Emma Cuzner is a medico-legal adviser at the Medical Defence Union

Dr Emma Cuzner, MDU medico-legal adviser