One of my GP partners arranged a prescription for an antibiotic to treat an ongoing UTI. He later realised that he had misread the MSU sensitivities, and the infection was resistant to that antibiotic. By then, the patient had had the item dispensed, and she asked if the practice would reimburse her the wasted prescription fee. How should we respond?
Dr Elliott Singer: Provide an apology, but don’t pay
The question is, if we were to reimburse the prescription cost, where would this end? Often we prescribe empirically for UTIs, sometimes patients don’t respond, a MSU is sent and we then discover that the organism was resistant to the antibiotic. Should the patient be reimbursed in this situation? Consider the number of times we prescribe a medication and the patient returns to state that, for whatever reason, they did not tolerate the medication. Should we reimburse the prescription charge then as well?
Contrary to common public perception, GP practices aren’t that profitable. We do not have a budget to refund patients for this type of prescribing error. There is the equity issue as well: if we have to refund patients when our actions have resulted in unnecessary expense, should we not be able to charge patients when their actions have led to unnecessary expense for the practice – such as when they do not attend appointments?
It would be reasonable to provide the patient with a formal apology and explain to her that, as a result of this error, you will be reviewing practice policy to determine if a system can be put in place to prevent recurrence.
Although the patient will not be happy, you can only explain that there are no mechanisms that enable the practice to refund a prescription charge so you will not be able to accede to her request.
Dr Elliott Singer is a medical director for Londonwide LMCs and a GP in Chingford, east London
Dr Fiona Cornish: Apologise and offer to pay
The first thing to do is apologise to the patient and be candid about misreading the lab result with the sensitivities. Patients are often very accepting of an honest error like this, and will put up with the inconvenience of collecting another prescription. However, I completely understand this patient’s unwillingness to pay the £8.20 again – I would feel the same way.
In this situation, I would offer a refund without being asked. A reputation is worth far more than a prescription charge. The patient will feel much better and you can decide later whether this should be a practice or a personal expense. It is important to discuss this with your partners and practice manager in case the situation arises again and to ensure there is consistency in the response you give.
This is a different situation from one where the prescription turns out to need changing, through no fault of the GP – for example, if a short course needs to be extended, if sensitivities later show a need to change, or if a patient can’t ‘manage’ tablets and requests a suspension. In such cases, the patient will need to pay for a second prescription.
If the GP is a dispensing doctor, I think it would be reasonable to swap the medication to the appropriate one without charge, providing the original FP10 has not already been sent to the prescription pricing authority, and the incorrect medication has been destroyed.
I would strongly favour a commonsense approach, rather than allowing this to escalate into a complaint.
Dr Fiona Cornish is a GP in Cambridge and a former president of the Medical Women’s Federation
Dr Helen Manson: Deal with the complaint quickly
The patient is concerned about the prescription charge and this should be treated as a complaint. An oral complaint that is resolved to the patient’s satisfaction no later than the next working day does not need to follow the formal complaints procedure. There is much to be gained by acting swiftly, speaking to the patient, apologising and trying to put things right.
‘Putting things right’ is one of the Parliamentary and Health Service Ombudsman’s six principles on complaints handling, which involves acknowledging mistakes, apologising and providing prompt and appropriate remedies. These remedies should take account of any financial loss patients may have suffered as a result of a mistake made in the practice. By providing a refund for the prescription charge as a goodwill gesture, the practice may be able to resolve the patient’s concern and avoid a more formal complaint investigation and response. But this decision is at the practice’s discretion.
It’s also advisable to review the error as part of patient safety incident reporting procedures. Although this scenario did not result in harm to the patient, it is easy to think of similar mistakes that could. Perhaps the practice should review how it handles test results that require action, to see if there is anything that can be done to reduce human error.
Dr Helen Manson is a medicolegal adviser at the Medical Defence Union