A personal experience leaves columnist Dr Copperfield more sympathetic to patients… and to the idea of favourable NHS treatment for doctors
I don’t know if you’ve noticed this, but people seem to get iller as they get older. And so it is with me, as each new dawn appears to bring with it another bit of me dropping off.
No surprise, then, that I find myself unwillingly thrust into the role of ‘patient’. I won’t bore you with a tedious homily of insights from the post-op ward in which I’m writing this column. But I will say that my supposed ‘two-week referral’ led to six weeks of radio silence, the hospital helpline failing to respond to multiple calls and, when eventually I did make contact, me being listed for the wrong procedure. This all means I now have much greater sympathy for patients who call us in desperation, because by that point it boils down to us or Ghostbusters.
So I did what absolutely everyone else seems to do these days if they can, and that’s ‘go private’. Which clearly is the Government’s unspoken policy for reducing secondary care waiting lists, the cunning bastards.
Which got me thinking, and not just about my bank balance. Specifically, it made me wonder, is there a case for NHS workers getting preferential treatment? Bear with me. I’m no great fan of queue jumping. I’m so egalitarian that, mid-Covid, I nobly declined the ‘essential worker’ fast-track at Waitrose that the massive ‘NHS hero’ badge I was wearing proved I was entitled to.
But there is the precedent of preferential treatment for veterans, of course. Now, obviously, I’m not going to make the crass and oft-repeated metaphor-riddled parallel about us GPs being on the front line of the NHS’s War on Illness, even if coping with all the flak from enemy patients is a form of trench warfare that can leave you a bit shell-shocked.
What I will say, though, is that it’s probably reasonable to feel a bit pissed off when you’ve devoted 35 years to the NHS, and worked above and beyond through goodwill, dedication and a belief in the system, only to find the secondary care door slammed in your face when you need treatment yourself. Like I did. Yes, I know, I will get a nice pension, but I’d like to be around to enjoy it, right?
Back in the day, of course, we could just ring up our consultant mates to help us out, and they would, willingly. Trouble is, there’s no back door anymore – the bureaucracy is too stifling and the pathways too rigid.
But the argument for preferential treatment for NHS staff probably goes beyond my own simmering resentment and selfishness. To keep the NHS running, you need to have ailing staff treated promptly, efficiently and conveniently – that way you avoid stressing a creaking service even more.
Besides, in the current climate when more of us are opting for early retirement, what better way to retain older staff than to guarantee them prompt NHS care when, like me, they start falling apart?
So if only for these reasons of pragmatism, NHS, why not start looking after your own? In the meantime, I might try submitting my private bill to NHS England to see if they’ll stump up. A patient genuinely once tried that with me by way of a protest about his inability to get a GP appointment. I laughed about it then, but I’m not laughing now.
Although that might be the stitches.
Dr Copperfield is a GP in Essex. Read more of his blogs here
used to go without saying now GMC and defence unions think its a breach of duties
Great idea ….. the problem is there are so many of us , and capacity is so limited, that if this did happen, then only people who would get treated at all would be nhs staff. I can almost hear the Daily Wail headlines now …….
You can only get reimbursement of private health care costs by the NHS if you went abroad and had a holiday along with it. Yes, patients have been successful with this, and it is cheaper than having an op in private Britain, and it is shorter than waiting lists and avoids suitability criteria too.
I still specify in referral letters if the patient is a staff member, and I believe strongly that, especially whilst resources are so stretched in the NHS, it is important to deal with staff members very promptly to get them back to work quicker to increase capacity in the NHS.
Let’s face it, it makes economic sense and all private companies do this if they can; and if they are not able to sack the staff member to avoid the costs of having them off sick.
Unfortunately, NHS proved how little it valued it’s staff during the ongoing covid pandemic, where they could provide PPE for MPs, but not for hospital staff; and have been trying hard to sack all those with long covid now, despite the fact that reducing transmission and protecting staff would be far cheaper, even now.
I do hope you recovering well – and that the pension will be drawn for very many years!
I totally agree with your sentiments. I think our professional colleges should treat us as special case. It happens in in all other departments. Thankfully I was treated very well with my health issues by hospital. I had option go go private but I decided to stick with nhs. In old times I could ring consultant to see me or my dear one and they obliged. Now other staff are watching to report Queue jumping hence doctors are careful..
Charging your gp colleagues by another gp for private certificates is not good either. I never charged my colleague.
Hope you get well soon, and the local medics are reading this column!
I agree -city banks pay for private health insurance to keep their workers going. The NHS doesn’t need the private sector- as it has err.. the NHS to fall back on.
Get well soon DC. I was wondering about the reduction in your oft acerbic and always hilarious insights over the last few weeks. Great to have your posts back.
I did a medical SHO locum in around 1994 in Epsom Hospital.
They had a top floor which was the private wing that I had to cover occasionally. The impressive thing was that all hospital employees were fast tracked to this private wing and received gold standard care – from the hospital porter to the consultant.
This preferential treatment for NHS staff and their loved ones has been gradually eroded. It used to be the only perk of the job.
Now there are none.
Wishing you a full recovery and lots of warm get well wishes x
Best wishes.
I dislike it being called a perk. This is akin to having a robot on the production line left unrepaired because everyone else is too busy trying to make up for the broken robot to repair it. We all know what Toyota would do. I suspect they would actually have staff hanging around potentially under employed to get in there quickly at short notice to fix the robot as production is their raison d’etre and everything is focussed on that. So on appt to fix a nurse or a porter quickly in reality may actually get 20-30 patients treated as well by a swift return to productivity rather than having them languishing at home in a queue getting bigger whilst they languish at home being unproductive. I bet some clever person could even do the maths and show that fast tracking the workers who see the patients would get more patients seen and not clog up the system as someone suggested above.
Every single idea, thought contusion, plan, scheme, access management, pay disputes, triage system, staff shortage, staff illness, patient dissatisfaction stems from their being no clear price signal in the NHS AND the forced taxation and presence of the NHS crowding out all other healthcare in the low and medium cost prices brackets.
If we could put our NHS insurance allowance towards healthcare of our choice (including NHS PLUS with top up fee) things would be immeasurably better.
Until that time it’s all just pressure groups trying to prove their ‘according to need’ is more important than another group’s ‘according to need’. That includes staff, other keyworkers, patients with multiple illnesses, veterans, men, women, children, workers, those at risk of not working, cancer patients, menopause patients, every single ‘GP to be aware of disease X’ patients etc etc.
Everyone can plead special status, and when ‘need’ is the only currency to access healthcare that is what everyone has to spend their time doing.
Risk alert
NHS staff jumping the queue
MDDUS advisers are starting to see a rise in calls concerning NHS employees using inside access to expedite personal healthcare
People waiting in line
Date: 31 May 2023
|
6 minute read
It’s not uncommon for healthcare professionals to be approached by patients in the supermarket or other non-clinical settings asking for advice or looking to bypass systems and gain quicker access to appointments or referrals. However, MDDUS advisers are now starting to see a rise in calls concerning NHS employees using their privileged position to inappropriately obtain contact details for staff at GP practices or hospital departments where they are awaiting appointments and treatment.
Members report being contacted through the official NHSmail platform on various issues. These range from requests for a GP callback when struggling to get through to a busy practice by phone, to individuals divulging detailed clinical symptoms in the hope that this will illicit advice or treatment.
Using the NHS directory system inappropriately in such a way could result in disciplinary action and even possible dismissal if an employee is found guilty of gross misconduct.
Physician heal thyself
Given the current pressure on the NHS with workforce challenges and growing patient demand it’s not surprising that staff are experiencing more work-related illness. The 2022 NHS annual staff survey found that 44.8 per cent reported feeling unwell as the result of work-related stress. The NHS has been identified as having higher than average stress-related sickness absence, compared against all job sectors across the country – and this can be added to expected disease levels among healthcare workers.
Healthcare professionals and their families face the same anxiety as the general public over access to NHS medical and dental care – with long waiting times for treatment and a “scramble” for appointments. It may be tempting to use inside influence to facilitate quicker access to healthcare services but this can risk consequences on several counts.
Objective care
Being asked to provide healthcare advice or treatment for a friend or colleague can put doctors in a difficult situation. Refusing such a request might seem awkward or overscrupulous but it is important to recognise that personal relationships can potentially inhibit the ability to make clinical decisions objectively.
The GMC is clear on the matter in its guidance Good medical practice, stating (paragraph 16g): “In providing clinical care you must… wherever possible, avoid providing medical care to yourself or anyone with whom you have a close personal relationship.”
Making a referral or “expediting” a request could be viewed as offering clinical care in this context and also an abuse of privilege.
There is no absolute restriction on dentists providing care to colleagues or family. However, GDC Standard 9.1.4 states that: “You must maintain appropriate boundaries in the relationships you have with patients. You must not take advantage of your position as a dental professional in your relationships with patients.”
A less formal dentist-patient relationship can present risk in providing objective care.
Test results
Another example of using privileged access to provide a ‘personal favour’ would be logging into a clinical system to review test results upon request from a friend or colleague. They may be anxious to hear from their doctor and ask if you can check for them.
Refusing such a request may again seem awkward and unsympathetic but it is not appropriate to blur patient-doctor boundaries in this way and it is likely to fall foul of organisational policies, including data protection (see below). Our advice is to explain why you cannot access their records and why it is safer for them to await an official review from their doctor.
Data protection concerns
Another serious risk to consider is patient confidentiality. A colleague might reach out for advice on behalf of a relative or friend but this could be problematic without appropriate consent to share personal health details. Disclosing identifiers or sensitive information without consent would constitute a breach of patient confidentiality either by the colleague asking for advice on behalf of their friend or the treating clinician sharing details about the patient with their colleague.
There is also the risk that an email might be forwarded to the wrong recipient. Contact details being searched for on the NHS mail directory could result in the selection of the wrong email address, with similar or the same names being listed and the contents of the email ending up in the wrong mailbox.
The GMC offers specific guidance on confidentiality, stating: “Doctors, like everyone else, must comply with the law when using, accessing or disclosing personal information.”
GMC advice on confidentiality is underpinned by eight principles, including the requirement to: “Make sure any personal information you hold or control is effectively protected at all times against improper access, disclosure or loss.”
The GDC offers similar guidance in its Standards for the dental team, stating: “You must protect the confidentiality of patients’ information and only use it for the purpose for which it was given.”
Continuity of care
What if a colleague contacts you for health advice on a matter of immediate concern? It may seem inadvisable to provide advice in such a context but it is important to recognise when you have a duty to act swiftly.
How such requests are recorded is important. Any kind of advice response from a clinician, even if only to signpost to the most appropriate point of contact, should be recorded contemporaneously and added to the clinical record of the patient to ensure continuity of care, especially any description of symptoms that leads to clinical or dental advice being given.
Organisational policies
Organisations should maintain policies that set out the legitimate ways in which patients can contact a service for access to advice and treatment. A policy should also be agreed for the benefit of staff and clinicians, setting out protocols for staff being contacted for advice or requests outside of normal channels. This should include circumstances in which high-risk clinical information is disclosed, making sure that the patient and their personal information is protected.
Apart from avoiding regulatory or other difficulties, such policies will help prevent reputational damage to the organisation from claims of unequal access to services. Responding safely and equitably to requests for advice or access to healthcare should help prevent you or the practice coming under criticism if a complaint is raised.
Key points
Undertake a risk assessment to determine the best way to redirect individuals who contact you informally for advice.
Act swiftly and refer to organisational policy if you are concerned about a person’s immediate symptoms or welfare.
Be mindful of regulatory guidance, particularly involving patient confidentiality.
Contact MDDUS if you are unsure how to manage such circumstances.
Kay Louise Grant | MDDUS
Kay Louise Grant is a risk adviser at MDDUS
@douglas callow. Interesting and thanks. But why the difference between dentists treating family and colleagues compared with doctors? Personally, this guidance is over risk averse for the benefit of the defence organisations. I can see why it is there but cripples common sense, humanity and the natural inclination of doctors wanting to do that best for themselves and their friends and families with the skills they have in most reasonable cases within a completely crap non functional healthcare system.
neo 99 agree fully
Left wondering if someone has perhaps had a quiet word with defence unions from our political leaders or NHSE?
makes no sense
It makes sense to treat your own colleagues first. They help reduce the massive workload and stress. Stick to the good old school teachings.