Business Dilemmas

When the time comes to retire and perhaps close your private practice, there are some important issues to consider. Dr Kathryn Leask highlights what to be aware of.

 

 

 

Dilemma 1

What must I do on retirement?

Q I am a private consultant who is looking to retire and close my private practice. What issues should I consider as I begin this process? 

A Your primary concern is to your patients, who will need to know your plans as soon as possible to discuss their ongoing care. 

For these patients, you will need to discuss the options with them and involve them in any decision- making. 

This may include referring them on to another colleague in private practice. In Delegation and Referral (2013), the GMC says you should explain to the patient that you plan to transfer their care and pass on the relevant information about their condition and history. 

Make sure the patient knows who will be responsible for their future care or treatment. The patient will also need to know that, in referring them on, you will be disclosing confidential information and that without that disclosure, referral on is not possible.

As a private practitioner, you will collect and hold information about patients and will therefore need to be registered as a data controller with the Information Com­missioner’s Office. This is a statutory duty.

Even after closing the practice, as long as you hold information, you will need to be able to fulfil your duties as a data controller. 

These duties include responding to a Subject Access Request – that is a request for access to the notes you hold about a patient. The request could be made for a number of reasons, including clinical negligence claims.

Legal responsibility

You will therefore need to safely retain your patients’ records. This is a legal responsibility under Principle 7 of the Date Protection Act. The Department of Health publishes an NHS Code of Practice for Records Management, part 2 of which lists the retention schedules. 

Although, as a private practitioner, you are working outside the NHS and are therefore technically exempt, the GMC’s Confidentiality  guidance states that everybody should follow guidance on how long health records should be kept, even if you do not work in the NHS

The retention schedules detail the minimum retention period for each type of health record. The starting point for calculating retention is the beginning of the year after the last entry in the record.

Finally, you need to consider any employees who remain at your practice at the time it closes, as some may be made redundant. 

Redundancies are never an easy option because it means the termination of employment through no fault of their own. It is essential that you keep staff informed of what is going on and seek specialist employment advice if necessary.

Dr Kathryn Leask is a medico-legal adviser at the Medical Defence Union

 

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Coping with an unruly guide dog

It doesn’t go well at this doctor’s practice when a patient brings along an assistance dog. Dr Sally Old gives advice on how to handle things if an unwelcome hound arrives to see you.

 

 

 

 

Dilemma 2

Can we stop dog from coming in?

Q A patient recently brought their assistance dog, which was a large, boisterous dog. During his visit, it jumped up at a nurse who was frightened of dogs. 

Obviously, I do not want my staff to be frightened at work and am wondering whether we can refuse entry to the animal because of hygiene or patient safety? 

A Assistance dogs are often thought of as guide or hearing dogs for blind or deaf people, but they can also refer to service dogs for those with disabilities not related to vision or hearing. 

While many of these dogs receive specific training, it should be noted that assistance dogs can be owner-selected and trained.

Medical facilities should be accommodating of service dogs as outlined in the Equality Act 2010, and the Disability Discrimination Act (DDA) 1995 in Northern Ireland. The law sets out a duty to make reasonable adjustments to enable disabled users to access services. 

The Equality and Human Rights Commission has produced a guide for businesses on assistance dogs.

This advises that you can expect that assistance dogs will be highly trained, that they will not wander freely around the premises, they should sit or lie quietly on the floor next to their owner and are unlikely to foul in a public place. 

Most will wear a harness or collar identifying them as an assistance dog, though there is no requirement for this.

Disability discrimination

It is the responsibility of the practice to take reasonable steps to minimise the exposure of staff who have a phobia or are allergic to dogs. However, neither are valid reasons for denying an assistance dog entry to the practice. 

Refusing entry to an assistance dog could result in a complaint or a claim of disability discrimination which could involve financial compensation.

The law requires reasonable adjustments to be made. This is an objective test, and the courts will consider the facts of each specific case – for example, if it were obvious that the dog was poorly trained. 

In this case, given the incident with a nurse, it would seem reasonable to ask the patient to try to ensure the dog is well behaved when on the premises.

Dr Sally Old is a medico-legal adviser at the Medical Defence Union (MDU)

• See ‘When asked to attend an adverse event meeting’