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Secret Diary of a PM: When is a temporary patient not temporary?

This week has seen me getting closely involved with issues surrounding a temporary patient who seemed to be here more than at home, and had some rather strange expectations – an issue that took many hours to resolve.


A temporary patient, as we all know, is someone who comes to the area for a short period and then goes home and back to their registered GP. Maximum stay is three months and then they need to be registered permanently if they are still in the area.

That is fair enough and whilst we do get paid a little for the patient in our GMS contract, it is swings and roundabouts and in the majority of cases it’s not really a massive issue – until suddenly it is!

We currently have a temporary patient who registered over two year ago and has been seen at our surgery off and on since then. They state they spend less than two months in our area, with the rest of their time divided between being in their permanently registered area and out of the country.

One of the partners queried recently that this patient had been seen many times over the past few years, offered referrals, hospital tests etc. and seemed to be here more than at home. We were treating some very complex issues and they were concerned that we did not have the patient’s full medical history.

So, we asked them to register at our surgery so we could get their full records.  A fair request, but they refused, saying they were only here for a short time each year. My response was that without your full records how can we be sure you are being treated correctly? Therefore we told them we were not prepared to continue treating them.

The patient decided to get their permanent GP surgery involved, who said we have to treat him. They would, wouldn’t they, as we were paying for his care and not them!

The patient suggested that they would be happy to sign a disclaimer saying if anything went wrong as a result of us not having their full medical details they would not sue us.  That puts our doctors at risk and is something they are just not prepared to take.

I tried to reason with the patient by saying ‘you basically have two sets of notes and two records - neither practice having the full picture’.  ‘Oh no,’ they said – ‘everything I have with you and secondary care I get copies to send down to my registered GP’. ‘That’s fine,’ I say, ‘but we do not have your notes nor your medical history. Surely you do not want us to be taking risks?’

The patient was adamant they were and I was adamant we would not see then. So, they contacted PALS and put a complaint in, and when that didn’t work called our CCG to put in a complaint to them too. Whilst in some respects I had support from our CCG, I was told I was breaching patient choice, and we had to see him.

Patient choice is good, don’t get me wrong, but where has doctor’s choice gone? Surely the CCG could see the potential risks and also the costs involved in treating this patient?

After a lot of calls and emails we have reluctantly agreed that as from now we will only treat to the exact letter of what a temporary patient is entitled to, that is not for long-term conditions - only those that are immediate and necessary. For any referrals and tests they will need to go back to their own GP.

I cannot help thinking there is more to this one than meets the eye, could you imagine what would happen if all patients did this? Utter chaos!


Comments

SB 17/05/2018

Sadly, I think this is a problem of your GPs' own making. A temporary patient should only be provided with care suitable for a temporary stay in the area. Quite what that means depends on the individual circumstances, but would usually be limited to problems that cannot wait to be dealt with by the patient's own GP. Of course, if someone effectively has two homes and spends a lot of time at both, that makes it more difficult. But there is no doubt that primary responsibility for ongoing care and long term conditions lies with the registered GP.

Nicky 16/05/2018

I thought patient choice was to choose which ONE practice you are registered with.


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