Whether it's for a learning need, for your annual NHS appraisal, or because you've had a change of heart, it's important for us as professionals to do, so doing it safely is of paramount importance.
One of the difficulties in doing locum GP work is that it is difficult to follow-up the outcomes of patients you have seen. This is especially problematic in relation to short-term sessional GP positions; however, provided that there are appropriate safeguards in relation to consent and confidentiality, then there is no reason why one cannot follow up a patient.
The reasons for wanting to ascertain the final diagnosis in relation to specific patients are both out of professional interest and professional development. In addition, it demonstrates to the patient that you have an ongoing interest in their case, despite the fact that you are only working in the practice for a short period.
There are occasions when a GP locum can identify, at the time of the consultation, reasons why it would be helpful to know what the outcome was, eg, if a patient presents with an unusual rash and is referred to a consultant dermatologist, or if a patient presents with a chronic cough and is referred for a chest X-ray. In such circumstances, it is helpful to broach the subject with the patient at the time of the consultation.
What to say:
“I would be really interested to know the outcome of the results/referral; unfortunately I am only at the practice for a short time and will no longer be working here when they become available. In the circumstances I wondered whether you might be so kind as to give me your consent to contact the practice when the results become available.”
Obtaining consent to follow up a patient, and where to store information
A record of verbal consent could be recorded on the computer; alternatively, you could invite the patient to sign a pre-prepared consent form (with a space for you to fill in the nature of the investigation that has been ordered and the name of the patient). You might also want to retain a list of the cases that you want to follow-up; however, in order to avoid any breach of confidentiality in the event that the list is lost or stolen, this is best done in an anonymised way.
A useful way of doing this is to use the practice patient identification number (which will not identify the patient to anyone who does not have access to the practice computer system); however, if you are going to pursue the option of obtaining written consent, then the consent forms could simply be left at the practice with the intention that you will either ring or call to determine the outcome.
In circumstances when the practice computer system does not generate a patient identification number, then an alternative would be to use the patient’s date of birth, date seen and identity of the practice.
If the information is to be stored online, then despite the fact that it will be anonymised, you could use a password-protected storage system.
The practice will be able to identify the patient from the patient identification number (or from the other information as outlined above), so there will be no need for you to hold patient-identifiable information.
Working in different practices, do you ever get that 4am brain worm about a patient you saw the day before? At NASGP, we're used to this experience, so have developed a tool that may not only keep those brain worms away but also help you improve patient care and help generate evidence for appraisal.
With pressure for appointments increasing, it can be difficult to ensure that a patient of concern has access to the follow-up you had intended. Try using this form to flag up to reception when a patient really needs review.
In its confidentiality guidance, the GMC states that implied consent would be sufficient in cases where patient data is being used for the purposes of clinical audit, which would include following up a patient's progress with the aim of personal learning and improvement. This means that if a locum sees a patient and then subsequently wishes to access the records of that patient held by that patient’s regular GP, they can do so without breaching confidentiality.
We've developed an electronic logbook using Google Forms that can be installed as a form on your smartphone, where you can then access the information back home on your computer. You will also need a free Gmail account.
- On your PC/Mac, access the read-only NASGP AppraisalAid | Patient logbook.
- You'll see an ugly spreadsheet - yeugh - but ignore that for now. Instead, click on |sign-in| in the top right hand corner. This is where you'll need to either sign in with your Gmail account, or sign up for a free one.
- Once you're signed in, go to |File| >Make a copy...
- This copy is now in your personal secure Google Drive.
- Still in the spreadsheet, go to |Form| >Go to live form
This form is an easy smartphone-friendly way to securely record patients of interest. Add them to this form on-the-go, and then back home, from your Mac/PC, click on |Edit this form| >View responses.
Smartphone? Make sure you're viewing the live form, then copy the url/weblink and email it to your smartphone. Open the link on your smartphone, then find a teenager who'll then create a shortcut to it for you.
Working with the practice
The above approach will require the approval and co-operation of the practice; therefore, when you accept a GP locum post it would be helpful to prepare a leaflet explaining your intentions and enclose a copy of the consent form. Whilst it will mean a little extra work for the practice, most will recognise that the request reflects a committed sessional GP and it is unlikely that there will be significant objections.
The above approach also does not require you to store patient-identifiable information either in hard copy or in electronic form, and hence means there is no risk of an inadvertent breach of confidentiality.
There may also be occasions when you see a patient in the early stage of a disease process, when it may not be apparent that they have a significant underlying diagnosis (for example; a patient that presents with non-specific viral symptoms that subsequently turns out to be SBE). In these circumstances, you may not appreciate at the time of the consultation that it would be helpful to know the outcome and a learning opportunity may be lost. You therefore might wish to ask practices to update you, with the consent of the patient, if there is an outcome that was unexpected at the time of your consultation.
Writer and editor at MPS. MPS’s educational risk management workshops, ‘Mastering Professional Interactions’ and ‘Medical Records for GPs’ provide further information on the risks to patients and doctors when patient care passes between doctors, and on good record-keeping. They are free as a benefit of membership to MPS members too.