How to safely follow up a patient

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 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.

Charlotte Hudson

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.

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2 Responses

  1. Richard Fieldhouse
    A member contacted us with a query about this post asking; "Please could you clarify if on a return visit to the practice as a locum you are able to access the records without asking the patient for consent. I regularly look at records for my own learning and often do a random review of a surgery just to see if the patients present again with the same problem, this is a large part of my QIA for my appraisal folder. It would be near impossible to get consent from each of these patients as it would prove very time consuming and would need a feat of memory. I also have concerns about the change in relationship between a GP working as a locum and the patient if they ask for permission to review the notes asI feel this might add a feeling of uncertainty in the quality of the GP on the part of the patient.."
    • Hi All I went back to the GMC guidance on confidentiality and conferred with MPS to come up with this reply to the member, which I hope is of help: "I think Charlotte's article is referring to the situation where you want to follow up a patient after leaving the practice and no longer have access to the practice records. Therefore, it deals with how to safely store patient data outside of the practice records and how to demonstrate to the practice, if you recontact them for patient information, that you have a legitimate interest in accessing the patient record and they are not breaching confidentiality in sharing patient information with you. I don't know about you, but I work over a wide area and it is not always feasible to visit practices in person to follow up patients, so I often phone for follow up information. This is fine if you are well-known to the practice and they recognise your voice etc. However, if you speak to an unfamiliar member of practice staff, they quite rightly have a duty to consider confidentiality very carefully. This is where, I think Charlotte's advice about seeking and recording patient consent and recording the practice identifier number is key. If you can say the following; " I am Dr XXX. I saw a patient with a practice record number XXX on [date]. If you look at the consultation note from that date, you will see I recorded their verbal consent for me to contact the practice to see how they are getting on." is a powerful prompt to the practice that you are who you say you are, you have a legitimate interest in accessing the record and they are not breaching confidentiality in talking to you. In the situation you describe where you are able to access the patient record yourself when you next work at the practice, you are then an ongoing part of the healthcare team and it is part of your duty as a doctor to review your work and participate in quality improvement as set down by the GMC. For both these reasons, implied consent may be presumed for looking at patient records in this situation. The GMC states in its Confidentiality guidance that implied consent is sufficient in the following situations- for ongoing provision of care and for local clinical audit (which would include following up patients’ progress with the aim of personal learning and improvement) It would therefore seem unnecessary to seek explicit consent for reviewing records in the way you describe. Certainly, it is a normal part of my own quality review and reflections and, I agree, it would be impossible to do this valuable reflective work if you had to seek explicit consent from each and every patient."

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