Rights and Responsibilities When you join a G.P. Practice, there are certain services, referrals to other services, treatment, and redress you can expect as a right. You are entitled to receive health care on the basis of your clinical need rather than how much you an afford.
The Patients Charter outlines these rights. Many G.P. Practices and Health Authorities also produce local charters of service concerning your rights and expectations. But this is a two-way thing, as you have responsibilities as well as rights towards the practice; towards the other patients and towards the staff.
I want a second opinion Sorry, but there’s no automatic entitlement to one. If your doctor is any good though, he or she will probably allow you to have a second opinion if you’re concerned about the diagnosis or treatment. Many doctors will even encourage it for your peace of mind.
My GP refuses to see me Your GP can refuse to see you if you have not made an appointment or if he or she believes you don’t need treatment. In an emergency you have a right to see a doctor – but not necessarily your own GP.
I want to change doctors but the new doctor won’t take me Tough. You have to do your best to find a doctor who will. If you really can’t get any doctor to accept you, the Health Board is legally obliged to find you one and can force a doctor to accept you. You can write to the Health Board (in England: The Family Health Services Authority) and ask for a list of doctors in your area. The Health Board keeps a register with the doctors’ gender, age, qualifications and the services offered at that practice. A GP can remove you from his/her list without giving a reason.
Help your GP to help you With today’s heavy workloads, he or she probably has between six and nine minutes to see you. Taking up more time may mean depriving someone else of the benefit of the doctor’s time without improving the treatment you receive. If you are ill, then make a list of symptoms, the frequency, if they are getting worse or staying the same, and if other aspects of your life have changed and may be influencing your health. Use the list to explain yourself clearly and concisely, and be honest and open.
If something’s not clear If you don’t understand the doctor’s advice, ask questions, and then follow instructions carefully. If you want a general discussion – for instance, about filling in your living will, explain the need and make an appointment. Get your doctor to advise you on preventative measures and about smoking, exercise, diet and depression. Don’t bother your doctor about colds and flu when the only advice is going to be rest, lots of liquid and an aspirin!
Choosing a doctor Make a short list of surgeries and visit them to get a practice leaflet and see what the waiting rooms are like. What are the surgery hours? Are the staff courteous and helpful? Don’t fill in a registration on the spot – consider arranging a pre-registration interview (you may have to pay a small fee for this) to see if you feel comfortable and confident about that doctor. Find out if you can just turn up and wait during surgery hours or whether they run an appointments system. Ask if the GP is a fund holder: it might make the difference between the doctor being able to buy the treatment required or waiting in line for the local health authority to make it available.
I want to see my medical records You have a right to see them unless a) your doctor thinks it would he harmful to you or someone else; b) it would breach the confidentiality of a third party; c) the records were handwritten before November 1991. It may be very necessary’ to see your records if you are thinking of taking legal action against your doctors. If you are refused the records then a court order will be needed to ensure their release.
I have a complaint There are different ways to complain. Many problems arise from lack of communication. Your GP may not even be aware that there is a problem. Make an appointment to discuss the matter, or write a letter. You can also address your letter to the Complaints Officer, c/o the GP’s practice, NHS Trust or Local Health Board. You should make your complaint no later than six months after the event.
If this fails you may want to submit your complaint for Independent Review to the Health Board (Scotland) or Family Health Services (England & Wales) – find the address in your local telephone directory. You must not leave it longer than four weeks from the letter from the Complaints Officer (see above).
Further advice on complaints procedures can be found in the Department of Health’s leaflet on Complaints (phone 0800-22-44-88 for a free copy). The Health Board may take action against the doctor if there has been a breach of the doctor’s contract with the Board. They could, for example, limit the number of patients on a doctor’s list. No compensation is available to you as the patient.
If you are still dissatisfied, you can also ask the Health Service Commissioner (Ombudsman) to investigate.
Complaints to the GMC A second course is to complain to the General Medical Council (not the British Medical Association!) if you believe a doctor is guilty of serious professional misconduct or has failed to meet the required professional standards. In serious cases, the GMC could reprimand or even suspend the doctor, but no direct compensation is available to the patient.
Legal action If you believe the doctor has been negligent, legal action is a third route. You should consult a solicitor experienced in medical negligence and who practices under the Legal Aid Scheme. The time limit for raising a court action is three years from the alleged incident. It is very difficult to win such an action but you may receive financial compensation if you succeed. Finally, if you are a patient in hospital, you can also make a complaint to the designated officer for each hospital or group of hospitals within the Health Authority or Board.
Admission to Hospital Admission to hospital is on the recommendation of a GP, your family doctor, who should already know about your wishes and, if you have completed such documents, have a copy of your Living Will and/or Values History in the medical records.
In unforeseen circumstances – if, for example, you are in a traffic accident – you would of course be given emergency treatment on admission to hospital. The doctors will generally act under the assumption that you would opt for life. Some people carry their living will on their person, as this could assist decision making, especially after initial emergency treatment. Emergency treatment should be given when a) the patient is incapable of consenting, b) immediately necessary, c) it cannot reasonably be postponed to seek the patient’s consent, and d) there is no indication that the patient would have refused consent.
Providing you are able to communicate, doctors must seek your informed consent before commencing further treatment. They have to give you enough information so that your consent can really be “informed”. They should tell you about possible treatment alternatives and the likelihood of any side effects. They should also be willing to discuss the probable outcome(s) of treatment with you. They should explain the nature, likely outcome, and any possible outcomes of any operation they propose. This information must be given in layperson’s language.
If you do not understand any aspect of the doctor’s explanation, ask him or her to put it in layperson’s language. You have the right to withhold consent for treatment, or for an operation, even if by doing so you are likely to shorten your life. You also have the right to discharge yourself unless you have been detained under the compulsory powers of the Mental Health (Scotland) Act 1984 (or England: Mental Health Act 1983) or have a notifiable infectious disease.
If you are admitted to a teaching hospital, you have the right to refuse permission to have students examine you. Your own wishes are paramount. The doctors must listen to you, no matter what the rest of your family says. Family members may play a significant role in drawing attention to the wishes in a living will and insisting that those wishes are respected. Above all, you have the right to have your personal dignity and self esteem respected at all times.
Useful names and addresses
Health Boards – see the phone book.
General Medical Council (GMC), 178 Great Portland Street, London W1N 6AE . 0171-580-7642. (The GMC also publishes a booklet called, “Making a complaint about the professional conduct of a doctor.”)
Patients Association – 8 Guildford Street, London WC1N 1DT. Tel 0171-242-3460
Medical Victims Association – 137 Morriston Rd, Elgin IV30 2NB.
UKCC (UK Central Council for Nursing, Midwifery & Health Visiting) 23 Portland Place, London W1N 4JT. Tel 0171-637-7181.
(Operates an interdisciplinary procedure to investigate complaints of professional misconduct involving registered nurses, midwives and health visitors. )
‘NHS’ The Ombudsman Tel 0131-225-7465
Mental Welfare Commission Tel 0131-225-7034.
NHS Helpline Tel 0800-22-44-88
General Medical Council advice on seeking patient consent
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