Mr Jerard Ross
Patients and their records are your main priorities, and form part of the medico-legal considerations involved with practice closure
Running a private practice is an exciting challenge and, handled well, can be an enjoyable and sometimes lucrative alternative or addition to NHS practice.
However, one area which is rarely spoken about is your responsibilities when 'winding up' a private practice. It can be a source of concern for many doctors. So what are the issues to consider?
The patient will also need to know that in referring them on you will be disclosing confidential information and that without that disclosure, such referral is not possible
Care of patients must be your first concern. You might consider them in three categories - those you have treated and no longer see, those you review regularly and those who are likely to require further treatment.
These last two groups of patients, particularly, will need to know your plans well in advance and to discuss their ongoing care. Being made aware as soon as possible after you have made your decision allows these patients to express their preferences. In Delegation and referral (2013) the GMC says that 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 under the Data Protection Act 1998 (DPA). Such 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 different reasons, including clinical negligence claims.
You will therefore need to safely retain your patients' records. This is a legal responsibility under Principle 7 of the DPA. 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 from the Public Records Acts, the GMC guidance in 'Confidentiality' (2009) makes clear that everyone should use the retention schedule and does not distinguish between private and NHS records.
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.
We recommend that you check the schedule with reference to the types of records you hold. The following are a few examples of the timescale of retention:
- general hospital records (not specified elsewhere in the schedule) - 8 years after conclusion of treatment or death
- joint replacement surgery - 10 years
- oncology records - 30 years
- records relating to litigation should be reviewed 10 years after the file has been closed.
Children and young people's records should be retained:
- until the patient's 25th birthday, or
- 26th birthday if the young person was 17 at the conclusion of treatment, or
- eight years after death, unless the illness or death could have potential relevance to adult conditions or genetic implications.
You should consider, in your planning, who will fulfil these duties in the event of your death. Your death does not remove the requirement for fulfilment of statutory duties as regards other people's data which your estate might hold. Patients may still require access to their personal information. We recommend that you discuss this issue with your solicitor when drawing up a will.
We often get calls from doctors who are retiring from medical practice, or private practice, but wish to continue with medico-legal work, such as writing expert reports.
The introduction of revalidation and licensing has made it necessary for any doctor who sees patients, even if not treating, to hold a licence to practise. This will require ongoing engagement with a Responsible Officer and continuing professional development.
For individual advice on your own circumstances, call 0800 716 646.
Mr Jerard Ross
Jerard graduated from the University of Aberdeen in 1994. He then moved into surgical training in Edinburgh before completing his MD at the University of Manchester. Before joining the MDU he was a consultant in adult and paediatric neurosurgery in Edinburgh where he was the surgeon to the Scottish National Paediatric Epilepsy Programme.
See more by Mr Jerard Ross