Ending your professional relationship with a patient

Ending your professional relationship with a patient

1

Good medical practice sets out the principles, values, and standards of care and professional behaviour expected of all medical professionals registered with us. The standards of good practice apply to doctors, physician associates and anaesthesia associates (collectively referred to as medical professionals and whom we address directly as ‘you’ throughout the guidance). As with all our professional standards, this guidance applies to all our registrants to the extent it is relevant to the individual’s practice. Ending your professional relationship with a patient builds on Good medical practice to provide more detail on our expectations of medical professionals in this area.  

2

The professional standards describe good practice, and not every departure from them will be considered serious. You must use your professional judgement to apply the standards to your day-to-day practice. If you do this, act in good faith and in the interests of patients, you will be able to explain and justify your decisions and actions. We say more about professional judgement, and how the professional standards relate to our fitness to practise processes, appraisal and revalidation, at the beginning of Good medical practice.

When might it be necessary to end a relationship?

3

In rare circumstances, the breakdown of trust between you and a patient means you can’t continue to provide them with good clinical care. This might occur when a patient has, for example: 

  1. been violent, abusive, or made threats to you or a colleague
  2. displayed other criminal behaviour, such as stealing from you or the premises
  3. acted in a sexual way towards you
  4. persistently acted unreasonably.
4

Relationships with patients may also end for other reasons, for example because a contract or service ends, or because of the closure or relocation of a practice. In such circumstances you should follow the guidance at paragraph 13. 

5

You should not end a professional relationship with a patient solely because of: 

  1. a complaint the patient made about you or your colleagues. You must make sure that any complaints or concerns raised by the patient are responded to promptly, fully and honestly (Good medical practice, paragraph 46)
  2. the resource implications of the patient’s care or treatment. 

Before you end the relationship

6

It may be reasonable to end a relationship immediately in certain circumstances. For example, primary care regulations and contracts allow for the immediate removal of patients from practice lists if a patient has been violent or behaved in a way that has caused other people to fear for their safety. You must follow local or national guidance and regulations.

7

In other circumstances, before you end a professional relationship with a patient you should:

  1. tell the patient that you are considering ending the relationship and explain the reasons why
  2. do what you can to restore the professional relationship. This could include setting expectations for the patient’s future behaviour
  3. discuss the situation with an experienced colleague or your employer, or contracting body. 
8

You must seek advice from a safeguarding lead if you are concerned that ending a relationship with a patient could leave them, or someone close to them, at risk of significant harm.

9

You must make sure that you are acting fairly and not discriminating against the patient (see paragraphs 19, 33 and 56, Good medical practice).

When you've made the decision to end the relationship

10

If after considering paragraphs 6–9, you decide to end your professional relationship with a patient you must: 

  1. tell the patient or make arrangements for the patient to be told of your decision and the reasons for it – where practical, this should be done in writing
  2. consult and follow relevant local guidance and regulations
  3. make sure arrangements are in place for the continuing care of the patient if they are unable to make arrangements for themselves
  4. pass on all medical records without delay to ensure continuity of care, in accordance with paragraph 65 of Good Medical Practice
  5. record your decision to end the relationship, making sure that information recorded in the patient’s records is factual and objective, and does not include anything that could unfairly prejudice the patient’s future treatment.

Ending relationships with those close to a patient

11

You should not end relationships with those close to a patient simply because you are ending a relationship with the patient on the grounds of their behaviour.

12

If it is necessary to end the relationship with other patients (for example, because of risks to staff arising from ongoing contact with the former patient), you must make sure that arrangements are made for the continuing care of children and young people or any dependent adults who are unable to make arrangements for themselves. 

Closing or relocating your practice or service

13

If you are closing or relocating your practice or service, you should: 

  1. give advance notice to your patients 
  2. where relevant, make sure that arrangements are made for the continuing care of all your current patients in accordance with paragraph 65 of Good Medical Practice.
  3. make sure all patient records are transferred or managed appropriately in line with data protection and record retention requirements (see paragraphs 125–130 of Confidentiality: good practice in handling patient information).