Clinical Practice

Colleges agree on LMC and GP communication

The Royal New Zealand College of General Practitioners and the New Zealand College of Midwives have agreed on the minimum information that must be conveyed from a woman’s LMC to her GP at the end of pregnancy. It has also been agreed that this information must be sent to the GP by the fourth week after delivery rather than the mother being expected to convey the form in person when she next visits the practice.

A form detailing this information is available. If you receive a form with the box ticked beside “I will follow up this summary with a phone call” please be alert to this and make it easy for the LMC to get through to you.

Feedback on the form and on communication between LMCs and GPs generally would be appreciated and can be sent to Frances Townsend in the Policy Unit.

Download the form (PDF 48 KB)

Coroners Act 2006

It is Friday afternoon just before the long weekend. You’ve seen your last patient and at last you can head away for a well-deserved break and that tramp you’ve been planning for ages. And it’ll be great - no emails, no phones and you can switch off your cell phone and even if you don’t, well you’ll be out of range anyway . . .

BUT WAIT!

The new Coroners Act 2006 came into force on 1 July last year. With it come some new obligations and a reinforcement of some others. Sue Johnson, Regional Coroner for Canterbury has provided us with some suggestions for you to consider in order to meet your obligations. She will be running a workshop at this years conference. But to find our more now click here

Quality Planning before you go away

Have you made provisions to ensure your patients are able to access 24-hour medical care while you’re away?
A. Yes, of course I have.

But what about your records? You need to ensure your deputising service has access to your patient records. Have you organised this?
A. I don’t think I can do that? Don't the Privacy Act and the Health Information Privacy Code apply? I’d need the patients to consent.

No, you don’t need their consent. All other laws override the Privacy Act and the Health Information Privacy Code and one of these is the Code of Health and Disability Services Consumers’ Rights and you need to comply with Right 4(5):

Right 4(5) Every consumer has the right to co-operation among providers to ensure quality care and continuity of services.

Also, if you use the Privacy Act and Health Information Code correctly you don’t need individual consent to do anything you want with your patients’ health information. If you let your patients know the purposes for collecting their health information then you can go ahead and use it for those purposes without going back to get consent. So, put up a sign informing your patients that when you are away they need not be concerned about continuity of care because your deputising service can access their records. In other words you are telling your patients that one of the purposes for collecting their health information is to share it with the deputising service. This means you are using the Health Information Privacy Code correctly to safely handle your patients’ health information.

There's another reason you should make your patients notes accessible to your deputising service: one of your patients might die while you are away – and here we’re talking about a patient whose death would not be unexpected to you a death you’d be able to issue a cause of death certificate for if you were there.

You need to ensure your work answer phone has the number of your deputising service so they can be contacted.

A cause of death certificate can be issued by a substitute doctor if you are away. The substitute doctor must have examined the body, taken into account the circumstances of the death AND read your patient’s medical records.

If you go away and do not leave access to your records there is a huge delay.

Police resources are taken up searching for you.
The Coroner has to be advised. The Coroners are on call 24 hours a day 7 days a week and will try to contact you if it appears from the circumstances of the death you would likely be able to issue a cause of death certificate. Even if you are unavailable, the police and coroner will try to find you. And yes, if necessary they will try to track you down on your tramp!
When you have not left access to your patient records to a deputy doctor then sometimes the body has to be taken a long way from home to a mortuary for storage in a refrigerated facilities until you can be contacted. This is distressing for a family.
The family can’t organise the funeral. This is particularly distressing if the family/whanau for cultural or religious reasons customarily require the body to be available soon after death.
Unnecessary post-mortems should not have to take place to facilitate an early release just because you’ve not left access to your records. This is distressing for families and costly to the taxpayer.

The new Coroners Act 2006 came into force on 1 July last year. Family and whanau have rights under that Act, including that there is minimal delay in having the body released back to them for the funeral.

So what you can do is this

Even if your practice is in a rural area, miles from anywhere you should organise a deputy to cover you when you are away and leave their phone number available on your surgery answerphone
Make sure your deputising service includes a doctor who can access your records:
If you have manual records, provide the deputy doctor with access to your surgery and let them know whereabouts in there the notes are kept
If your practice has computerised records, give your deputy doctor access to the records via their computer or provide them with access to your computer. They may require some assistance in accessing the computer programme if unfamiliar with it. Make sure you check that they know how to access it before you go away.

Now, go enjoy that tramp. (And the coroner won’t now be radioing the hut warden to track you down!)

Sue Johnson is the Regional Coroner, Christchurch
Phone +64 3 353 0444

Sue's region encompasses Christchurch, Banks Peninsula, North Canterbury, Nelson, Marlborough and Tasman.

This topic is to be discussed at the College Conference in Queenstown in July. Be there to have your say!

Posted 19 May 2008