Discontinuing care

Can our practice discontinue care where safety concerns exist?

Your practice can discontinue care for a patient where there are genuine safety concerns for your practice team and others who attend the practice. These concerns may prevent you from providing ongoing high-quality care for that patient.

The practice has obligations under:

• work health and safety (WHS) laws (refer to section below)
• the Medical Board of Australia’s Good medical practice: A code of conduct for doctors in Australia (section 3.4.5, ‘Keeping yourself and your staff safe when caring for patients’).

If we discontinue care, what is our ongoing duty of care to the patient?

Your practice must:

• ensure that a patient is not excluded on the grounds of illness (including mental illness) or disability  
• ensure that in a medical emergency, the patient receives medical care
• explain to the patient that while care is being discontinued at your practice, getting care for any ongoing or new medical issues is important
• act to reduce imminent harm to the patient (eg by treating them in an emergency and/or calling an ambulance)
• ensure an appropriate and timely clinical handover is available to future care providers.

How do we discontinue care?

You can have the discussion with the patient (and carer if appropriate) in person, if safe to do so. It would be prudent to follow up this conversation with a letter (See 'Letter templates' section below).

In advising them that you are discontinuing their care, the letter should:

• outline the boundaries you are setting (for example, that the patient is not to call or attend the practice)
• make an offer to transfer a copy of the patient’s health information to a new practice with the patient’s permission.

What else would we need to do?

Your practice should:

• establish whether the patient has a carer, to ensure they are appropriately involved in relevant deliberations and communications
• keep a detailed factual report of the conversation or measures taken in informing the patient about the decision to discontinue care, including a copy of any letter sent to the patient
• flag the patient file so that the entire practice team knows that the patient has been instructed to no longer attend the practice
• agree upon the practice’s response to a violation of the boundaries you have set (for example, what the practice will do if the patient calls or attends). This should be supported by thorough training, including scripts for reception staff and the opportunity for rehearsal.
• There may be situations where a letter to other treatment providers may be necessary. If required, this letter should be factual and simply state that the practice is no longer involved in the patient’s care.
• If you hold any concerns regarding the process of discontinuing care, speak with your MDO.