Discontinuing care

Can our practice discontinue care where safety concerns exist?

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

GPs have obligations under: 

• work health and safety laws (refer to section on work health and safety)
• 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 our practice discontinues care, what is the GP’s 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 although care is being discontinued at your practice, getting care for any ongoing or new medical issues is important
• ensure an appropriate and timely clinical handover is available to future care providers (for example, offer to promptly transfer medical records). 

How should our practice discontinue care?

You can discuss with the patient in person, if safe to do so. It would be prudent to follow up this conversation with a letter. Preventing and managing patient aggression and violence: A brief guide for general practices has sample templates in which the wording could be changed to describe incidents of sexual harassment.

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)
• offer to transfer a copy of the patient’s health information to a new practice with the patient’s permission
• take care of any urgent medical matters for the patient (for example, ensure that they have a supply of their medication). 

What else does our practice need to do?

Your practice should: 

• establish whether the patient has a carer, to ensure they are appropriately involved in relevant deliberations and communications (while being mindful of patient confidentiality and privacy)
• 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 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

There may be situations when a letter to other treatment providers may be necessary. If required, this letter should 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.