The decision to leave medicine is never easy but doctors who retire, sell their practice or are suspended still have record-keeping obligations under legislation and best-practice guidelines.
This article answers common questions about records management when closing a practice and highlights the importance of ensuring continuity of care for your patients, whether you’re part of a group or a solo practice.
Communication is key
For patients, the loss of their doctor can cause considerable anxiety about who will provide their medical care in future.
For a planned departure, advising patients as soon as the decision is made is key. Ideally this is around six months before your departure. The Medical Board of Australia’s Good Medical Practice: a code of conduct (in effect from 1 October 2020, section 4.16 Closing or relocating your practice) states good medical practice involves giving advance notice when this is possible. You should also advise of the manner in which you propose to deal with their health information.
As a solo GP, often without a practice manager, many of these tasks fall to you. You may wish to get advice from your medical indemnity insurer or even consider employing someone short-term due to the administrative load. Equally, if you have complex patients who may need additional support to find a new doctor, you may wish to connect them with a colleague who can meet their needs or find a doctor you could recommend for them.
Group practice GPs
Patients concerned that their history will be lost will need reassurance that their records are either accessible for other doctors in the practice or transferred to another practice in a timely manner if that is their preference.
Whether your decision has been for retirement, health reasons or something else altogether, it is advisable to decide on the message you’d like to give patients about your reasons for leaving. Work with your practice manager where relevant to devise a “script” for all medical, paramedical or administration staff involved in the practice. Patients will and do ask other staff, including specialists you have referred them to.
Specialists also have close, constant and sometimes long term contact with patients. Given that patients may need to book ahead as far as 12 months, you may need to consider a mail out to your patients and your referring general practitioners advising them of your decision.
What if I cease practising without prior notice?
If you leave a practice, close a practice, retire without notice or are suspended, best practice requires that you provide a method for patients to contact you to obtain copies of their medical records for at least three months.
You can do this by providing a webpage with more information or leaving a message on an answering machine which directs patients on how to access this information. If records need storing, you should take reasonable efforts to inform patients how they can locate and access their records, and to protect records from unauthorised access, modification or disclosure.
Any patient records not passed onto another medical practitioner or the patient, need storing securely for the statutory period. New South Wales legislation stipulates inactive individual patient medical records should be kept until the patient has reached the age of 25 years or for a minimum of seven years from the time of last contact - whichever is longer.
Do I need to provide patient access to medical records?
A patient has the legal right to access these records and doctors should provide copies to the patient’s new practitioner/s, or to the patient directly if that is their preference.
Patients are required to call or write to their doctor seeking a copy of their medical records and doctors must respond promptly to the request. As a guide, the Office of the Australian Information Commissioner (OAIC) recommends that doctors complete these requests within 30 days.
If you transfer medical records to another practitioner or medical practice, record the name of the individual or practice where the records have been transferred to and their address, together with the date of transfer. Record similar details if you have provided copies of the records directly to the patient.
In recognition of the time involved in completing this, doctors are entitled to charge for the costs incurred in copying and transferring medical records. This can be by a one off flat fee, or a fee per page charge and is at the discretion of the practice but must be reasonable.
Can I refuse to provide a patient access to their records?
Access to a patient’s medical records can only be denied in exceptional circumstances, such as:
• a serious threat to the life, health or safety of any individual, or to public health or public safety or
• unreasonable impact on the privacy of other individuals.
If access is denied, you must advise the patient in writing why the request was declined. The reasons for refusing access should also be noted in the patient’s records.
Patient consent for transfer of health information
Where there is a transfer of personal information to a new legal entity (through sale of the business for example), for the purposes of the Privacy Act, personal information is being ‘disclosed’ by the initial practitioner to the new practitioner.
You must obtain express patient consent before any other provider receives the records. If you are closing your practice and selling it to another provider you need to make sure individual patients have consented to this transfer (either verbally or in writing). If a patient does not consent to the disclosure of health information, discuss with the patient their preferred option, such as giving the information to the patient or transferring it to a different health service provider.
If you cannot contact a patient for their consent, you must make appropriate arrangements to secure their health records for future access.
How do I dispose of patient records appropriately?
When disposing of medical records the primary concern must be the preservation of confidentiality. This involves taking reasonable steps to permanently de-identify the personal health information of your patients.
When disposing of records, practitioners are required to keep a register identifying the:
• name of the individual to whom the health information related
• period of time over which the health record extends
• the deleted or disposed of date.
If you use a commercial company to dispose of the records, the company should provide certification to confirm confidential destruction. Practitioners should retain copies of any certificates of destruction.
- Inform your patients as early as possible of your intention to cease practise where possible.
- Ensure information is available for patients on how to seek their records for at least three months after you cease practising.
- Patients are entitled to have their records transferred to another doctor and doctor can charge reasonable fees for costs incurred in providing these records.
- Ensure records are thorough and contain all the information their new treating doctor will need.
- Seek patients’ permission before transferring patient information or records to a third party (for example, to the new owner of the practice).
- Office of the Australian Information Commissioner (OAIC): Privacy Principles
- Good Practice Guide - Medical Board of Australia
- RACGP: Closing a medical practice
- Information and Privacy Commission NSW: Providing Access to Health Information – A Guide for Healthcare Providers
- The National Privacy Principles
- A guide for medical practitioners transitioning to an encore career or retirement