How do I maintain professional boundaries with patients in a private setting?
The GMC rules are the same as in the NHS, but private practice creates new pressure points: direct access, payment, friends as patients, gifts and social media.
The short answer
The GMC’s standards on boundaries apply in exactly the same way whether a patient pays or not. What changes in private practice is the pressure on them: patients may expect direct access to you, friends and colleagues may ask to become patients, and payment can blur the line between a service relationship and a personal one. Decide your rules before these situations arise, write them into your practice policies and patient information, and record anything unusual in the notes.
Key points
- GMC boundaries guidance applies to all doctors, whatever the setting or how the patient pays.
- Avoid treating yourself or anyone you have a close personal relationship with, wherever possible.
- Set out how and when patients can contact you, and keep clinical contact on practice channels.
- Do not accept gifts or hospitality that could affect, or be seen to affect, your clinical decisions.
- Offer a chaperone for intimate examinations and record the offer and the outcome.
The rules do not change, the pressures do
GMC guidance on maintaining personal and professional boundaries came into effect with Good medical practice on 30 January 2024. Good medical practice says you must not act in a sexual way towards patients or use your professional position to pursue a sexual or improper emotional relationship with a patient or someone close to them. None of that depends on whether the NHS or the patient is paying.
What is different in private practice is the setting. You are often working alone, with fewer colleagues to notice when things drift. Patients may see you as their personal doctor and expect access that an NHS practice would never offer. And the commercial relationship can make it harder to say no. Most boundary problems start small, so the aim is to spot the pressure points early.
Access and contact
Direct access is one of the things patients pay for, and it is also where boundaries slip first. Decide in advance:
- which channels patients can use to contact you, such as the practice phone, a patient portal or practice email
- when you will respond, and what patients should do outside those hours
- whether you ever give out a personal mobile number, and if so on what terms
Put this in your patient information and stick to it. Keep clinical conversations on practice systems so they are recorded and someone else can pick them up if you are away. See should I give patients my phone number?
Friends, family and colleagues as patients
Once you are known as a private GP, friends, neighbours and colleagues will ask to see you. Good medical practice says you must, wherever possible, avoid providing medical care to yourself or anyone with whom you have a close personal relationship. A close relationship is a matter of judgement. It can include friends, colleagues and some acquaintances, not only family.
The risks are well known: you may not ask the difficult questions, examine properly or keep objective notes, and confidentiality is harder to protect socially. A practical policy:
- Refer close friends and family to a colleague or another service.
- For acquaintances, decide case by case, and record in the notes that you considered the relationship.
- Do not offer informal advice or prescriptions outside a proper consultation, even when asked socially.
Gifts, discounts and money
GMC guidance on conflicts of interest says you must not ask for or accept, from patients or anyone else, any inducement, gift or hospitality that may affect or be seen to affect the way you prescribe for, treat or refer patients. The same guidance says that if a patient offers an unsolicited gift, you should explain that you cannot accept it unless it is of minimal value, and that you must not encourage patients to give you gifts or money. Gifts linked to a request, or repeated gifts from the same patient, need particular care.
- Keep a simple gifts register and record anything above a threshold you set.
- Apply fees consistently. Informal discounts for favoured patients blur the relationship and can look like an inducement.
- Do not borrow money from patients, lend to them, or get involved in their business or financial affairs.
See handling conflicts of interest for referrals and financial interests.
Social media
GMC guidance on using social media says the same standards apply online as face to face. The MDOs generally advise not accepting friend requests from patients on personal accounts. If a patient raises a clinical question through your personal profile, direct them to your practice channels. A separate professional account for your practice makes this easier.
Examinations and chaperones
Private GPs often work without nurses or receptionists in the room, which makes chaperone arrangements harder but no less important. GMC guidance on intimate examinations and chaperones says you should offer a chaperone, record the discussion and its outcome, and note the chaperone’s identity if one is present. If you work alone, arrange how you will provide a trained chaperone before you offer intimate examinations. If you cannot, and the examination can wait, rebook.
Warning signs
Stop and think if you notice any of these:
- seeing a patient outside normal hours without clinical need
- sharing personal problems with a patient, or a patient becoming emotionally dependent on you
- communicating by personal messaging apps
- changing fees or rules for one patient
- not wanting a colleague to see the notes
If a patient behaves inappropriately towards you, keep the next contact professional, involve a colleague, and record what happened. If the relationship cannot recover, GMC guidance on ending a professional relationship allows you to end it only when trust has broken down so far that you cannot provide good care. You must tell the patient why, in writing where practical, and make sure their care continues. Talk to your medical defence organisation early.
Former patients
GMC guidance does not set a time after which a personal relationship with a former patient becomes acceptable. It says the more recently the professional relationship ended, and the longer and more intense it was, the less likely a relationship would be appropriate. You must not pursue a relationship with a former patient who is still vulnerable.
Frequently asked questions
Can I treat a friend privately if they insist?
GMC guidance says you should avoid it wherever possible. The exception is an emergency where no other route is available, such as their own GP, out-of-hours services or the emergency department.
Can I accept a gift from a grateful patient?
Only if it is of minimal value. GMC guidance says to explain that you cannot accept anything more, and never anything that could affect, or be seen to affect, how you treat, prescribe or refer. A gifts register helps you show your reasoning.
Should I have a chaperone policy as a solo private GP?
Yes. The CQC will expect one, and it should say how you offer and provide a trained chaperone, how you record the offer, and what happens if none is available.
What if a patient messages me on my personal social media?
Do not discuss their care there. Reply briefly pointing them to the practice’s contact channels, and record the contact if it was clinical.
