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FAQs


Please click on the expandable boxes below to view our frequently asked questions (FAQs).
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  • General Practice is currently under unprecedented pressure with fewer doctors dealing with ageing populations, increasing complexity of disease and increasing patient expectation levels.  Colleagues in secondary care can sometimes direct work inappropriately to practices, when it would often be safer for the patient and more efficient for the NHS if they had undertaken the work themselves.  Examples of this include the forwarding of abnormal results from tests undertaken in secondary care to the patient’s GP, requests to refer patients to another specialty within secondary care, requests to prescribe medication off-licence and requests to prescribe medication for patients undergoing hospital investigations.

     

    Clinical responsibility remains with the clinician arranging an investigation or prescribing a medicine/treatment.  Hospital clinicians have been repeatedly made aware by the local Medical Director that they are responsible for:

    • actioning abnormal results that they have requested
    • referring to other colleagues within secondary care where they feel another specialist opinion is required
    • prescribing licensed medications where possible for patients and where an off-licence prescription is commenced there should be no expectation that the patient’s GP will assume prescribing responsibility
    • prescribing any treatments or medicines required for patients for whom they have arranged the investigation.

     

    Where you have been asked to undertake secondary care work inappropriately, we would advise you to decline to undertake such work, informing the clinician using the attached form and copying us in to your correspondence (having anonymised the patient details first)

    ATTACH HAMISH LAING  FORM/DOCUMENT

  • GPs are required under the GMS contract to provide certain information and certification free of charge.  This includes sickness certification, death certification and clinical referral.  A full list is set out in Schedule 4 of the NHS regulations www.legislation.gov.uk/uksi/2004/291/schedule/4/made

    GPs are often asked to provide medical reports or information for patients/outside organisations which are not contractual.  These include:

    • Insurance Company/PMA reports,
    • Legal reports,
    • Occupational Health reports,
    • DVLA reports
    • Reports for Case Conferences/Safeguarding meetings
    • Evidence to support benefit claims &
    • Blue Badge applications.

     

    Practices are not contractually obliged to provide such information and therefore when such requests are received can reasonably:

    • Decline to undertake the work,
    • Undertake the work and not charge a fee (at a cost of clinical/administrative time and effort to the practice, which may be considerable and impinge on patient care),
    • Charge a reasonable fee to the requester (outside agency/company/patient themselves).

    Practices should satisfy themselves that before supplying any patient information to a third party that they have the appropriate patient consent in place.  Since the Competition Act 1998, the BMA no longer recommends the levels of remuneration/fees payable for such work.  Practices should set their own reasonable fees, taking account of the administrative and clinical burden involved in completion and preferably agree the fee prior to completion of the work.

  • From 1 April 2016 new information sharing processes between GPs and the police were introduced in an attempt to ensure those licensed to possess firearm and shotgun certificates are medically fit to carry arms. We have significant concerns about these arrangements and we continue to raise them with the Home Office with the aim of agreeing a process that is fair to GPs in particular, and doctors in general, and safe for the wider public. Discussions are ongoing and any future improvements may necessitate the revision of this guidance.

    From 3rd March 2017 new advice on the current system has been issued which takes into account our discussions with the Home Office, the police and the British Association for Shooting and Conservation (BASC), as well as external legal advice.

    Click here to read this information. Or download a sample letter here.

    Please note, it is not acceptable to:

    • disregard the letter
    • not inform the police
    • delay a reply

    In doing any of the above, you could place yourself at professional risk.

    Where there is a reasonable belief that an individual either applying for a firearm or shotgun license or already holding one, may represent a danger to themselves or others, we strongly advise doctors to encourage the applicant to reconsider or revoke their application.

    If the applicant refuses, you should consider breaching normal confidentiality and inform the police firearms licensing department as a matter of urgency.

    This advice only relates to the initial letter asking GPs to add a marker to the patient record. Applicants are still being advised by BASC to pay their GP for any full medical report being requested by the police as part of their application.

    Further information

    If you are in any doubt, you should seek further ethical and legal advice from the Ethics department and the defence bodies.

    Ethics department
    E: info.ethics@bma.org.uk

  • The BMA has received new legal advice regarding medical note requests received from the police, which are detailed below.

    There is clear guidance regarding the obligations that GPs have with respect to copying and/or release of the GP record. For your reference, these circumstances are:

    · If the police do not have a court order or warrant they may request voluntary disclosure of a patient’s health records under section 29 of the Data Protection Act 1998.
    · However, while health professionals have the power to disclose the records to the police where section 29 applies, there is no obligation to do so.
    · In such cases health professionals remain bound by the long-established common law duty of confidentiality and may only disclose information where the patient has given consent, or there is an overriding public interest. They may also be required to defend their decision to disclose before the GMC which is a statutory tribunal.
    · Disclosures in the public interest based on common law are made where disclosure is essential to prevent a serious threat to public health, national security, the life of the individual or a third party, or to prevent or detect serious crime. This includes crimes such as murder, manslaughter, rape, treason, kidnapping and abuse of children or other vulnerable people. Serious harm to the security of the state or to public order and serious fraud will also fall into this category.

    Your practice is entitled to a fee for producing the notes. There is no set fee for producing these notes, as they are not considered a subject access request that you may receive from a patient. Therefore the practice is able to set its own fee.

    In order for you to proceed with the police request, please use thie pro forma which can be found on the dcouments page under useful documents, that we recommend you complete and send to the police authority. We recommend that you obtain each of the following: 

    1. Provide written patient consent to release of their records OR provide written confirmation as to the nature of the serious crime allegedly committed by the patient and an explanation as to why the patient’s records, or other information requested, are considered necessary for the specific purpose you are pursuing. You will require one of these in order to fulfil your responsibilities as the Caldicott Guardian.

    2. Confirmation in writing that the fee of £xx will be paid within 28 days of the police receiving the record. This fee is due to the disproportionate effort placed on an already overburdened GP practice to provide these notes which recognises the need to support the police in their investigation of a crime, where appropriate to do so.

    3. Written confirmation from a senior police officer – ranked Superintendent or above – that he or she considers that the crime being investigated is a serious crime in line with the examples provided above.

    Once you are in receipt of each of these at the practice, and have checked the appropriateness of release of the records, you should respond to the police authority as soon as possible.

    Alternatively, should it be appropriate for the police to view the record (based on answer to 1 above), then there is the option for them to view the record in the practice in the presence of a practice staff member. In this situation there is no fee chargeable.
    There is no set fee for providing records in this manner. Therefore it is the responsibility of individual practices to set their own fee for this work. When completing the attached pro forma you must enter the fee you choose to charge.

    It is vital that the police agree in writing to pay the fee, otherwise you will not be able to claim for the service. If the police authority do not agree to pay the GP can decide whether they would like to provide the service free of charge, or not at all.

    Please note that if the police authorities have a court order or warrant for disclosure of the records, you may be required to comply with the request even where a fee has not been paid or agreed. This will depend on a number of factors, including the terms of the court order or warrant.

    GPs should, in all cases where there is no patient consent, consider whether the benefits to an individual or to society of disclosing the records outweigh both the public and the patient’s interest in keeping the information confidential before agreeing to disclose the records.

    For any queries please email info.professionalfees@bma.org.uk

    21 June 2017

    1. 1.     Work out the cost of the service
    • Look at current level of remuneration and cost to deliver service.
    • Have a chat amongst clinical team and with practice manager to decide next steps.
    • If you wish to continue then read no further

     

    1. 2.     Payment not covering costs and / or impacting on GMS care?
    • You can withdraw from the service

     

    1. 3.     How to withdraw:
    • Give 3/12 notice in writing to the Health Board of your intention and reasons.
    • Ask for them to inform you of where to redirect patients once notice period has ended. Put a time date on response to this and put a diary marker in your diary to check this has been responded too.
    • Copy in the other services affected by the decision

     

    Top tip – make sure you get confirmation of receipt – email route perfect for this

     

    1. 4.     Continue to provide the service for 3/12
    • Start updating your staff that service is no longer going to be provided and ensure all know where to refer patients once service has ended. Consider giving them a “script” to use when faced with such requests
    • Start to inform your patients via posters / screen messages / during consultations of when this service will no longer be available and why (if appropriate)
    • The LMC will be developing patient information materials for you to use in some cases
    • Consider how you can best utilise the freed up resource/ time to provide additional capacity within your clinical team

     

    1. 5.     Keep track
    • Make a note on your systems when service is due to end
    • Remind all staff after that date that you no longer provide these services and where they should send patients.

     

    1. 6.     What if the HB don’t tell you what to do with patients after notice period?

     

     

     

    YOUR LMC IS HERE TO SUPPORT YOU.

    It is not unusual to feel concerned at stopping work OR to think that you are the only practice considering taking this action. YOU ARE NOT. Practices can no longer continue providing services at financial or clinical capacity costs to themselves.  Follow the checklist above, discuss as a practice and reach your own conclusion.

  • We have had several practices report an increase in consultations from school pupils and nursery age children regarding fitness to attend school/nursery.  The GMS contract makes no provision for such work and therefore other than treating the patient who ‘is ill, or believes themselves to be ill’, there are no circumstances where a GP is required to issue a Med 3 or any letter/report to a school/nursery confirming fitness to attend.  GPs are not contracted to advise schools on attendance or medication requirements whilst at school and head teachers have been reminded of this by the Education Minister and Local Education Authorities.  Any such request may be considered as extra-contractual and could reasonably expect to be chargeable work.

     

    A useful Public Health Wales document can be found here which gives explicit advice on whether pupils with common childhood diseases should be excluded from education: https://www.gov.uk/.../infection-control-in-schools-poster     

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