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Wessex LMCs Bulletin - December 2002
CONTENTS
1) Editorial
2) Patients admitted to hospital
3) Ambulance services and GP requests
4) Ambulance Service and "Urgent Requests"
5) Criminal records bureau certificates for GPs
6) Police Matters
7) Violent Patients
8) Data Protection
9) Intramuscular Methotrexate
10) Microlight Pilot's Licence
11) National confidentiality consultation
12) Supplementary Lists and Data Protection
13) Interval Certification
14) Patient Group Directions for immunisation clinics
15) Certification for Private Patients
16) What to do with your old computer?
17) Insurance Reports and Medicals
18) Resignation and Retirement
19) Social Services
20) Working outside the Practice for PCTs
21) Pre-Employment Questionnaire
22) G.P.S.I
23) Higher Professional Education Scheme
24) Guidance on destruction of controlled drugs
25) "INFO SHARE" on LMC LIVE
Attachments:
Att 1) Hospital Admissions
Att 2) MDU Advice
Att 3) GPs working outside the Practice for PCTs
Att 4) Pre-Employment Questionnaire
1) Editorial
You will be well aware of the fact that the Contract negotiations are drawing to a conclusion and we are expecting full details of the priced
Contract to be made available on the 10th January, 2003. This will be followed by "Road Shows" of negotiators coming out to actually answer the queries of GPs.
These meetings, will be organised by the LMC, to allow the fullest possible discussion of the Terms and Conditions which will precede the vote, (
the National Ballot) which will take place in February.
It is pointless to consider in any detail what provisions there might be in the new Contract, but from the leader of the NHS Confederation side,
the feeling is that the new GMS Contract will offer all that PMS does and perhaps some advantages as well and may well result in a year or so in only a single GP Contract being operated in the NHS.
The OOH arrangements are likely to be operative as soon as possible after the 1st April, with the facility of the practices to give notice of
their intention to opt out of primary responsibility for this field. The government has made it perfectly plain it wants the Contract "by and
large" to be implemented in every way it possibly can be in April 2003 and only put off those things which require primary legislation and cannot be managed in any other way. One can only presume this is
because they do not wish to "rock" the medical boat any more with the possibility of an election in two year's time.
The English Consultants' rejection of their Contract was a necessary reminder to the "money obsessed" politicians that as far as a true
profession is concerned, the amount of money which is paid to them is not the sole determinant of whether or not the services they provide are acceptable to them as a profession.
It would be worth perhaps considering three words which we use glibly every day of the week which are:
Together they refer to a Statutory Body – a PCT
PCTs are widely felt to be management led; driven by political
direction and target orientated. It sometimes seems that "if it can't be measured it can't be worthwhile". It is generally accepted that
Primary Care Trusts have failed abysmally to give that degree of primary care emphasis which everyone expected when the concept was announced in the NHS Plan. The obsession with balance sheets means
the vast majority of funding goes to secondary care.
One of the functions the new Contract will be expected to provide is a way of preventing diversion of money which is intended for primary
care use into the secondary care sector, thus to allow primary care to receive the proper investment.
Primary care of course is not equivalent to general practice, although too often PCTs believe the two are synonymous terms. The concept of
primary care delivery being the responsibility of the primary healthcare team is widespread, but actually the leader and the person taking responsibility for that delivery of care is the general practitioner.
Primary means "first importance" and it can also refer to first contact
and usually means the general practitioner, either directly or through their staff.
Care means more than government target achievement. It means care
when you are ill as well as acting in a preventive way when the person is well.
Primary Care together then, means first importance for ill people and the first opportunity the general public have to access health services.
I do not believe that Primary Care managers are best placed to assess patients' priorities, and accordingly it is up to the GPs to make sure that
they, in conjunction with other health professionals, make it perfectly clear that "care" means more than what the PCT has been told by the government is important to politicians.
Trust - This depends on whether it is a word spelt with a capital,
which of course can be synonymous with an organisation politically driven and in which sometimes very little trust can be reposed, and "trust" which is that invested by patients in general practitioners, as
their agents, to ensure that the care which is necessary, is provided.
Trusts are too easily directed by government and made to consider targets as the pre-eminent function they are there to meet; perhaps
Foundation Hospitals will be able to remedy that impression.
The real trust then is that placed by patients in general practitioners and we must not betray it by allowing ourselves to be influenced by other
than the patients' real needs. This means that once more we have to take professional responsibility for the decisions we take and if this runs
counter to received the wisdom of political direction, then we must stand up and be counted.
If the new Contract is really to deliver a quality agenda, it is vital that GPs are the definers of that quality. 48 hour access is a typical
example of something which has a politically directed imperative behind it, but has not been shown to be a determinant of better care.
GPs have this opportunity now to demonstrate how important their patients are to them and how professional they are as doctors. We
must not shrink from judging the new Contract proposals on the basis of whether or not it gives the power back to the general practitioner, to deliver quality in the sense that only they can define it.
Dr R I Button
Chief Executive
e-mail: bob.button@wessexlmcs.org.uk
2) Patients admitted to hospital
Attached to this Bulletin as an Annex (Annex 1) is an information sheet produced by a practice in New Milton which they offer to patients who are due to go into hospital.
This contains useful information particularly with regard to Certification and medication which enables the patient to make suitable arrangements
before they are discharged so that unnecessary work is not caused to GPs.
The practice concerned has agreed to this being used by any practice who wishes it and have agreed that the practice may personalise this
for their own purposes.
RB
3) Ambulance services and GP requests
The problem:
- Clinically unacceptable delays in transporting patients to hospitals who have been seen and assessed by a GP as requiring urgent admission to hospital.
When a GP has seen or assessed a patient clinically and decided to transfer a patient to hospital, it is the GPs responsibility to arrange for
an ambulance where necessary within the clinically appropriate time frame. If the ambulance cannot meet the time frame the GP has the choice of contacting the "emergency" ambulance by dialling 999.
It is a common experience for GPs throughout the country to be telephoned by ambulance control just before the agreed "in hospital"
time has expired to be asked if the ambulance can "have a little more time". This activity shifts the responsibility back to the GP in terms of
the overall risk management of the patient, in these circumstances it could be argued that the GP should reassess the patient prior to granting an extension. This is clearly wasteful of GPs time.
It is not always appreciated by GPs that by agreeing to an extension of time that not only are they accepting the medico-legal liability but also
the clock starts again for the ambulance service. These call do not show up, as a failure to meet a target and the service will continue to be under resourced.
What should GPs do?
- Make a full assessment of the patient's condition including the time required for transfer to hospital and the stick to the "in hospital"
time. Decline any extension EXCEPT in the most unusual circumstances AND where the GP is a position to reassess the patient.
- If any difficulties are encountered consider immediately upgrading to a 999 call.
- Keep a record of the job number, the time of the original call, and the agreed "in hospital" time.
- Keep the LMC informed of any problems.
- Refer complaints direct to the ambulance service.
NW
4) Ambulance Service and "Urgent Requests"
The Ambulance Service recently had occasion to re-direct an ambulance which had been summoned urgently by a doctor to a patient in severe
left-ventricular failure. This ambulance was re-directed by the staff at Hampshire Ambulance as a result of a "999" call by a member of the public.
The result was that the ambulance arrived too late and the patient died.
Hampshire Ambulance who were contacted about this have now issued instructions to their staff to make if perfectly plain that once a vehicle
has been allocated to an "Urgent 1" category case (such as the case above), that this must not be diverted to any other case.
It is important that they accept, as they do, that once the definition and diagnosis by a skilled medical attendant has established that the medical
need is a priority one this cannot be allowed to be overridden by a possibly uninformed request for an emergency ambulance from a member of the public.
The Ambulance Service is as keen as general practitioners to ensure that adequate service is provided for those people in urgent need of it and
have undertaken that this will be the course that they will follow in future.
Should any doctor find any examples to the contrary would he/she please let me know at the LMC office, as soon as possible so that the
matter can be discussed with the Ambulance Service.
RB
5) Criminal records bureau certificates for GPs
The Department of Health has indicated that for the present "there is no requirement on GPs to provide CRB certificates as part of the
application process, or any catch-up exercise, for either the main or supplementary list. Consequently health authorities/PCTs ought not to request certificates."
CD
6) Police matters
The issue of providing documentation of injuries in response to a police request has arisen once again. Hampshire Constabulary has confirmed
that their policy is that the police should not direct patients to the GP for the sole purpose of recording injuries. Please let us know if this continues to be a problem.
***
One of our GPs was concerned to learn that a violent sex offender had recently registered with their practice. The notes containing the
relevant information were not received until some weeks later and there were fears that female staff and other patients at the practice may have been at risk in the interim period.
Hampshire Constabulary has confirmed that it does not disclose information routinely about ex-offenders. Offenders are not required to
supply details of the medical practice they are registered with and this information is not recorded on the police national computer. Individual
cases are assessed at a multi-agency risk assessment meeting and the public protection team implements any recommendations locally.
Our GP was particularly concerned to learn from the patient that there were a number of other sex offenders living close to the surgery, who
were very likely to be registered with their practice.
Obviously the confidentiality of ex-offenders must be taken into account, but a failure to identify violent sex offenders to the practice
may well pose an unacceptable risk, particularly to female GPs who may be required to visit patients at home on their own.
If you are worried that a patient presents a potential threat you may write to the police for information to confirm or refute your suspicions.
A decision to provide you with information must be made by an officer of at least Assistant Chief Constable rank. If the patient's valid written
consent to disclosure of information is provided with the initial enquiry this may speed up the provision of further information.
If you have ongoing concerns about this problem, especially if you have experienced any particular difficulties in your practice, please contact us
so that we may take up the issue on your behalf.
CD
7) Violent Patients
In the year 2000 the first HSC issued that year required Health Authorities to put in place adequate facilities for the treatment of
violent patients or patients who had a violent propensity.
Singularly little, in fact usually nothing at all, was done by the Health Authorities over the succeeding two years.
After GPC pressure the Chief Executive of the NHS was prevailed upon to notify Strategic Health Authorities and PCTs that they would be
required to have submitted a plan by the 31st October, 2002 to adequately demonstrate they had taken into account the zero tolerance policy of the NHS with regard to violence and harassment.
Certain of the PCTs have still not yet completed an adequate policy and their names have been communicated to the GPC for onward
transmission to the Ministry.
It is absolutely essential however, that doctors do not allow themselves, their staff, or their other patients to be placed at risk by people who
have too little control over their own emotions and tend to be either violent or harassing in their approach to claim medical services.
Good advice is forthcoming from all PCTs about what practices can do to minimise the risk of a person who has not previously been violent,
who either out of character or expectedly, does develop a violent tendency. Help will be given by PCTs to train staff in how to deal with the situation.
Once a patient has developed a violent habit however, it is essential the practice makes it perfectly plain, that it refuses to give further
treatment to that patient until it is possible to do so in a safe environment.
This means that either the PCTs must have available a place where the patient may be seen in safety, often associated with Police presence.
Or that there are practices commissioned by the PCTs to deal with patients who have been violent in other practices and have been able to put in place the necessary facilities to protect themselves and their own
patients. This service of course would be subject to an extra payment from the PCT for the extra work, responsibility and danger involved.
If a patient is being physically violent, or in fact is verbally aggressive or is importuning enough at the surgery to dislocate the normal activities of
surgery, it is important for practices to realise that this harassment is also a criminal offence.
Should a patient's activities be thought by the practice to be of a harassing nature, please contact the LMC office for direct advice.
Normally we would suggest that a patient who is harassing staff or other patients should be dealt with by the Police being called. The Police
have the power under criminal law to arrest this person and formally caution them and if any subsequent disturbance occurs to re-arrest them
and take them before the Courts. It is very important indeed that practices do not find themselves unable to deliver the quality service
they wish to as a result of the unreasonable behaviour of what is a tiny minority of patients. Only by every practice making it perfectly plain that they will not accept behaviour of this sort, under any
circumstances, will it once more become the case that doctor's surgeries are treated with the respect they deserve.
RB
8) Data Protection
Remember to remove patient identifiable details from all correspondence unless it is absolutely essential for the purpose.
From time to time we receive correspondence at Wessex LMCS where a patient's identifiable details have not been obliterated. Everyone at
the LMC office is bound by a strict contractual and/or professional duty of confidence and we endeavour to obscure all identifiable patient details.
Revealing the identity of a patient in this way to a third party without the patient's consent is, however, a clear breach of patient confidentiality.
Beware
Patient details revealed in correspondence to other offices may not always be handled with such discretion so it is vital to exercise great
caution at all times when revealing patient identifiable information.
If it is vital to disclose patient identifiable details ensure that you have the patient's explicit and valid consent.
It is important to remember that a signature on a piece of paper may well not constitute valid consent unless the patient is:
- competent to give that consent
- it is based upon full information that the patient is able to understand
- it is given entirely voluntarily
If in doubt check with the patient!
CD
9) Intramuscular Methotrexate
It is generally recommended that Intramuscular doses of Methotrexate are not administered by practices or practice nurses.
This drug is possibly extremely toxic and the recommendations are that it should be administered under Specialist supervision and by people
who are familiar with and experienced in its administration.
It has recently come to our notice that doctors are being approached by Rheumatologists about providing Intramuscular Methotrexate injections
to patients and yet the doctor is not in a position to fully determine that this a safe procedure, nor are they in charge of the dosages given.
These requests for administration of Intramuscular Methotrexate in the surgery premises by your practice nurses should be firmly resisted, since it places not only you, but your nurses at medico-legal risk.
GPs will make their own final decision about whether this advice is to be heeded, but it is consistent advice which has been given by the LMC
for some while now and has the support of the Pharmaceutical Advisers of the various Strategic Health Authorities/PCTs as well.
Should you have any particular problems, please do contact the LMC for advice.
RB
10) Microlight Pilot's Licence
It has recently been brought to the attention of the LMC that the British Microlight Association are suggesting that for a fee of £10, GPs should
sign a form that certifies their patient is "fit to fly" and that this can be done by looking at the medical records and does not require a medical examination.
The simple answer is do not sign this.
By signing such a form a GP is taking a degree of legal responsibility.
To put yourself in a position to certify the pilot is "fit to fly" you need to see them and examine them and this requires the payment of an
appropriate fee.
NW
11) National confidentiality consultation
A major consultation is to be carried out on a patient confidentiality management system for the NHS from 22 October 2002 to 31 January
2003. The aim is to canvass the widest range of opinion.
The consultation proposes new ways for staff to work as well as new tools, processes and technology to support them in sharing patient information.
Wessex LMCs urges all GPs and practice staff to ensure that their views are known and taken into account.
It is to be hoped that the legal and ethical position will be clarified as a result in order to end the current uncertainty that has caused so many
difficulties in primary care.
Further information and an online consultation pack can be found at www.nhsia.nhs.uk/confidentiality
Alternatively a pre-printed consultation pack or CD ROM can be obtained from the information hotline on 08453 660066.
CD
12) Supplementary Lists and Data Protection
We recently had a number of complaints that some PCTs were providing the contact details of doctors on their Supplementary List to third parties.
We contacted all of our local PCTs advising them that this was not permissible without the prior informed consent of the doctors concerned.
We have been assured that no local PCT is now issuing contact details without consent.
One of our doctors, however, was recently contacted by a commercial agency that implied that contact details had indeed been provided by the PCT.
This was not the case. The agency acquires the names of doctors on the supplementary list from the PCTs and cross checks these with the private addresses of registered doctors in the published
Medical Register.
We contacted the GMC who confirmed that they recently removed addresses from their web site after a number of complaints from doctors.
The GMC must have an address at which a doctor may be contacted. If you do not wish your private address to be listed in the Medical Register
you may ask that an alternative contact address, such as a PO box or bank, is published in future editions.
CD
13) Interval Certification
The term Interval Certification refers to the request often made by insurance companies for details about a medical condition subsequent to
a claim being made under the policy.
This has generally been held in poor regard by the medical profession, since often it is a factor which only comes to light when the insurance
company, which has sought to avoid the necessity for a medical report in the first place and accepted instead the patient's unconfirmed statements, then tries to obtain medical evidence that will enable it to
avoid payment on the policy.
This often occurs when the patient has died. In these circumstances the access to the medical record is within the remit of the next of kin and
the patient may well have expressed a desire that no details of the medical condition should be given to anyone subsequent to their death. If this has been recorded in the notes this will override any apparent
consent which may have been given to the insurance company at the time of the proposal. Most people do not realise that in the small print
of the proposal is an indication that you allow the insurance company to consult your records, either before or after your death from any
medical adviser who has advised you at any time in your life.
Obviously the GP needs to protect himself against the disclosure of information, which could adversely affect the interests of his patient, or
the patient's next of kin.
If you are approached in this way therefore, may I suggest that you first of all check very carefully whether or not the person has clearly
indicated they do not want information to be given and secondly before any consideration is given for the release of documentation, you should check with the next of kin and make sure they are fully informed as to
the likely result of disclosure of information.
This is covered by the Access to Medical Records Act and as this means that the information released is restricted to that which occurred after
November 1991.
The Medical Defence Union has issued some useful advice in this matter and I append to the Bulletin for you to keep for reference. (Annex 2)
Should you in any particular case have concerns about releasing information outside the normal agreed procedures, then please take advice from the LMC office.
One further point which should be borne in mind. When patients have signed up for medical travel insurance, which might include transporting
them back to this country for treatment, it is inappropriate for the insurance company to place any conditions on this before they activate the medical evacuation. Should the company have any doubts about
whether it has a valid contract to fulfil, the correct course of action is for the patient's treatment and evacuation to proceed and any legal discussion about who should be responsible for payment to be made
after the patient has recovered. It is totally inappropriate for doctors to be contacted in the middle of an afternoon and asked for information,
so that insurance company can try and avoid its responsibilities at a time when the individual concerned may well be unfit medically to give any informed consent as to release of information.
This is something which frequently happens in the holiday season but is not unknown with regard to evacuation of patients who have suffered
injuries on the ski slopes.
Again if you have any concerns about particular cases, please contact the office direct for detailed advice.
RB
14) Patient Group Directions for immunisation clinics
Some PCTs are advising that a PGD is required if a nurse holds an immunisation clinic.
Recently published GPC guidance indicates that this is not a legal requirement.
A GP may, however, choose to implement a formal PGD or use it as a practice protocol.
The legal position is that:
- Prescription only medicines (POMs) can be provided for patients only against a prescription from an "appropriate practitioner"
- the Medicines Act (1968) allows a person to administer a POM in accordance with the directions of an appropriate practitioner.
The GP may therefore prescribe immunisation for a number of named patients and may delegate administration to the practice nurse.
The GP is responsible for:
- the safe prescription of the immunisation for each individual patient
- for drawing up an adequate written practice protocol
- ensuring that the nurse is properly trained and competent
- ensuring that the nurse understands and adheres to the practice protocol.
The nurse is responsible for:
- correct administration of the immunisation
- strict adherence to the practice protocol & any specific instructions
- seeking specific further advice from the GP if necessary.
The doctor should ideally be present in the surgery during the clinic but, if he or she is called away in an emergency, the nurse may continue the
clinic at her own discretion.
The RCN locally have confirmed that this pragmatic approach is acceptable.
A PGD is essential if a district or community nurse employed by the PCT is to deliver an immunisation service for a GP.
CD
15) Certification for Private Patients
It was brought to our attention recently that some consultants have been providing their private patients with obviously inadequate certification
for a day or so only and asking the patient to obtain a certificate from the GP to cover the expected period of incapacity.
This is clearly unacceptable and we have written to most of the private hospitals in our area to try to arrange that this does not occur in future.
Obviously if the patient fails to recover as quickly as expected and needs to consult the GP for continuing care, the GP would provide any
further certification that was necessary.
Please contact Wessex LMCs if this problem persists despite our intervention.
CD
16) What to do with your old computer?
When a Practice is upgrading the computer system there may be some old computers that are no longer required. Practices will sometimes
donate these to the local school, staff etc.
So long as there is no patient data stored on the hard drive this is perfectly acceptable. If the computer is the clinical server or stores
patient data then more care needs to be taken.
In the end the only way to ensure that the clinical information cannot be accessed is to remove the hard disk and destroy it with a suitable "hammer".
Formatting the hard disk would appear on the surface to remove the data but this remains stored on the disk and it is not difficult to retrieve this data.
To ensure you do not breach patient confidentiality destroy the hard disk of any computer that has held patient data once it is finished with.
NW
17) Insurance Reports and Medicals
In June 2002 the BMA and Association of British Insurers recommended the following fees:
Insurance reports £54 (£60 from 1 April 2003)
Medical examinations £60 (£66 from 1 April 2003)
Supplementary reports £15
The newly agreed fees are recommendations only. You are entitled to set your own fees if you prefer.
They also agreed that:
- the company should pay 50% if the patient fails to keep an appointment
- reports should be returned within 20 working days of receipt of the request
- insurance companies may ask for a quicker response e.g. to complete a loan.
A full report takes on average 30 - 45 minutes and, allegedly, in the past around three-quarters of GPs were paid only £31. This was not our
experience in Wessex and, when the ABI / BMA agreement was withdrawn, most GPs negotiated higher rates than the newly agreed fees!
You are not obliged by your Terms of Service to provide reports or carry out medical examinations for insurance purposes.
If you do provide a report:
- Patients are entitled to see any report prior to it being sent to the company.
- You must not release a report for 21 days to allow the patient time to seek access.
- You may release it earlier if the patient has seen it and agreed to the release.
- If the patient sees the report you must not release it until he/she gives consent, even if this is longer than 21 days.
Patients are entitled to see a report for up to 6 months after it has been sent and the GP must keep an accurate dated copy for at least 6 months.
Some companies have demanded a copy of the entire record under the Data Protection Act rather than pay fees higher than the recommended rate.
- Patients are entitled to a copy of their complete medical records (with limited exceptions)
- This copy must be provided within 40 days of the written request and receipt of the fee.
- There is a legal maximum charge of £50 for copies of manual or mixed records or £10 for automated records.
Only supply Data Protection Act copies for insurance purposes direct to the patient.
You must ensure that you have the patient's informed consent to disclosure.
CD
18) Resignation and Retirement
Increasingly doctors are considering leaving the NHS, either by resigning before their retirement age, or retiring at the first possible opportunity.
Most doctors know that retirement is theoretically possible at the age of 50 and can result in an actuarially reduced pension payment. It is also
possible to retire at 50 and go into another job and freeze your pension until the age of 60. If you resign with the intention of returning to a less
than full time commitment in the future, three month's notice must be given to the PCT of your intention and you must have at least one calendar month's absence from NHS service before you may once more
resume NHS activity. Should you do this of course and associate it with a retirement payment of your cash lump sum, then you would not
be eligible for further superannuation in your NHS service.
Speaking more generally about partners leaving practices, it is very important to understand that there is no right whatsoever to an
automatic replacement of a partner who retires, nor is it an automatic right to be allowed to reduce your commitment from either full time to half time. These are matters which are at the
discretion of the PCT and the LMC is consulted.
Should anyone be contemplating action of this type then it would be advisable to talk to the LMC for the detailed advice which is necessary
in any particular case.
Practices who are considering whether or not they wish to replace a doctor, should talk to the LMC as well, preferably before they have
written to the PCT so that advice may be given. All these decisions are going to be subject to a delay at the PCT before it is possible to know whether the practice has permission
to advertise and appoint a new partner. It is therefore, advisable wherever possible to think in terms of a six month's leeway period, before any new partner is
expected to start, in order that there is no gap between the old partner leaving and new partner coming.
It is also worth bearing in mind that there is a dearth of GP principal applicants at the moment and it is highly likely that on the initial trawl a
practice may not receive any applicants whatsoever for a partnership vacancy.
Information of a general nature about changing partners, resignations and retirement has recently been placed on our award winning website (www.lmclive.co.uk)
so check this out before contacting the office for any more detailed advice which you may require.
Premature Medical Retirement which is considered by some doctors needs to be dealt with by personal contact with the office. However, I
must make it plain that medical retirements are never considered unless the person concerned is off work at the time; that the advice to medically retire is supported by a Consultant and that it is going to be
impossible for the person concerned to undertake any form of medical work. The Government has I believe made it perfectly plain it wants the
rules of medical retirement, on ill health grounds to be tightened up and certainly there is much more resistance to cases being granted the
enhancement to pension which is associated with this course of action.
RB
19) Social Services
In a previous Bulletin article, I indicated that it was inappropriate to discuss cases over the telephone with the Social Services and that the
Social Services Officer should seek an appointment at your surgery, and armed with identification details be prepared to discuss the matter with you in person.
My attention has been drawn by Doctor Huw Llewellyn in Dorset to the fact that there are occasions, when due to the extreme urgency of the
situation discussion with the Social Services may be appropriate on the telephone in order that immediate action may be taken.
This particularly applies to Child Protection matters and there are certain factors which I think must be considered before such agreement
to the telephone consultation is embarked upon.
First of all the GP should return the call preferably through a switchboard to a checked number, not to a mobile phone. This will do
as much as possible to ensure that the information is being passed to the person who is entitled to receive it and that the person on the phone is indeed the person whom they purport to be.
The doctor must be satisfied there is immediate risk of significant harm to the child before varying their normal procedure of interviewing
the Social Services personally.
All that I have said before relating to consent is still relevant in that you have a responsibility not just to the child, but also to the people who
are in charge of the child, usually the parents. There is a very difficult situation when the possibility of seeking consent to disclosure of
information about a child who is the subject of a Child Protection Investigation, may prejudice a Police investigation. In these circumstances I would always advise detailed advice being taken from
the office before contact is made.
If you do agree to discuss matters with the Social Worker, it is essential that you satisfy yourself first and foremost as to the information they
have. It is vital that you are given all the confidential information the Social Worker may have in order that you may determine whether or
not it is appropriate for you to breach any confidentiality in discussing matters with them. Should the Social Worker not be willing to grant you access to the confidential information they have, it is wholly
unreasonable to expect you to breach your confidentiality
requirements to assist them. You would not therefore, proceed to give any information without the parent's consent.
May I also ask you once again to consider using the "
lmclive" website where information on Data Protection – Child Protection in the Data
Protection Confidentiality Section offers very clear advice which may be of help to you.
Doctors can find themselves between "Scylla and Charybdis". The Scylla of protecting confidentiality interests and the Charybdis of
avoiding unnecessary danger to children. This is the essence of medicine and general practice in particular in that so rarely are there
clearcut answers and in every case we are seeking to do the best we can in a situation which is not clearcut or unambiguous.
RB
20) Working outside the Practice for PCTs
The basis of this article comes from advice issued from the Somerset LMC recently to its constituent GPs with respect to the way in which
they are increasingly being called upon by the PCTs to attend meetings or work with the PCTs to develop policies. The article is self-explanatory and has only been amended in a minor way by me. I
am very grateful to Dr Harry Yoxall the Secretary of the LMC in Somerset for permission to reproduce this excellent advice for the Wessex LMCs. Annex 3
RB
21) Pre-Employment Questionnaire
Many practices taking on new staff members, or even new partners need to be assured that there are no medical reasons which might interfere
with the performance of their duties.
Until a proper Occupational Health Service is available, at perhaps even after that, the use of a Pre-Employment Medical Questionnaire can be
extremely useful.
Such a Questionnaire is produced as an Annex to this Bulletin and can be copied and used at the practice's discretion to assist them in their
recruitment process. It is important to explain to the individual concerned that the information given will remain totally confidential and
that in the event of it being felt necessary for any medical examination to be carried out, this would be performed by someone external to the practice; probably in the Occupational Health Service.
Should anyone have any suggestions about how this questionnaire might be improved, please contact the office and speak to Jenny Steiner, the
General Manager. Annex 4
RB
22) G.P.S.I
May I particularly also draw your attention to the importance of negotiating contracts with regard to activities as a GP with special
interests ( GPSI) through the LMC and not attempting to do it direct. Not only is it an important decision to make whether you wish to be
employed or to offer your services in a self-employed fashion, but it is also important that the laws which relate to employment are carefully considered.
This is best done through the LMC who are at present working with the BMA to develop contracts for this purpose.
RB
23) Higher Professional Education Scheme
Higher Professional Education is a national initiative set up by the Department of Health. It is aimed at those doctors who have recently
qualified to offer them further protected learning at a critical time in their career development.
To qualify for the scheme, you normally need to have received your Certificate of Completion of training from the JCPTGP within the past
two years. The scheme does not depend on your being a Principal and is open to GP Principals, salaried doctors and Assistant GP's in the Wessex Deanery. Please note that GP Retainers do NOT qualify for this
particular programme.
Those who are eligible will be entitled to locum fees for 20 days of education at the rate of £250 per day and in addition there are some
modest funds available for course fees and travel expenses. These 20 days are usually taken over a 12 month period but this may be extended
to 2 years. The emphasis of HPE is on self directed learning but local educationalists will be available to assist individuals and groups. All HPE
GPs are expected to create a PDP to enrol into the scheme that is formally signed off by the local GP Tutor and at the end of their time to have produced a further PDP to aid future appraisal and revalidation.
If you are interested in joining or require further information, please contact your local GP Tutor or the Wessex Deanery. Tel:
Winchester 01962 863511
This article was submitted by Dr Andy Hall, Deputy Director Wessex Deanery
24) Guidance on destruction of controlled drugs
It has been drawn to our attention that LMC Guidance on Storing, Recording and Disposing of controlled drugs referred to a police
officer as a person authorised to destroy controlled drugs. The police officer must be authorised by the Home Office to carry out this function.
We try to ensure that our advice is as accurate as we can make it, but inevitably slips do occur from time to time. We welcome any
comments, suggestions and corrections from colleagues to help us ensure that the web site provides consistently sound and relevant advice.
CD
25) "INFO SHARE" on LMC LIVE
We are starting a new INFO SHARE section on LMC LIVE to facilitate sharing Best Practice, Time Savers and Quick Tips.
To make it work we need your ideas and contributions for this section.
We would like to hear from GPs, their staff, nurses, health visitors, community nurses, social workers, pharmacists, PCTs, IT buffs - in fact
anyone with useful tips, ideas or documentation that they would be willing to share with others on the web!
We would be happy to include policy documents, guidance, protocols, letter templates, practice posters, patient handouts etc in pdf or word
format.
We would be equally happy for one to two lines describing IT tips or practical suggestions!
Don't be shy.
Please send your contributions now to
christine.dewbury@wessexlmcs.org.uk
Examples
Would you like to provide better information to patients with diabetes without spending even more hours in each consultation? Download a
personalised information sheet and adapt it for use in your own practice. Click on Info Share
under Best Practice.
Bothered by housing forms or requests for post-op certification? See how one practice deals with these problems. Click on Info Share under Time Savers.
Do you need to know how to e-mail an Internet link or copy a chunk from a pdf file into a word document? Click on Info Share under Quick Tips to find out!
Could colleagues have the answers to your practice problems?
Check it out on
INFO SHARE
CD
Key to Contributors
RB = Dr Bob Button, Chief Executive
NW = Dr Nigel Watson,
Deputy Chief Executive
CD = Dr Christine Dewbury, Medical Secretary
Please note:
New easy e-mail address for all LMC staff - just type - Christian name dot
surname followed by @wessexlmcs.org.uk (all in lower case)
eg bob.button@wessexlmcs.org.uk
Bulletin - 01/12/02
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