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Wessex LMCs Bulletin - June 2003
CONTENTS
1) Editorial - The Uncertain Future
2) Disability Discrimination Act
3) Non principals
4) New email addresses
5) Police Referrals to GPs
6) Probation officers requesting reports
7) Charity levy
8) NHS complaints reform - Making things right
9) CHI
10) GP Access to Medical Records/Discharge Summaries
11) Asylum Seekers and Closed Lists
12) Release of Medical Records to Insurance Companies
13) GP's Responsibility for patients while they are at home awaiting
admission
14) Organ Donation
15) Contacting GPs
16) Doctors Support Line
17) Freedom of Information Act 2000
18) Reports for the Citizen's Advice Bureau (CAB)
19) Pensions
20) Policy on Violence and Harassment
21) Appointments for venepuncture
22) Short Term Sickness Certification
23) Adoption and fostering medicals
24) Appraisal payments
Appendices:
Appendix 1)
Appendix 2) - Short Term Certification
Appendix 3)
1) Editorial - The Uncertain Future
General practice is about to change.
This is not a matter on which we have any vote at all.
The Government has decided that the future provision of general practice will be of a radically different sort.
Thefirst thing to remember is that the general practice of 40 years ago has gone forever. The types of general practice now are so variable.
There was a time when the only form of general practitioner was a full-time male principal / partner.
We have the following variations on that theme in the modern NHS:
Principal / partner
Salaried assistant
Retainer
Flexible career scheme GP
Locum GP
Part-timer
PMS provider
PMS performer
GP Registrar
All these types of general practitioner have different aspirations for their day-to-day lives. The contractual arrangements therefore must take
account of all these different types of practitioner.
Principals still form the vast majority of the profession, and as such still feel that they are the driving force behind the provision of general
practice. The recent and continuing difficulty that practices have had in actually recruiting new partners though is an indication that the profession as a whole is not wedded to this as the only form for service
provision in the future.
This is one of the reasons why the GPC have felt it appropriate to enable allthe above groups to fully participate in the vote on the new proposed G M S contract.
The timescale for this vote is likely to be much shorter than at one-time supposed. It has been clearly shown that the Government are not willing
to allow the whole situation to drag on for months more.
The Government wants a radical change in the role that general practice plays in the modern NHS. It is no longer content to see GPs as providing
a diagnostic and treatment service but wishes them instead to be the first line in health provision in the country, and this means inevitably the provision of a lot of preventative care.
Some have suggested that the Government might well set up a rival service solely to provide this type of care. I think they understand that
the general public would be likely to be difficult to persuade to use it. Therefore they believe the correct way is to use the affection that the general public have for their family doctors to push their preventive
agenda. Since they are the paymasters it is arguable that they have this right.
There can be no question of returning to the status quo; the past must be consigned to history. Evolution teaches us that those who cannot
accommodate change must inevitably be left on the sidelines as new situations develop. For some general practitioners this time for change will be too radical and they will therefore decide that theirprofessional
contribution is over. They will either change to providing a locum service or they will decide to take their pension and do something else. Some of course will see their future in private medicine provision or
even in emigration. The vast majority of general practitioners though will see their future as inside the NHS.
The likely changes of the new contract therefore would appear to be an appropriate time to consider the relationship between general practice
and both our colleagues in hospital trusts and those in the PCTs.
Members of both these groups are interdependent with modern-day general practice. They both face the same problems that general
practice does. An almost undeliverable government agenda associated with inadequate funding and over regulation. We all share however the common aim to deliver a professional service to patients. I believe it is
in our mutual interest that we should work together as far as possible to achieve the best service,rather than allow the Government to form barriers between us.
The change that overcame Health Authorities a couple of years ago, and the impending changes to hospital trusts by forming Foundation Trusts
are indicators of the radical changes the government intends to push through with regard to both the administration and the secondary care provision of the NHS. GPs are about to be equally radically reorganised
either with or without agreement.
Much has been debated about the financial value of the proposed new GP contract. This is undoubtedly vital to ensure the survival of general
practitioners and their practices.
There is another facet however to the new contract. That which allows doctors greater freedom to set the contract terms and conditions
without it being any longer a unilateral imposition by the government. GPs must accept that the status quo is not an option that if we vote “No” to the contract, the Government will still impose it via a PMS
route. This would mean we would lack any national negotiating power and would inevitably lead to some doctors being disadvantaged relative to their colleagues,by virtue of PCTs seeking to impose differing local
interpretations and pay rates. I firmly believe that the new contract offers the profession a much greater degree of control than would be possible under the existing PMS contract.
I look forward therefore to the impending vote on the new contract, since this will be an opportunity for the profession itself, in all its
forms, to express clearly its feeling about the way forward in a modern 21st century National Health Service.
One of the great strengths of general practice is that it can adapt to any situation, and make it work.. Whatever the vote result, I believe
it can do it now as well.
Bob Button
Chief Executive
Wessex LMCs
2) Disability Discrimination Act
Did you know that ?
- by October 2004 Part III of the Disability Discrimination Act 1995 will come fully into force?
- by that date you must take all reasonable steps to ensure that your premises are adapted appropriately to provide services and
facilities for disabled patients and staff?
- a disabled person is defined in the Act as anyone who 'has a physical or mental impairment which has a substantial and
long-term adverse effect on his ability to carry out normal day-to-day activities'?
- if disabled patients or staff believe you have failed to take all reasonable steps to enable them to overcome the difficulties they
face, they may take action and seek unlimited compensation in the County Court?
You do now!
The Access to Health Service Premises; Audit Checklist may be helpful in assessing any changes that you may be required to make. Additional
information is also available from NHS Estates and the GPC.
Direct links to this documentation and the GPC guidance entitled 'Model Publication Schemes for Health Sector Bodies' can be found in the Q&A
section under Practice Matters 2 (PRA 69) of www.lmclive.co.uk
CD
3) Non principals
We do not have the address of every non principal out there and so if you have not heard from us encouraging you to join the LMC please
contact us. There are many advantages to membership. As well as representing you at a local and national level, payment of the levy enables you to tap into the wealth of experience and advice we offer.
Call us at the office on 01962 867793 for more details.
JS
4) New email addresses
Our email addresses changed last year and the previous addresses @btclick.com will cease to work from this month so please add the new
ones to your address book. They are now in the format:
name.surname@wessexlmcs.org.uk
JS
5) Police Referrals to GPs
Attached as a Annex to this Bulletin is a double-sided sheet giving details of the information passed to Police Forces requiring them not to
unnecessarily trouble GPs to examine or record injuries to patients who may be the subject of legal action. It is very important indeed that GPs should refer to this guidance when they are refusing to perform such
examinations for patients who may have been misdirected to them by Police Officers.
I hope possessing these letters which you can keep in the office, will enable you to immediately refer to them in the case of need.
(See Appendix 1)
RB
6) Probation officers requesting reports
The LMC have had some enquiries recently asking whether GPs are required to provide reports on request for the Probation Service and if a
charge is applicable.
The Probation Service regularly asks for a medical report to support their work with the Court and their clients.
This is a service for which the GP is entitled to charge a fee .
This work requires time, knowledge of the patient/client and access to medical records. Increasingly these reports are being asked for at short
notice. The LMC would suggest the Practice has one fee for a report produced in less than 1 week and one for a report produced in under two weeks.
If GPs experience further problems with the Probation Service, could they please contact the office and we will implement formal discussions
with the Probation Service.
NW
7) Charity levy
A big thank you to all the GPs who signed up to the charities levy. This month we have sent off a cheque for 7,500 to be shared between the
BMA Charities and the Cameron Fund bringing the total contributed in 2002-03 to almost 16,000. These charities work to help all doctors and their families in times of need and much appreciate the contributions
they receive from Hampshire, Wiltshire and Dorset GPs.
JS
8) NHS complaints reform - Making things right
Complaints are an extremely unpleasant aspect of modern general practice.
Last year alone
- 140,000 formal complaints were dealt with under the NHS Complaints Procedure
- 3,500 complainants requested Independent Review
This new initiative aims to build on the existing NHS Complaints Procedure.
The reforms will not be fully operational before April 2004 when the Commission for Healthcare Audit and Inspection (CHAI) will assume
responsibility for independent scrutiny of NHS complaints.
The most common causes of complaint are;
- attitudes of staff
- communication and information to patients
LMC recommendations
- Take time to read through the Complaints Guidance on
www.lmclive.co.uk
- Carry out a risk assessment to see if you can reduce the risk of complaints.
- Make sure that your practice has an effective written complaints procedure.
- Make sure that everyone knows what to do if a complaint is received.
- In the event of a complaint contact the LMC at the earliest opportunity.
- Correct handling of complaints is essential for effective damage limitation
CD
9) CHI
CHI is about to be re-named CHAI but I don't think its effective
function as far as GPs are concerned will change in the slightest. It would be a good time though to draw your attention once more to the guidance document issued by the GPC in August 2001 entitled
"Commission for health improvement (CHI): GPs' obligations - Guidance for GPs."
This can be accessed via the website - lmclive.co.uk but if you would like a hard copy, you may also contact the office where Jenny Steiner,
the general manager will be able to deal with your query.
I think it is important that GPs do understand how much co-operation they have to give to CHI investigations. Although not part of the GPs'
Terms of Service there are considerable obligations contained in the CHI Regulations that can be placed on GPs to provide anything CHI require in the way of information. I think it would be wise for GPs to be fully
aware of their responsibilities and their rights and privileges before they find themselves being requested by CHI for information about something they are unsure about.
RB
10) GP Access to Medical Records/Discharge Summaries
Across the whole of the Wessex area I am seeing problems with this particular situation. It is occurring in Dorset with respect to patients
being transferred from a hospital to a rest home, which might be in a different area from that which their previous GP covered and no adequate information being passed to the new doctor.
In Portsmouth there is a chronic problem with lateness in passing discharge information to doctors, and doctors find themselves frequently
on the telephone trying to find details of discharge medication and what exactly has happened to the patient; both to explain to the patient and to provide the on-going care. I know that Portsmouth hospitals are
trying desperately to resolve this situation, at least initially by having some form of 'Fax' Discharge form available immediately to the practice at the time of the patient's discharge, and this shows a
willingness to address what is a very difficult problem.
The responsibility for the patient once they are discharged from any hospital are entirely with the GP. Should the GP act without adequate
information, the excuse they have not received the discharge summary would not, in my opinion, be an adequate medico-legal defence. Unfortunately, although it is not possible for us to make sure it never
happens, the LMC would appreciate details of those cases where you are failing to get any discharge notifications containing adequate detail to
enable you to carry out your function. If it is a general problem with a particular organisation we can then take it up directly with them. It is
not possible for the LMC to follow through on behalf of individual cases for a GP, if only because of confidentiality restrictions.
It is also the situation that Social Services often require extra information when patients are discharged from hospital and they will
normally approach the GP for this when the patient is in the community. Another reason why the GP must feel comfortable about the amount of information they have.
It is to be hoped that in the future this situation will improve, but as I have indicated above, where you have a recurring problem, I would
appreciate knowing about it, so that the LMCs in the various areas can take appropriate action.
RB
11) Asylum Seekers and Closed Lists
It has come to the LMC's attention that there are some practices who are seeking to close their lists preferentially to Asylum Seekers whilst
remaining open to other members of the community. The LMC firmly believes that this is unethical and that the doctor's availability for delivery of care should be equal, regardless of the provenance of the
patient. Obviously if the doctor is already over-worked and can take on no more patients of any sort, then that should apply equally to asylum seekers, immigrants and all other members of the population, whether
they be English, Scottish, Welsh, Irish or whatever!
The LMC have circulated, in conjunction with some of the primary care agencies, advice about those occasions; which are very restricted;
when it might be reasonable to accept patients on what is otherwise a closed list. In order that the doctor should be protected against unfair allegations of racism or discrimination, it is strongly advised that you
follow these agreed procedures and do not close the list unless it is absolutely certain that it is closed to all comers.
With regard to asylum seekers there is nothing in my opinion to prevent a practice ensuring that the person requesting registration on their
medical list is indeed entitled to such registration. This can be in the form of adequate Home Office documentation, or indications from the Social Services that they are known asylum seekers and are entitled to
full medical care. Should the doctor have any doubts about this, then it is up to them to make the necessary enquiries either of the PPSA in Hampshire or the primary care agencies elsewhere and, except in an
emergency, may refuse other treatment to patients requesting it, unless they are satisfied that they are bona fide.
RB
12) Release of Medical Records to Insurance Companies
Recently a case arose where a doctor had been approached for a medical attendant's report during the life of the patient and had
provided this to the satisfaction of both the patient and an insurance company. Following the patient's death the insurance company then sought to obtain extra records with the obvious intention of seeking to
avoid paying out on the policy. It is salutary to remember that once a person is dead the right of transfer of the documentation falls under the Access to Health Records Act 1990 and the informed permission
of the next of kin is necessary before any documents relating to that person may be released.
It is important to note that it is not good enough for the insurance company to indicate that they have permission of that person during
their lifetime to release information, because that would only be effective for those details that were requested prior to the person's death and prior to the date of the permission being agreed to.
Obviously, doctors do not wish to be obstructive with insurance companies, but it must be made plain that you have a responsibility to
the patient, whether alive or dead, and their relatives, to make sure that by your actions you do not in any way call into question any rights they may have before payments are made under insurance policies. In
the event of any queries arising of a more detailed nature, it would be a good idea to check with the LMC if you have any doubts and we will seek to give you direct advice.
RB
13) GP's Responsibility for patients while they are at home awaiting admission
If a patient is felt by the GP to need admission to hospital, the GP will normally seek to gain agreement from the hospital to receive the
patient for treatment.
In the event of the hospital not being in a position to immediately accept the patient, then the GP may, if they wish, seek to find
voluntary acceptance from another hospital. However it is not the responsibility of the GP to do this and it is perfectly reasonable for the GP to pass the patient along to that hospital where the hospital are
required to find a bed for the patient. It is important to remember that once the doctor has made the decision that the patient is in need of hospital treatment, any delay thereafter is the responsibility of the GP
concerned and the responsibility only passes to the hospital when the patient has actually arrived there and are in the hospital premises. GPs who may be willing to try to find other hospitals who are willing to
admit a patient, must therefore bear in mind very carefully the possibility that their patient's interests might best be served by immediate transfer to a hospital premises, in order that any emergency
treatment in the event of any collapse or deterioration in condition can be promptly treated. It is an individual judgment for the GP to make as
to which course of action he should follow, but it is advisable that these matters are considered as part of that decision making process.
RB
14) Organ Donation
A case occurred recently where a doctor was contacted concerning the possible use of a deceased person's organs in a transplant programme.
Normally GPs are only too pleased to assist in any way in this life saving arrangement. It is not always possible however for GPs to have full
access to notes if they are contacted Out of Hours. The LMC has been in touch with the Transplant Authorities in Hampshire and supports their intention to avoid unnecessary troubling of GPs if that is possible. They
also understand the GP who may be on call may not be the individual's GP, nor may it always be the case that they have access to the full detailed medical notes. This is one of those occasions when both GPs
and the Transplant Service are going to have to act as reasonably as they can in each individual circumstance. It is not possible to make hard and fast rules about whether or not it is reasonable to approach GPs for
information, it is a question of judgment.
Having spoken to the Transplant Authorities, I am satisfied that they do understand the difficulties GPs face and will do their very best to avoid
troubling GPs unnecessarily. Obviously if the GP is in a position to easily give this information, then I think that on the infrequent occasions they
are likely to be approached in this way, GPs will, I am sure, do their very best to co-operate.
RB
15) Contacting GPs
In the course of my work I frequently have to ring doctors at their surgeries.
There is nothing quite so infuriating as some of the systems of so called "guided access" that we get. My staff are also very fed-up with
sometimes being forced to wade through a long selection of alternatives, only to be told at the end to "hang on" anyway. Understandably GPs, having been one myself I know this only too well,
can be inundated with telephone calls, such that it actually prevents useful work being done. It is important though that GP contact is not excluded completely, because there can be occasions when urgent
contact with the GP is something which is necessary. There is normally in the system a chance for the person to indicate the urgency of their request and in that circumstance they can be directed immediately to
someone answering the telephone. An early option in the list of options allowing the caller to key in a direct extension though, would be very helpful.
A further problem occurs when Consultants or the LMC office, wish to return calls from GPs received earlier in the day when it was
inappropriate to speak. Consultants in the Portsmouth area have drawn to our attention the impossibility sometimes of getting through to GPs during the lunch time when their staff may well have switched their
phone to an answerphone for emergency care only. It would be very helpful indeed, certainly in the Portsmouth area, if GPs would agree to provide Consultants with their by-pass number, where they can be
contacted during lunch times so that the Consultant/GP contact can be facilitated. Consultants have given the undertaking that this telephone number will not be used by all and sundry, but will be available only to
Consultants, who wish to speak to GPs direct and when this is the only time they can do so.
E-mail contact from or to Consultants is also something which will prove extremely useful and GPs may well wish to make sure that in their
referral letters they give an e-mail address, often their nhs.net address by which the Consultant can contact them in case of need.
All the above remarks concerning Consultants refer equally to the LMC. We try very hard to reply promptly to queries, but do sometimes have
difficulty in contacting GPs for the reasons given above.
RB
16) Doctors Support Line
This began in October 2002. This independent service is intended for GPs who are under stress or pressure or need to talk things over with
people in a completely confidential way. There's no need to give your name or address; the whole point is to allow doctors to talk to someone in a totally neutral way.
Dr Livesey Milia Miller and Dr Chris Manning are the ones who are overseeing the project and this is supported by the D O H. A service can
be accessed by ringing the doctor support line on 0870 765 0001. All calls will be answered in complete confidence by volunteer doctors.
Obviously this in no way replaces the services which are available to you from the LMC either directly by speaking to one of us on the
telephone or by onward reference to a specialist using pseudonymisation, but it does offer an alternative source of help.
RB
17) Freedom of Information Act 2000
This Act applies to all NHS bodies and includes hospitals, as well as doctors, dentists, pharmacists and opticians. It is intended to promote a
culture of openness and accountability and a better understanding of how public authorities carry out their duties, why they make the decisions they do and how they spend public money.
The Act will be fully implemented in January 2005 when the public will have extended rights of access to all types of personal or non-personal information.
All NHS bodies must have a Publication Scheme approved by the Information Commissioner in place from 31st October 2003.
A publication scheme is a commitment to make certain information available and a guide as to how and where that information is available. It must set out the
classes of information the authority publishes, the manner in which it is published and the details of any fee.
GPs cannot be included in another public authoritys scheme,but can administer their schemes jointly for example by publishing them on the
same website or having the same telephone contact point.
A Model publication scheme for GPs has been developed and has been approved by the Information Commissioner for a period of four years from 31st October 2003.
Further information on the Freedom of Information Act and a copy of the model scheme with guidance on its completion is available on www.lmclive.co.uk in the Data Protection section of Guidance.
We will provide further information as and when it is available to us.
CD
18) Reports for the Citizen's Advice Bureau (CAB)
I have in the past advised on the matter of providing reports for the CAB.
If you are approached by them concerning one of their clients for any form of report you are perfectly entitled to ask for a fee for your time.
You must make sure you have the informed consent of the patient before you make any reply at all. In certain circumstances, such as when you are merely being asked to confirm positive statements, you may
wish to assist this organisation by not pressing for any fee to be paid.
GPs often find themselves in a difficult situation though when approached by organisations which act either as charities, or as
"patients' friends". I'm afraid these organisations must be treated in the same way as you would the social services or other welfare organisations
as recipients of your valuable time. This means I'm afraid that either they must accommodate to you by asking for confirmation of positive statements, or if they insist on asking you for answers to open-ended
questions; then they must realise that the cost of your time must be met by them.
RB
19) Pensions
Update from the pensions agency - 24/03/03
- Locum pensions for GMS/PMS GPs
- Pension forms online
NHS locum pensions scheme extended to GMS and PMS GPs
The NHS Pensions Scheme has been extended from April 1st 2003 to include the locum earnings of GPs providing GMS or PMS services.
GPs who wish to pension their locum earnings must present their pension records to the PCT not more than 10 weeks after the end of any locum
work, enclosing GP locum forms A & B and their "employee" contributions.
Qualified GMS/PMS GPs will also be able to apply to pension earnings for NHS GP locum work backdated from 1 April 2002.
Added years contributions may also be backdated from 1 April 2002.
PCTs have been instructed not to process applications until the amendment regulations have been confirmed.
Further advice:
NHS Pensions Newsletter; Advance information about NHS GP Locum
work undertaken by GMS/PMS GPs
http://www.nhspa.gov.uk/library/tn2003/tn2_2003.pdf
NHS Pension Scheme membership for GP locum medical practitioners
http://www.nhspa.gov.uk/nhsgplocums.cfm
Helpline 01253 774678
Pensions online
The NHS Pensions Agency introduced new electronic forms on March 5th. From April 22nd 2003 only the new e-forms will be accepted, unless the
agency has registered their agreement to the continuing receipt of paper forms.
Further information:
Pensions online update
http://www.nhspa.gov.uk/library/tn2003/tn3_2003.pdf
Enquiries: csandwell@nhspa.gov.uk
CD
20) Policy on Violence and Harassment
The PCTs have had the responsibility to develop a strategy on dealing with violence and the threat of violence towards GPs and their staff.
They were expected to develop this policy in consultation with the LMC and local practices. In addition the PCTs have an obligation to provide facilities for the medical care of patients who have been violent.
The Department of Health instructed PCT Chief Executives to have these policies and facilities in place by 31st January 2003.
The LMC has had discussions with most PCTs.
If your practice has neither been involved or received a policy from your PCT, please contact the Primary Care Lead within the PCT
LMC Views
- If a patient is violent or threatens violence the following action is recommended:
- a) The patient is immediately reported to the Police.
- b) The patient should immediately be de-registered under Regulation 9A of the GPs' Terms of Service.
The PCT must support the practice in the above action.
- The PCT will not allocate such patients unless the Practice agrees to this and the PPSA will inform a practice of a past history of
violence for any patient newly joining a practice.
- The PCT must have:
A secure facility, or number of facilities, where patients who have been violent or threatened to be violent, can receive their
medical care.
And/or,
A secure Unit attached to a police station and Accident or Emergency Unit.
A contract with one or more practices to take care of the medical
needs of such a patient. The contract would include payment for providing this service and for any additional requirement e.g. equipment or alterations.
- The policy should ideally be expressible in no more than 2 pages of A4.
- Sample letters and practice based policies may be helpful for some practices and should be contained in an Annex, preferably in electronic form.
Models for the care of violent or potentially violent patients
1. Secure Unit
This may be at an Accident and Emergency Department, Primary Care Centre or Police Station.
In some PCTs it may be impractical for GPs to use such facilities due to pressures of time and distance. The capital costs and also ongoing
revenue costs may be significant.
2. Local Contracts
In some parts of the country a different approach has been tried. A Local Development Scheme (LDS) has been developed. Patients who are
violent or threaten violence are removed from a GP's list and the patient's medical needs are then looked after by a different practice for a set period of time.
The contract could be with several practices who are paid a retainer for providing a service, or with individual practices who are paid for each
patient to whom they provide medical services that fall into this category.
If the patient has behaved reasonably after a 12-month period the contract ceases.
NW
21) Appointments for venepuncture
The Royal Hampshire Hospital pathology department have recently presumed, without any consultation, to advise practices that in future
the practice must make an appointment for blood tests needed for “priority” patients e.g. fasting diabetics.
Two important points need to be made:
- Path Labs do not instruct practices on what they do, but may consult the LMC as the GP representative to discuss such proposals.
- Patients are perfectly capable of arranging their own appointments for Diagnostic Radiology and are just as capable of doing the same for venepuncture.
I would be grateful if any other such cheeky presumptions are made of this sort, if you would notify us at the LMC office.
RB
22) Short Term Sickness Certification
There are a number of very frustrating problems being faced by GPs with regard to sickness certification, which waste valuable
appointments. It is estimated that in 2001 2.4 million unnecessary GP appointments plus an additional 37,000 hours of GP time were wasted on this task.
In 2002 a Cabinet Office report identified sickness certification as an unnecessary burden on GPs. Although sick pay regulations do not require
employees to obtain sick notes from GPs until after seven days off work, many employers nevertheless demand this. In most of these short-term cases, GPs' time is wasted by having to fill out sick notes, rather than
actually treating patients.
Another problem is hospitals forgetting or refusing to issue sickness certification following a period of in-patient treatment.
As you may be aware there is much discussion at a national level about removing sickness certification from GPs and providing this service
through an Occupational Health. Although this seems attractive it may or may not be agreed and implemented, so for the immediate future GPs need to cope with these issues.
Employers request for sickness certification for 7 days or fewer..
GPs are not obliged to provide their patients with sickness certification for illnesses of seven days or fewer.
Each Partnership should have an agreed policy on how to deal with these issues. If GPs within a Practice have different policies for dealing
with these issues then it becomes more difficult to say NO.
Suggested policy:
- Patients are not issued with sickness certification for a period of time of less than seven days unless the employer pays.
- If a patient questions this and has said his/her employer insists, give the patient a copy of the LMC's letter (Appendix No.2)
- Refer the patient to the following web site www.managingabsence.org.uk.
- If a particular employer repeatedly requests sickness certification for less than 1 week, please inform the Office and we will write to
the organisation and tackle the issue with them.
Hospitals not issuing sickness certification following an in-patient stay
When a patient is discharged from hospital, the patient should be issued with sickness certification. This should cover the period of time the
person was in hospital and also following discharge, until the person is expected to return to work. This could often usually be for a period of up to 6 weeks.
Some hospitals have refused to issue sickness certification or have tried to say they are only allowed to issue a certificate to cover the period of
time the person was an "In-patient". This is absolute rubbish, and all hospitals have been instructed to comply with the Cabinet Office's instructions.
The LMC writes to Trust Chief Executives, Medical Directors and specific Consultants on a regular basis to remind them of their obligations. If your
local hospital/consultant does not issue sickness certification, let us know and we will address the issue with the hospital.
My practice has tried to be proactive about this. When patients submit a form from the hospital requiring a list of current medication, prior to
admission to hospital, the Practice attaches its own letter to this. (Available at www.lmclive.co.uk look under time savers - hospital admissions, also see Appendix No 3 )
In essence the letter wishes the patient well for their admission. It also reminds the patient to obtain sickness certification, medication and a discharge summary.
NW
23) Adoption and fostering medicals
Adoption and Fostering Medicals are outside GMS and therefore GPs are entitled to negotiate a fee for their services. This negotiation must be
carried out prior to undertaking this work.
There are a number of collaborative fees which are laid down on an annual basis by the D.D.R.B. of which Adoption and Fostering Medicals
are one part. This is currently 35.65.
This is not a fee that the LMC recommend practices charge - it should be more in line with a fee to reflect a doctor's time and expertise. GPs
have performed these medicals indicate they take between 30 - 45 minutes.
NW
24) Appraisal payments
The LMC has noticed quite wide discrepancies between the amounts paid by different PCTs for both Appraisees and Appraisers.
As the result of a survey the following figures were given to us after enquiring on this point.
This may be of interest to all GPs.
FUNDING LEVELS FOR APPRAISALS
|
PCTs
|
APPRAISEES
|
APPRAISERS
|
Dorset |
|
|
|
Bournemouth
|
125
|
225
|
|
North Dorset
|
300
|
400
|
|
Poole
|
300
|
400
|
|
S & East Dorset
|
125
|
500
|
|
S West Dorset
|
300
|
500
|
Wiltshire |
|
|
|
Kennet & N Wilts
|
350
|
450
|
|
Swindon
|
100 to attend training
75 for appraisal
|
50 per hour
|
|
S Wilts
|
240
|
570
|
|
W Wilts
|
500
|
500
|
Hampshire |
|
|
|
North Hants
|
500
|
500
|
|
Blackwater Valley & Hart
|
500
|
500
|
|
East Hants
|
Up to two sessions backfill (300)
|
450
|
|
Portsmouth City
|
150-300
|
450
|
|
Fareham & Gosport
|
Up to 300
|
450
|
|
Isle of Wight
|
Not agreed
|
500
|
|
Soton City
|
400
|
500
|
|
Eastleigh & TVS
|
500
|
500
|
|
New Forest
|
500
|
500
|
|
Mid Hants
|
Up to 600 for first appraisal
|
400 plus one session per month reimbursed
|
RB
|
