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Wessex LMCs Bulletin - September 2002
CONTENTS
1) Editorial - What Now?
2) Finding Time for Patients
3) Donations from Grateful Patients
4) Pre-Operative checking in general practice
5) Complaints
6) Community Care Assessments
7) Passport Counter Signatures
8) Retainer Costs and Seniority Changes
9) Nanny is alive and well and lives in Dorset
10) Insurance underwriting decisions
11) Web Site
12) Dealing with the Media
13) Housing Application
14) Death of Care Home Residents
15) Social Services and Confidential Information
16) Road Traffic Act fees
17) Prepayment and exemption certificates
Attachments:
Att 1) Counter-signatories for Passport Applications
1) Editorial - What Now?
So the first ballot has received what one might term "approva" from the profession. It is important not to get carried away however with the
degree of positive response since if you analyse the actual voting, less than a majority of the members of the profession actually voted in favour (49.4%). The greatest concern I have is that something around
30% of the profession decided not to bother to vote at all.
It is possible they felt this was a foregone conclusion, that it would go forward for pricing and were only interested in having their opinion
heard at the time of pricing. If that is so then provided they vote next time, all will be well.
A small note here: Anyone who did not receive a ballot paper in the first round should make sure they contact the GPC office in London to ensure
that they are given the opportunity to vote in the subsequent Ballot. I know a lot of GPs were upset about not receiving a Ballot paper from the GPC office.
It is hoped that the result of negotiations will be available for discussion around the country by February next year. Obviously it is going to take a
while after that before full pricing is implemented. It is unclear at the moment exactly what will happen with regard to the Review Body Award, although the BMA will of course be providing evidence.
The answer to the GP problem however, is not solely money. Even though this would go some way towards resolving things, if only by
providing enough opportunity for GPs to run their business efficiently and get enough help to enable them to cope with the ever increasing workload. The much more important point is managing the demand on
the GP and granting the time, space and facilities to practise his art, for which he has been so expensively trained.
I am still not yet convinced that we have managed to overcome the problems of demand related to the number of GPs there are to answer
that demand. A particular concern to me at the moment is that of allocations. Where is the point of GPs trying to provide a quality service, if they are forced to accept more patients than they know they
can reasonably cope with. Only when an answer to allocations is reached can we really talk about having controlled demand.
One of the articles in the Bulletin this time is one which was originally produced by Somerset LMC, which deals with "Finding time for patients".
I commend to you the sentiments expressed. (See page 3)
There is a particular concern at the moment with the OOH arrangements in this area, since for various reasons some co-ops have found it
impossible to continue, not least because of the immense bureaucratic load which is being proposed from October of this year, which would necessitate increased staffing and increased expenditure on computer
equipment, to provide the detailed returns which are proposed.
Although the Government is well motivated in seeking to maintain high quality in OOH services, it has always struck me as somewhat odd that
they are willing to put so much effort and time into assessing the quality of the services OOH, but paying relatively less attention to quality for
the majority of the time when patients are seeing doctors during the day. Their intentions with regard to improving the quality in the OOH period however, whilst wholly commendable seem to be out of
proportion to the work required in producing the detailed data returns.
One thing is for certain, if the GPs do not get a satisfactory Contract at this stage, I fear for the future of general practice in its entirety
in this country, because I think it really is a "last chance saloon".
Other happenings in our area include: the new LMCs which are to be elected during September and to take office from the 1st October.
These will comprise the West Hampshire LMC; which is the old Mid Hampshire PCT area plus the old Southampton LMC; the North East Hampshire LMC; which will be Blackwater Valley and North Hampshire
PCTs; and Portsmouth and the Isle of Wight LMC ; Dorset LMC and Wiltshire LMC.
These LMCs will have a lot of work to do with the changes taking place if the NHS De-Regulation Bill becomes operative from 1st October. This
is a radical change in the manner in which your Contract is administered and there will be a lot of work undoubtedly for LMCs in working closely with the management teams of the PCTs to ensure that doctors are not
in any way disadvantaged.
It is also a function of the LMCs to ensure that adequate provision of funding for primary care is made before even more work is transferred from secondary care.
Last but by no means least, a very important announcement:
Dr Nigel Watson, presently Chairman of the Southampton & South West
Hampshire LMC is joining the team here at the Wessex LMC as my Deputy from the 1st October and will be working here for 2 days a week. Nigel is already the GPC Regional Representative for the
Hampshire and IOW area, as well as having special interests in GP computing. I know he will bring a great deal of expertise to the office to enable us to continue, as I hope we do already, providing you with all
the support you need and freeing you up from administrative burdens wherever possible, thus helping you to do the job which you originally intended when you joined general practice.
Bob Button
Chief Executive
2) Finding Time for Patients
This article appeared originally in the Somerset LMC Newsletter written by their Secretary Dr Harry Yoxall.
He has agreed to me reproducing it here amended appropriately for locality relevance, I commend to you the sentiments which are fully supported by the Wessex group of LMCs.
Finding Time for Patients Is that meeting really necessary?
One of the central tenets of the NHS Plan is the importance of clinical leadership. Ministers like to bang on about how "power is being given
back to front line clinicians". What is conveniently forgotten is that there are not enough clinicians to provide the service, never mind manage it as well. Each new bright idea draws doctors away from
patient contact time, and we haven't even started appraisal yet.
Adding an obligation to do jury service is another really helpful suggestion. It is an interesting question as to how we can square a 24
hour obligation to be available to patients with an obligation to be in court. If colleagues decline, on principle, to take on the GP's clinical responsibility what does he or she do? Telephone triage on a mobile
phone in the Jury Box?
Meanwhile, there is a crisis brewing with respect to locum availability, because of the explosion in demand. This has a serious knock on effect,
especially on small practices. We have heard of a single handed GP unable to obtain sickness cover and another doctor unable to find anyone to do a morning surgery after he does a night shift at the co-op whilst
his partner is on holiday.
Whilst it is important that GPs remain engaged in the system, most of us are in the job because we actually want to look after our patients.
Advanced Access brings benefits to patients and practices, but means that you have to offer enough appointments to meet the demand. We have to set some limits to the extra tasks we take on, and we have to
say no to unnecessary or inappropriate requests for time out of the surgery.
The LMC has suggested some ground rules that bear repeating:
- Attendance at meetings should attract a locum payment at the LMC rate or the actual cost as supported by an invoice. There are still a
lot of people (including a few on PCTs) who don't understand that we don't draw a normal salary and that going to meetings costs GPs money.
- You should expect 2 weeks notice of a meeting, except in really exceptional and urgent circumstances. If not, don't go.
- Meetings involving GPs should be convened at lunchtime or in the early afternoon on Tuesdays, Wednesdays or Thursdays if possible.
You should assume that if a meeting is called on a Monday morning then the time has been deliberately chosen to preclude GP attendance.
- If a meeting is a waste of time say so and don't go again. We'd like to know about these in case there turn out to be any regular culprits.
- Meetings that involve other members of the practice team being used as a resource (as opposed to being given information) should
lead to the practice being reimbursed for their time. It is not up to us to pay for the management of the NHS!
If you are invited to a meeting, find out about reimbursement arrangements before you go. Where the LMC is asked to nominate a
representative we will be responsible for doing this on your behalf. In other cases we can find out or negotiate for you if you are in doubt.
Finally, there has been comment that invitations to GPs to attend meetings often go unanswered, which makes us appear rude. Please send
a short standard letter in response to such invitations regretting that the doctor is unable to attend due to pressure of work and the shortage of locums. We endorse the suggestion.
3) Donations from Grateful Patients
A case occurred recently where a patient wished to make an expression of her thanks for the care she received from her practice in the form of
a bequest after her death.
Unfortunately this bequest was made with the intention of benefiting the surgery, but was paid in the name of the local PCT.
It is very important that any such cheques which are drawn by the Executor of the Estate should be clearly made to the practice concerned
and not the PCT, since the PCT once they receive it are unable to disburse this money direct to the practitioners, as was, in this case, the deceased's intention.
Although this is not going to occur very often, it is extremely embarrassing when the deceased's wishes cannot be complied with, due
to a minor administrative muddle.
RB
4) Pre-Operative checking in general practice
There has unfortunately been an increasing tendency lately for hospitals to ask GPs to undertake pre-operative checks and tests for patients prior
to their admission to hospital particularly for booked surgery.
Examples have recently occurred in Portsmouth, where blood tests were requested, and in both Dorset and Wiltshire where requests were made
for an extensive MRSA testing to be performed by the GP, prior to the patient's admission.
I should like to make it plain that it is inappropriate for GPs to be requested to perform any sort of work of this nature. One of the reasons
for this is that this is part of the hospital admission process and needs to be performed by the hospital itself, in order that they accept the medico-legal responsibility which flows from pre-operative preparation,
as a necessary part of the whole operation procedure.
Hospitals often do not understand that GP practices are funded to provide GMS care, not to act as a back-up nursing service to the
hospital, nor to act as a taxi service to avoid the patient's necessity to travel to the hospital.
If you need the support of the LMC in resisting such requests, please feel free to contact us.
RB
5) Complaints
The complaints system is soon to be further re-organised although we await detail from the Government.
What is not widely realised still is that doctors are equally able to complain about patients, as patients are to complain about doctors. It
may not follow exactly the same path as the doctor is used to with regard to patient complaints, but nevertheless every Health Authority and from now that means every PCT must have in place a mechanism
whereby complaints from doctors about patients can be properly investigated and dealt with.
An interesting development in the Devon and Somerset area which I think could be very useful, is the definition of a vexatious complainant.
We are all familiar with those people for whom no service, however frequently or efficiently given, is ever going to be satisfactory. These
people are difficult to live with but there are others who make the lives of the doctors who care for them an absolute misery, by never leaving them alone and complaining on every occasion!
Where these people can be shown to be following a pattern of behaviour which is not only undesirable, but even perhaps persecutory, I
would suggest that it would be appropriate to ask your Health Authority, to consider implementing a vexatious complainants' list. Once added to
this list it is possible to regulate these patients' behaviour rather better. This will, I hope, give less trouble to doctors.
Another problem which is becoming increasingly common lately, is patients who consider it appropriate to bombard their doctors and
surgeries with constant queries and tie up the telephone line in such a way that it is not possible for the patients who have real need to get
through. They are also likely to require extremely long consultations on frequent occasions, often with matters which are much less than serious, or even frankly minor.
In these circumstances doctors and their staff find that their time is being wasted. One way to deal with this, if you feel this is amounting to
harassment, is to contact the police and invite them to bring criminal charges against the person. When harassment hasbeen established in this way it is much easier to obtain an Injunction. The doctor has to comply
with all the Laws of the country. All I am seeking to do is to remind doctors that they are citizens of this country as well and have rights in just the same way as patients.
Should you have patients such as I describe above, whether vexatious, litigant type or of the harassment type, let us know the extent of the
problem so that this can be monitored.
RB
6) Community Care Assessments
I said before and I will repeat, Social Services are under the misapprehension that GPs are required to provide Community Care Assessment forms free of charge.
This is not so and never has been.
In a particular case, Social Services in Dorset appear to only be willing to pay for what they consider to be appropriate. Since they requested a
report from the doctor and the doctor considered a visit was required in order to complete the form, it was reasonable for him to understand that the cost of such a visit would be met by the Social Service
Department concerned.
It now transpires that they consider themselves to be the arbiters of what sort of contact should be necessary between the doctor and the patient.
My advice to all GPs and especially in the Dorset area, is that in the event of being approached for one of these forms to be completed, that
first of all they ascertain what sort of examination might be necessary, whether it be physical or oral or via records and gear their report costs
accordingly. They should receive written confirmation of agreement to pay before they proceed; just as I hope practices do with Solicitors.
In the past, doctors have actually completed forms with goodwill towards these departments but it appears that our trust was misplaced
and therefore I recommend that doctors do not continue to co-operate until such time as the Departments involved undertake to meet their reasonable fees.
Should any GPs have any problems of this sort, please do let us know at the LMC since we are anxious to follow these up and determine who the worst offenders are.
RB
7) Passport Counter Signatures
Attached to this Bulletin is a list of those people who are considered acceptable as counter-signatories to passport forms. GPs are specifically
excluded from this list and so anyone coming along asking you to counter-sign this certificate can be pointed to this list and invited to consult one of those who are named, rather than asking you as their GP.
Should you wish to perform this service for them, then there is no reason at all why a fee may not be charged. (Attachment No. 1)
RB
8) Retainer Costs and Seniority Changes
Two recent amendments to the Red Book should be noted.
People who in the past have legitimately paid their retainer doctors sums in respect of maternity, sick and holiday leave, have occasionally
run into troubles with getting the sessional payments involved. An amendment has now been produced which makes it a requirement for such payments to be made at the sessional rate to all practices involved.
Any doctors having problems please contact the LMC office.
Seniority payments at one stage were being withheld for a period if the GP concerned had a break in service of more than 6 months.
This has now been amended and backdated to the 1st April 2002. Therefore any doctor who is affected by this should consider contacting
the Health Authority or PCT or LMC who will then be able to arrange for the payments to be promptly credited or offer advice in detail about the applicability of the scheme in their case.
RB
9) Nanny is Alive and Well and Lives in Dorset
A recent case of a Verruca in Dorset led to the discovery that schools are still being required to work to a directive from Dorset County
Council with regard to the management of children going swimming with Verrucas, which appears to date from 25 years ago.
I have always taken the view that I have known people die from being unable to swim and therefore drowning, but I have never seen a fatal case of Verrucas yet!
Nevertheless the approach being taken by Dorset County Council appears to be that anyone who has these harmless papilloma virus wart outgrowths on their body should be treated like
some form of leper and restricted from going into the water or attending the swimming pool unless they have covered these offensive lesions, often with things called "Verruca socks".
It is absolutely vital that we do not allow archaic and ill informed guidance of this nature to go unchallenged. Surely as doctors we have a
responsibility to make sure that modern medical advances are brought to the attention even of Education Departments of County Councils so that they are made aware of the importance of getting the priority of
teaching the children to swim well above the level of the incidence of Verrucas and even more so when the suggested action is totally and completely ineffective anyway.
Please resist this further incidence of a request for unnecessary medical certification.
RB
10) Insurance underwriting decisions
In the past insurance companies often reached underwriting decisions on the basis of information that was unknown to the patient. They often
refused to discuss these decisions in order to protect the patient from bad news about their health.
An insurance company is not best placed to break bad news to patients. That is the role of the doctor.
However, patients nowadays are much more aware about their own health. In addition, under the Medical Reports Act, patients should
always be allowed to see any Insurance report before passing it to the company.
The BMA and ABI are currently drafting guidelines on the use of medical information for insurance purposes and are likely to recommend that an
insurance company should provide the patient with written reasons for an increased premium or a refusal to provide cover if requested to do so.
The GP is not best placed to explain actuarial decisions. That is the role of the Insurance Company.
If the company is concerned that the patient may not be aware of the problem, or believes that further care or treatment would be beneficial,
then a medical officer for the company should discuss the best way to proceed with the GP. The GP should then address the issue with the patient in a normal NHS consultation if this is necessary.
CD
11) Web Site
The BMA web site was recently completely redesigned and the necessity to "log-on" was introduced for many items.
This has caused considerable problems with all links to BMA/GPC guidance from any other web site including LMC LIVE.
The BMA site has proved much less user-friendly as a result of the changes and some of the guidance is no longer available. Wessex LMC
have notified the BMA of their views. We are still hoping that their web site may be redesigned again at some stage.
In the interim phase we apologise for any difficulties you may be experiencing.
We are currently updating our links, but to access any BMA guidance from LMC LIVE you should first log-on to the BMA web site. If the link is still
not effective try searching the BMA site directly at www.bma.org.uk
If you experience any difficulties you should make your views known to the BMA directly.
CD
12) Dealing with the Media
There are occasions when practices get contacted by the media, either local or national, especially in connection with complaints or patient
comments which rebound upon the practice.
Both the LMC and the BMA locally or nationally are in possession of a lot of good advice about the way in which contacts with the press should
be handled. It is often the case also, that there is a Press Officer at the local PCT who can advise.
Personally I think you are better off coming to the LMC locally for advice, since I am more likely to be au fait with the local situation and
sensitivities and often know the local media.
One of the important things about the Press is that they need their answers very quickly. If on a previous occasion they showed they could
not be trusted to report accurately the facts they are given, then it is important that we are able to modify our approach in future, so that they don't do the same thing again. Speed of response is not always the
best course even if the Press seek it. Do not be rushed.
The important thing is for the practice to take any advice they may need before they speak to the Press and not to feel they have to answer
without reference to anyone. A properly constructed response is likely to be positive in its effect. One that is badly worded can lead the media to draw interpretations from it which were quite contrary to the
impression the practice has sought to give. Even 5-10 minutes thought can often result in a response which is more accurate and safer.
May I remind you there is an interesting piece on our website dealing with press matters in the form of an article which appeared in the
December 2001 Bulletin. If you have difficulty in finding it
Go to "Search" box and enter "Media" and you will find a list of references.
RB
13) Housing Application
I am disappointed to find that Fareham Borough Council has contacted a doctor and asked for information relating to a Housing Application.
Following the submission of that information by the doctor they then refused to pay the fee.
I would suggest that all doctors approached by this Council should make it perfectly plain that no report will be forthcoming unless a written
undertaking to pay the fee is made in advance of the report.
I stress this is not part of your Terms of Service and as such is a private service for which a payment must be made. The Borough Council having
asked for it were the commissioners of the service and therefore were responsible for the payment.
RB
14) Death of Care Home Residents
A number of GPs have recently been told that it is now a legal requirement under the new Care Homes Regulations to notify a care
home of the cause of death of elderly patients who had been residents.
This is not strictly accurate.
The regulations require that the person registered to run the home notifies the Commission of the circumstances of death of any resident.
In addition the home must keep records of the date on which the service user left the care home, was transferred to another care home
or to a hospital and the name of the care home or hospital and the date on which the service user was transferred.
If the patient died at the care home, the date, time and cause of death must be given.
From the GP's point of view there are, however, a number of important points to bear in mind:
- 1) the common law duty of confidentiality extends beyond death
- 2) even if data is in the public domain a GP should not divulge any information that he or she personally has acquired in the course of
a confidential consultation
- 3) a breach of confidentiality does not have to cause any harm for there to be a breach of the law
- 4) a breach of confidentiality after death is only permitted if it is overwhelmingly in the public interest e.g. if the care home was
thought to be causing the death of elderly residents a disclosure, limited to the minimum that would serve the purpose, would probably be defensible.
If the patient dies at the care home the cause of death would probably be known.
However, if the patient had been transferred to a hospital and died there then the transfer must be recorded and the circumstances of
death should be notified by the care home. The cause of death does not appear to be required in this situation and disclosing it could breach the
patient's right to confidentiality. This is likely to be in breach of the doctor's legal and ethical obligations in that respect.
Further information, including relevant links, may be found in the Q& A section under Practice Matters PRA 13
CD
15) Social Services and Confidential Information
I am given to understand that more and more frequently Social Service Departments are contacting GPs and seeking confidential information over the telephone.
This is particularly the case in respect of Child Protection, which is a very emotive issue and one which GPs are indeed keen to see
performed efficiently. They do however have a responsibility to all the members of the family, which will include the father and mother as well.
GPs are often encouraged by the Social Services to ignore confidentiality rules in these matters because of their emotive nature
and GPs must be aware of the fact that there is no difference in this regard than any other. Despite the Social Services Department sometimes quoting the Children Act, there is nothing in this Act which
indicates that GPs are required to give confidential information if they consider it not appropriate.
Confidentiality in all its aspects has been dealt with widely on the website www.lmclive.co.uk and it would be worthwhile GPs consulting that.
One of the most worrying things is that Social Services seek reports of this nature over the telephone. This is in all circumstances wholly
inappropriate and on every occasion should be resisted. Not only is it not possible for you to be sure the person with whom you are dealing is in
fact an appropriate person to share such confidential information, but you need to ascertain in detail exactly what requirement there is for it.
You should have, ideally in writing, disclosed to you the information on which the Social Services have felt it appropriate to act and assure
yourself there is an adequate reason for the request to be made in the first place.
If and when you do decide to give information of a confidential nature to the Social Services Department, it is vital that you are aware of the
degree of confidentiality with which it will be treated inside the Social Services Department before the information is given. It has transpired in
previous cases that the term "confidential" may be interpreted quite differently in a social work environment than it is by you in your surgery.
It is very important therefore you make sure your understanding of the term "confidentiality" is reflected entirely in the same way by the Social Services Department. This can often mean that you will need to
require of them that the information passed on is solely for the information of the named people to whom you refer and not to be distributed widely.
Should you be contacted by a Social Services Department over the telephone asking for information of this sort, please feel free to take
advice from the LMC office on any occasion.
RB
16) Road Traffic Act Fees
A GP is required by the Terms of Service and the GMC code on Good Medical Practice to provide emergency treatment when necessary.
However, the Health Authority will make no payment for any service for which a fee is payable under Section 158 of the Road Traffic Act 1988.
If a patient presents at the surgery a day or two after the accident a fee may not be claimed under the Road Traffic Act. Care must then be given
under normal GMS. If a report for the insurance company is subsequently required then you may charge for this in the normal way.
The Road Traffic Act allows for payment for emergency treatment of traffic casualties that is required immediately as a result of bodily injury
(including fatal injury) to a person caused by, or arising out of, the use of a motor vehicles on a road.
In order to claim you must be the first to administer immediate treatment before the patient is admitted to hospital. You may charge
the fee for each patient treated.
The fee is levied on the user of the vehicle involved in the accident, regardless of fault, but should be covered by all motor vehicle insurance
policies. According to the department of Health most insurance companies reimburse this without "no claims" bonuses being affected.
The Road Traffic Accidents (Payments for Treatment) order 1995 determines the current fee of £21.30. The GP is allowed to claim a
mileage allowance of 41p per mile for each complete mile or part of a mile for any distance in excess of 2 miles that he/she must travel to attend the accident. These fees have not been raised since 1995!
The Road Traffic (NHS Charges) Act 1999 simplified the charging procedures for hospitals, but does not include GPs.
The current procedures for claiming means that a GP providing immediate care must ask the driver of the vehicle, who may have been
injured, for details of his/her insurance company at the time that treatment is provided. This may be quite inappropriate if the driver is injured and is in any case distasteful even if the driver is merely in a
state of shock. It is hardly in the interest of good doctor/patient relationships or good medical practice.
You should make an oral request to the driver. If that is not done a written request should be made to the driver and must be served within
seven days of the treatment being given. The claim must be signed by the doctor, giving his or her name and address, the circumstances in which the treatment was given and the fact that the claimant was the
first to administer treatment. The claim should then be served by delivering it to the driver in person or by sending it to the driver's usual or last known address by recorded delivery. The seven-day claim period
may be problematic if the driver is seriously injured and still receiving medical care.
In the event that the doctor is unable to obtain the necessary details from the driver then an approach may be made to the Chief Constable
who is required to provide the relevant information.
If for any reason the fee is not paid it may be recoverable by court proceedings as if it were a simple contract debt.
CD
17) Prepayment and exemption certificates
On October 1st the PPA will take over formal responsibility for issuing prepayment and exemption certificates from the Health Authorities. All
GPs recently received a letter from the PPA about this and some GPs were concerned that they would be required to return the patients' completed forms to the PPA on a daily basis.
The author of the letter has reassured us that there is no such obligation.
The application forms have been redesigned and supplies will be provided to GPs in due course. In the past some GPs chose to return
completed forms to the Health Authority and may wish to provide a similar service when the PPA take over administration of the scheme.
The PPA will provide prepaid envelopes for those GPs who choose to return the completed forms on behalf of their patients.
If GPs pop any forms into the envelope and into the post on a daily basis the PPA will try to turn applications around within a day or two.
There is, however, no obligation to return forms on the patients' behalf and you may tell your patients to return the form to the PPA themselves.
(There is no provision of prepaid envelopes for the use of patients at this stage.)
CD
Att 1) Counter-signatories for Passport Applications
Q DPA14 - Passport signatures - There is some concern that GPs will be obliged to provide their UK passport number when countersigning
passports in future. What is the current situation? I am worried about confidentiality and feel reluctant to provide this information. What is your view? What reassurances do we have about confidentiality? (29/05/02)
Answer - In view of the proposed changes in data sharing in the public
services many GPs have expressed concerns about the ways in which confidential data is likely to be used in the future. Several GPs have expressed similar concerns about providing their passport number when
countersigning a passport. We contacted the passport office to check out the current situation and received the following reply.
"It is now law to enter your passport number when countersigning. The passport number is obsolete without the supporting documents, i.e. the
passport, birth certificate, etc. You cannot obtain a fraudulent document, without all the pieces of information. The passport number means nothing to anyone except us."
In case you still have concerns about providing this data the following is a list of people who may act as countersignatories for the purposes of
issuing a passport.
- Accountant
- Articled Clerk of a Limited Company
- Assurance Agent of Recognised Company
- Bank/Building Society Official
- Barrister
- Broker
- Chairman/Director of Limited Company
- Chemist
- Chiropodist
- Christian Science Practitioner
- Commissioner of Oaths
- Councillor: Local or County
- Civil Servant (permanent)
- Dentist
- Engineer (with professional Qualifications)
- Fire Service Official
- Funeral Director
- Insurance agent (full time) of a recognised Company
- Journalist
- Justice of the Peace
- Legal Secretary (members and fellows of the Institute of legal secretaries)
- Local Government Officer
- Manager/Personnel Officer (of Limited Company)
- Member of Parliament
- Merchant Navy Officer
- Minister of a recognised religion
- Nurse (SRN and SEN)
- Officer of the armed services (Active or Retired)
- Optician
- Person with Honours (eg OBE MBE etc)
- Person with recognised qualification (eg BSc, PhD etc)
- Photographer (Professional)
- Police Officer
- Post Office Official
- President/Secretary of a recognised organisation
- Salvation Army Officer
- Social Worker
- Solicitor
- Surveyor
- Teacher, Lecturer
- Trade Union Officer
- Travel Agency (Qualified)
- Valuers and auctioneers (fellow and associate members of the incorporated society)
- Warrant officers and Chief Petty Officers
Or persons of similar standing to the above, working or retired, are acceptable as countersignatories.
CD
Key to Contributors
RB = Dr Bob Button, Chief Executive
CD = Dr Christine Dewbury, Medical Secretary
Bulletin - 01/09/02
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