Newsletter October 2001North
Staffs Hospital Centre Development Patient
Confidentiality and Reports for the Benefits Agency Access to Medical RecordsThe fee which practices may charge for access to medical records was due to change on 24 October. The BMA has negotiated for a continuation of the current fee structure for the time being. According to the DoH “the issue has been to strike a balance between ensuring that cost is not a barrier to individuals requesting access to their health records and allowing the NHS to recoup costsincurred in servicing requests, so that essential resources are not diverted from providing direct patient care. This is a difficult balance to strike, but a Department of Health led review of the current charges established that the present arrangement provides an acceptable compromise given current technology and record keeping practice”. Discussions will be continuing on a long-term solution. Hepatitis B VaccinationI note that the Police are now asking potential recruits to request Hepatitis B vaccination from their GPs, other organisations are also using this practice. I have written to the Police concerning this and received a reply which states that they have a duty under the Health & Safety at Work Act to advise that prospective applicants should start the Hepatitis B course prior to joining and taking up operational duties. They state that they will take over this responsibility and provide the vaccine once a person becomes a Police Officer. However, under the Act, the employer should carry out a COSSH assessment of risk and if they deem that there is a risk, the employer has a duty under the law to protect the employee. They cannot transfer that duty to the NHS. Hepatitis B immunisation is an area of great confusion. The recently issued guidance from the GPC suggests that we can refuse on the basis that we are not competent to carry out an occupational health risk assessment. However, if we refuse to immunise a patient who then goes on to contract the disease, we risk legal action. This has not been tested in court. As a rule of thumb, I tend to immunise if a patient asks personally, but refuse if the employer makes the request. In either event we are not allowed to charge either for providing the vaccine or administering. We may charge the employer a fee for providing a certificate which indicates that the patient has been immunised and has/has not seroconverted. However, the employer has to request the certificate and agree to pay. I have taken this issue up with both the Police and Keele University, who are asking student midwives to attend their GP for immunisation. With extremely limited NHS resource we should argue that this service should not be provided out of the NHS budget, however, I am also sure that none of us would wish to risk being sued for not providing a patient with an immunisation he requires. Flu VaccineThis campaign is now well under way. The GPC have been successful in negotiating an Item of Service fee for patients aged 65 and over. Unfortunately they have not been successful (in England) in negotiating a fee for younger patients who fall within at-risk groups. This has been left to local negotiation. GPs in Wales and Northern Ireland will receive an Item of Service payment for these patients. The GPC did produce an LDS which suggested a fee of £6.55, but this was rejected by North Staffs Health Authority. The success of local negotiation has been variable throughout the country. North Staffs has produced a scheme which will pay £2.00 per patient. A number of Health Authorities have refused to pay any fee at all claiming lack of resource. No wonder the Government is so keen on local negotiation. Where is all the investment in primary care? The LMC has reluctantly approved the LDS for this payment. They felt that the same Item of Service fee should apply to both over 65 and at risk groups. They were disappointed that the scheme was circulated to GPs before being presented to the LMC for approval. We will be pressing for an improved scheme next year. The Committee feels that it is up to individual practices to decide whether they feel the fees provided are adequate for them to take part in the scheme. A & E Discharge LettersThe Committee has been concerned for a long time about the quality of discharge letters received from the A & E Department and is currently taking this up in various quarters. Mr Ivan Phair, Consultant in A & E Medicine would like to receive copies of any letters which GPs consider to be inadequate so that he may take this up with the clinician involved. Violent PatientsColleagues are reminded that if they remove a patient because of violent and aggressive behaviour, this information needs to be passed on to the Health Authority to enable the Health Authority to inform any practice to which this patient is allocated, of the relevant history. Unfortunately, if a patient gains voluntary acceptance at a practice, there is currently no mechanism that ensures that this information is passed on apart from perhaps recording the incident in the medical records and ensuring it is passed back to the Health Authority as soon as possible so that it can be readily available for the new practice.
North Staffs Hospital Centre Development
Dr Simon Elsdon has been appointed as Director of Primary & Intermediate Care, to work with the Health Authority and Acute Trust on the “Fit for the Future” scheme which will see the building of a new hospital on the City General Site. He also will be liaising closely with the LMC on the development and its effects on general practice. We are particularly concerned about the introduction of “intermediate care” beds. It will probably be expected that these will be looked after by general practitioners. We need to ensure that these are adequately resourced and that appropriate training and support will be given to any doctor who wishes to take this work on. The committee is looking at ways of working with Simon to ensure that he is well informed of our opinion and given our support in his work. Local Incentive SchemesFollowing the announcement of a £50m fund nationally to fund local incentive schemes in general practice, PCTs/PCGs have drawn up a variety of schemes to distribute the money locally. Ideally these should have been discussed with the LMC before their implementation. Some comments have been made that the LMC has been obstructive in their views on these schemes, however, where we have raised concerns, it is over the legality of the mechanism of payments. We are extremely keen that more resource should find its way into general practice, but there are legal limitations on the way money can be paid to GPs and some of these schemes appear to fall outside these limits. We would not be thanked by anyone if we approved schemes which fall outside these limitations and where money is subsequently clawed back following a visit by the PCT/PCG auditors. A further problem has been that the rate of remuneration for some schemes has fallen way below that the committee considers adequate and the scheme, is therefore rejected on the basis that to do otherwise would set a dangerous precedent.
Patient Confidentiality and Reports for the Benefits
Agency
There is a growing trend for GPs to send computer-generated printouts of a patient’s medical record when responding to a request from the Benefits Agency for information. GPs should only release medical data that is relevant to the particular benefit claim, as disclosing information that is irrelevant is likely to be a breach of patient confidentiality. GPs should, therefore, carefully consider the data contained in computer-generated printouts of a patient’s medical record prior to disclosing. Further information on access to health records and the Data Protection Act 1998 can be found on the BMA website (www.bma.org.uk). DR PAUL GOLIK |