GP Fees and Services

Doctors offer a range of services that may come with fees. While most medical reports fall outside of a GP’s contract, the British Medical Association (BMA) provides guidance on reasonable fees for such work. However, there are certain certificates and services that GPs cannot charge for, including death certificates, stillbirth certificates, and notification of infectious diseases. Additionally, GPs cannot charge for providing evidence of bankruptcy, establishing patients unfit for jury service, and giving professional evidence in court. For more information on GP fees and services, refer to the BMA’s guidelines and the UK government’s Notification of Deaths Regulations.

How to Make a Subject Access Request

Subject Access Requests (SARs) can be made in three ways: electronically, in writing, or verbally. However, before access is granted, the requester’s identity must be verified using reasonable means. This is to ensure that the information is only disclosed to the person who has the right to access it.

If making an electronic request, it is important to ensure that the email or online form used is secure and that the requestor’s identity can be verified. When making a written request, it is recommended to send it via recorded delivery to ensure that it is received and to keep a copy of the request for future reference.

When making a verbal request, it is important to note down the date and time of the call, the name of the person who took the call, and any other relevant details. The requestor’s identity can be verified by asking security questions or requesting identification documents.

Overall, making a Subject Access Request is a straightforward process, but it is important to ensure that the requestor’s identity is verified before access is granted.

Understanding SWOT Analysis

SWOT analysis is a strategic planning tool that helps organisations identify their Strengths, Weaknesses, Opportunities, and Threats. It is a method used to evaluate the internal and external factors that may impact an organisation or plan. The analysis can be used to develop a clear objective and form part of an overall strategic planning programme.

The process involves identifying the strengths and weaknesses of an organisation’s internal factors, such as its resources, capabilities, and culture. It also considers the external factors, such as market trends, competition, and regulatory changes. By identifying these factors, organisations can develop strategies to maximise their strengths, address their weaknesses, take advantage of opportunities, and mitigate threats.

SWOT analysis is widely used in various industries, including healthcare. For instance, in the NHS, it can be used to manage change and improve patient care. In the Better Care Together initiative, a SWOT analysis was conducted to identify the strengths, weaknesses, opportunities, and threats of the healthcare system in Morecambe Bay. This helped the organisation develop a strategic plan to improve patient care and outcomes.

In summary, SWOT analysis is a valuable tool for organisations to evaluate their internal and external factors and develop strategies to achieve their objectives.

GP Obligations for DWP Medical Reports

GPs have a contractual obligation to complete medical reports for the Department for Work and Pensions (DWP) free of charge. This obligation is covered by the contractual arrangements between GPs and the relevant Primary Care Trust. The reports are required for Universal Credit or Employment and Support Allowance on an ESA113 or FRR2 form. The DWP obtains consent from the patient to approach the GP for the report, so there is no need for the GP to seek first-hand consent or a copy of the consent from the patient. The forms should be returned within 5 working days of receipt. It is acceptable for a practice nurse to complete the report, but the GP must authorise it by signing it at the end.

Importance of Secure Information Transmission

It is crucial to ensure that information is transmitted securely, regardless of the method used. This means that sending information via email is acceptable as long as it is secure. When answering questions related to this topic, it is essential to consider the broader principles involved rather than specific referral patterns. It is possible that different regions may have different referral methods, so it is important not to become confused or overwhelmed if the scenario presented doesn’t match your own practice. For example, just because you send referrals by letter doesn’t mean you should choose the option to send the referral by post as well. The key principle is that the method used should be secure. The NHS Code of Practice on Confidentiality provides further guidance on this topic.

Fit Notes and ESA Applications

In an Employment Support Assistance (ESA) application, the DWP may inform the GP that fit notes are no longer required if they believe the patient is fit to work. However, there are certain situations where further fit notes may be necessary. For example, if the patient’s condition worsens, if they develop a new health condition, or if they require evidence for an appeal against the DWP decision. In these cases, the decision to issue further fit notes is at the discretion of the doctor.

If a patient’s condition deteriorates after stopping or changing antidepressants, a further fit note may be considered. However, if their condition remains stable, no further fit notes should be issued. It is important for doctors to use their clinical judgment when deciding whether to issue fit notes, taking into account the patient’s individual circumstances and needs.

First Line Management of Needlestick Injuries

First line management of needlestick injuries involves immediate washing of the affected area under running water. It is important to report all incidents to the occupational health department and undergo a careful risk assessment. If the donor is known to be hepatitis B positive and the victim is non-immune, HBIG is given. However, antiretroviral therapy is only given after counselling if the donor is known to be HIV positive and the exposure is deemed high risk. By following these guidelines, the risk of infection can be minimized and appropriate treatment can be administered.

Death Certification Processes and Referral to the Coroner

The mode of death in a patient must be known before issuing a death certificate. If it is unknown, the case must be referred to the coroner. For instance, if a patient dies after acute onset chest pain, it is impossible to determine if they died of a myocardial infarction, pulmonary embolus, a thoracic aortic dissection, or another pathology.

The Coronavirus Act 2020 introduced temporary changes to death certification processes and cremation forms in England, Wales, and Northern Ireland. However, these changes expired in March 2022. The key changes included the requirement for a certifying doctor to have attended the deceased in their last illness and either seen them in the 28 days prior to death or after death. Video consultations were acceptable methods of ‘seeing’ a person in the last 28 days of their life but not after death.

If a medical practitioner has not attended the deceased in their last illness or not seen them in the 28 days prior to death or after death, they must refer the case to the coroner for discussion to establish if the coroner is content for them to issue a death certificate. Medical practitioners are advised to include the name of the person verifying death if they did not view the deceased themselves, whether a Part 100A has been issued by the coroner, and the names of other practitioners attending and their role on all cremation forms.

Understanding Medical Reports

Medical reports are often requested from doctors by various entities such as government bodies, employers, insurance companies, and patients themselves. However, the need for patient consent varies depending on the type of report being requested. Legal reports that are necessary for patient care, such as child protection reports and mental capacity assessments, do not require patient consent. Similarly, reports that serve the public good, such as notifications of infectious diseases and adverse drug reactions, do not require patient consent either.

On the other hand, reports that provide information on illness as an entitlement or excuse, as well as reports that declare patients fit for sports or occupation, or provide information for actuarial assessments, all require patient consent. It is important for patients to understand the purpose of the report being requested and whether or not their consent is required. By doing so, patients can make informed decisions about their medical information and ensure that their privacy is protected.

Subject Access Requests (SARs) and Patient Rights

A subject access request (SAR) is a request made by a patient or a third party authorized by the patient to access their health records under the GDPR and DPA 2018. It is important to note that a next of kin cannot give or withhold consent for the sharing of information on a patient’s behalf.

Patients with capacity have the right to access their own health records through a SAR, and they may also authorize a third party, such as a solicitor, to do so on their behalf. Competent young people may also seek access to their own records without giving reasons for doing so.

When it comes to children, those aged over 16 years are presumed to be competent and can make or consent to a SAR. In England, Wales, and Northern Ireland, children under 16 must demonstrate sufficient understanding to make or consent to an SAR, while in Scotland, anyone aged 12 or over is legally presumed to have such competence. It is important to explain the issues in a way that is suitable for the child’s age when assessing their competence.

Patients can authorize a solicitor to make a SAR on their behalf, and health professionals releasing information to solicitors acting for their patients should ensure they have the patient’s written consent. Overall, SARs are an important tool for patients to access their health records and exercise their rights.

Guidelines for Removing Patients from a Practice List

Removing a patient from a practice list is a serious decision that should not be taken lightly. The Royal College guidelines provide clear examples of situations that may justify removal, such as unacceptable behavior like violence or deception like stealing from the practice. However, clinical matters like patient choice or critical questioning and complaints do not normally justify removal. It is important to note that removal is never justified based on age, gender, ethnic origin, religion, or sexual orientation.

In exceptional situations where there is an ‘irretrievable breakdown’ in the doctor-patient relationship, a formal process should be agreed upon to try and rectify the problem. It is crucial to give reasons to the patient rather than unilaterally declaring an irretrievable breakdown.

If removal is necessary, the following steps should be taken: give warning to the patient, inform the clinical commissioning group in writing, and write to the patient. It is important to note that the patient’s family should not be automatically removed, although in some cases, it may be necessary.

Overall, removing a patient from a practice list should be a last resort and should only be done in accordance with the Royal College guidelines.

Accessing Medical Reports

Information contained in medical reports can be made available to patients upon request or if they appeal against a benefit entitlement decision. The report should include any relevant medical information, including diagnoses that continue to impact the patient significantly. However, harmful information that could negatively affect the patient’s health should not be disclosed and can be legally withheld by the Department of Work and Pensions. Such information should be clearly marked and managed appropriately.

Data protection legislation requires that information that would only embarrass the author or someone else should not be withheld. It is important to ensure that the report only includes issues that can be substantiated and that inappropriate personal remarks or suspicions of malingering without a firm basis are avoided. Additionally, letters or reports from other healthcare professionals should be included as they provide valuable information.

It is important to observe the Rehabilitation of Offenders Act 1974, which means that the report should not contain any reference to criminal convictions, whether spent or not, unless it is directly relevant to the patient’s condition or disability.

Notifiable Diseases in the UK

Measles, food poisoning, infectious bloody diarrhea, legionnaires’ disease, and severe acute respiratory syndrome (SARS) are among the notifiable diseases in the UK. This means that registered medical practitioners have a statutory duty to report suspected cases to the appropriate authorities. The reporting procedures vary slightly in different parts of the UK, but the general principles are the same. For example, in England and Wales, the GP should fill out a notification certificate immediately on diagnosis and ensure it gets to the officer within three days. The full list of notifiable diseases and reporting procedures is available on Public Health England’s website. While the exact mechanism of reporting may not be tested in the MRCGP AKT exam, it is important to have a general understanding of notifiable diseases in the UK.

Driving and Epilepsy Medication Withdrawal

Individuals who are undergoing withdrawal from anti-epilepsy medication should not drive. This applies for six months after the last dose. If a seizure occurs due to a physician-directed reduction or change in medication, the DVLA regulations require that the driver’s license be revoked for 12 months. However, if the previously effective medication is reinstated for at least six months and the driver remains seizure-free for at least six months, earlier relicensing may be considered. It is important to follow these guidelines to ensure the safety of both the driver and others on the road.

In straightforward cases of death, a medical certificate of cause of death (MCCD) can be completed by the doctor who attended the last illness. Deaths must be registered within 5 days, and if the certifying doctor has not seen the patient within 28 days preceding death, the death must be referred to the coroner. During the Coronavirus pandemic, temporary changes were made to the legislation around completion of MCCD and cremation. Video consultations are acceptable methods of ‘seeing’ a person in the last 28 days of their life but not after death. Doctors are advised to include certain information on all Cremation Forms.

ESA113 Medical Report for Employment and Support Allowance

When a person applies for Employment and Support Allowance (ESA), the Department for Work and Pensions (DWP) may request additional information from the patient’s doctor through an ESA113 medical report. This report is used to determine if the patient is unwell enough to receive ESA benefits.

It is important to note that the doctor is not required to interview or examine the patient in order to complete the report. Instead, they can provide a computer printout of the patient’s medical history, but any unanswered sections on the form must still be completed.

To assist doctors in completing the ESA113 report, the DWP has provided helpful guidance. This ensures that the report is accurate and provides the necessary information to determine the patient’s eligibility for ESA benefits.

Accepting Gifts as a GP: Guidelines and Grey Areas

Accepting gifts from patients or their relatives can be a tricky area for GPs. While there are clear guidelines, there are also grey areas that require careful consideration. Legally, any gift with a value of £100 or more must be registered. Gifts to organizations are generally less contentious than gifts to individuals. Accepting gifts worth less than £50 is usually acceptable, but it’s important to maintain a balance between not offending the patient and avoiding any gift that could affect professional judgment.

NHS England provides practical principles and rules for managing conflicts of interest in the NHS, while the GMC states that doctors must not accept any gift or hospitality that could affect the way they prescribe, treat, or refer patients. If the answer is not clear, it’s advisable to contact a trade union or indemnity provider. Most practices have their own gift policy, so it’s worth asking about this when joining a new practice.

In summary, accepting gifts as a GP requires careful consideration and adherence to guidelines. While there are grey areas, it’s important to maintain professionalism and avoid any gifts that could compromise patient care.

Subject Access Requests for Health Records

A subject access request (SAR) is a request made by a patient or a third party authorized by the patient for access to their health records under the General Data Protection Regulation (GDPR) and Data Protection Act 2018. This right of access applies not only to health records held by NHS bodies but also to those held by private health sectors and health professionals’ private practice records.

Individuals have the right to apply for access to their health records regardless of when they were compiled, subject to certain conditions. In cases where multi-contributory records have joint data controller arrangements, there must be a clearly documented agreement on how data controller responsibilities will be satisfied, including the handling of subject access requests.

Overall, it is important for healthcare providers to understand and comply with the regulations surrounding subject access requests for health records to ensure patient privacy and data protection.

The Caldicott Report: Protecting Patient Confidentiality

The Caldicott Report, published in 1997, focuses on safeguarding the confidentiality of patients and their medical records. It addresses the need for healthcare providers to ensure that patient information is kept secure and only accessed by authorized personnel. The report emphasizes the importance of balancing the need for patient confidentiality with the need for healthcare professionals to have access to relevant information to provide effective care. The Caldicott Report has had a significant impact on healthcare policy and practice in the UK, with its principles now embedded in legislation and guidelines. It serves as a reminder to healthcare providers of their responsibility to protect patient confidentiality and maintain trust in the healthcare system.

DS1500 Form for Terminally Ill Patients

A DS1500 form can be requested by a patient or their representative if the patient is deemed to be terminally ill. This form is specifically designed for patients who have six months or less to live, allowing them to apply for DWP benefits under special rules. In some cases, a representative may request the form if the patient is unaware of their diagnosis and/or prognosis.

The completed DS1500 can either be given to the patient or their representative or can be sent directly to the DWP. MacMillan nurses, nurse specialists, and practice nurses can complete the form, but only GPs and GMC registered consultants may claim a fee. The fee for completing the DS1500 can be claimed by a GP or GMC registered consultant using the DS1500 fee form.

Overall, the DS1500 form is an important tool for terminally ill patients and their families to access the necessary benefits and support during a difficult time.