Response from Prof Steve Field to Azeem Majeed | 21 February 2014 3:54am Azeem Marjed –
I know that some PCTs did and Area Teams are looking at enhanced service payments to help GP who are having to look after some care homes, these are locally negotiated above GMS, my point remains that this extra funding is above and beyond GMS. I fully understand the system, it is just that we have heard reports of GPs charging for what are GMS service and according to some national bodies representing care homes, GPs have even refused to register some patients in care home if they do not receive addition funds from the care home.
Comment from Prof Steve Field:
'Interesting reading but what I have been saying and with conversations with colleagues from the BMA, is that GPs shouldn’t be charging fees within the GMS. Anything over above that of course they have perfect right to make agreements for and levy a charge if they should so wish (see schedule 5 below I also mentioned it here in the CQC board meeting at 57:18 http://www.youtube.com/watch?v=U_B2D4FmnRk&feature=c4-overview&list=UUP_qU5W_c3jaLkOY0mWrB-w).'
SCHEDULE 5 Regulation 24 FEES AND CHARGES
The contractor may demand or accept a fee or other remuneration—
1. (a) from any statutory body for services rendered for the purposes of that body’s statutory functions;
2. (b) from any body, employer or school for a routine medical examination of persons for whose welfare the body, employer or school is responsible, or an examination of such persons for the purpose of advising the body, employer or school of any administrative action they might take;
3. (c) fortreatmentwhichisnotprimarymedicalservicesorotherwiserequiredtobeprovidedunder the contract and which is given—
1. (i) pursuanttotheprovisionsofsection65oftheAct(accommodationandservicesforprivate patients), or
2. (ii) in a registered nursing home which is not providing services under that Act,
if, in either case, the person administering the treatment is serving on the staV of a hospital providing services under the Act as a specialist providing treatment of the kind the patient requires and if, within 7 days of giving the treatment, the contractor or the person providing the treatment supplies the Primary Care Trust, on a form provided by it for the purpose, with such information about the treatment as it may require;
4. (d) under section 158 of the Road TraYc Act 1988 (payment for emergency treatment of traYc casualties)(a);
Commnet from the CQC:
The consultation published yesterday asks people their views on what the fundamental standards should be for all sectors that CQC regulates. The majority of the rest of consultation focuses on the changes we are introducing in the acute sector.
Over the next two years CQC will review and develop changes to the way it inspects other services, including those who provide GP, out of- hours and dental services. Later this year we will publish a more detailed consultation looking at these sectors and we will work with national stakeholders as well as GPs and practice staff in developing these plans. The CQC is committed to making sure whatever we do works and is appropriate and proportionate for this sector.
CQC clearly will expect service to be responsive to the needs of the local community. However we will not close a practice just because it is not open at all hours that are convenient to patients.
Comment from the CQC: This is from our online Q&A which might help allay some fears:
Q: Will my service be closed if my premises don’t meet the required standard?
A: We know there are concerns about the standard related to the safety and suitability of premises.
We won’t close your service just because you don’t have modern or state-of-the-art premises. We'll only take action if patients are being put at risk by unsafe premises.
If your premises don’t meet this essential standard because, for example, you don’t have the correct disabled access, you need to be managing those risks to patients. We'll ask you to tell us how you're doing that when you fill in your application.
Please find below a response from the CQC that may help clear up some of the confusion:
In assessing applications for registration the Care Quality Commission does not make direct judgement about an individual GP's ' fitness to practice’, that is the responsibility of the GMC. Providers were required to make applications to carry on regulated activities and the Commission is required to assess each one in line with the legislation. The Health and Social Care Act 2008 together with the associated regulations set out ’fitness’ requirements for individual or partner providers. The responsibility is on the applicant to show they satisfy the fitness requirements set out in the regulations, and the Commission would use this to make a judgement about fitness. If additional information is required this too would be requested and taken into account. If a provider, for whatever reason, chooses not to provide information that demonstrates they satisfy the fitness requirements the consequence is likely to be a notice of proposal to refuse registration. A provider has the right to challenge a notice of proposal to refuse registration.
Re Mark Hawking: CQC has done all it can to alert the provider of its intentions including truing up in person to speak to them. Yes I can confirm that the CQC is working very closely with the PCT’s and keeping them informed of the situation and also making sure that any plans that need to be put in place to transfer patient list happens smoothly and that patents are fully informed.
Re: Jeremy Luke comment: Thank you that’s very kind of you to say so. Regarding the notices that have been served it wouldn't be proper to talk about them in detail as they have 28 days to appeal the CQC decision. However I can say that we had concerns that were either raised on their application or from bodies such as they GMC and despite trying to vigorously contact them to talk though these issues (after which we still may have been able to register them) they refused to respond and CQC was left with no choice but to issue the refusal notices.
CQC would have no issues with having or not having electric doors, if people are able to access the surgery I cant imagine that being an issue that an inspector would ever raise!
Comment from the CQC - The CQC does not require any well run and maintained surgery to rip up their carpets, get rid of soft furnishings, rip up skirting boards or do £1,000's of infection control work to their surgeries, this is a myth and one we have been trying very hard to stamp down on.
If you do undertake any minor surgery then clearly the area where that is performed will need to be clean and infection free and proper safeguards and risk assessments will to take place in that area, otherwise the CQC will not be looking for anything else other than your surgery is well maintained and you do basics to keep things clean.
Other question around registration can be found here: http://www.cqc.org.uk/register/what-being-registered-cqc-will-mean#wherecanIfindguidance