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Independents' Day

BMA concedes GPs may press parents over vaccinations

BMA ethics guide highlights fears over target pay and other GP dilemmas ­ Cato Pedder reports

There is a 'real risk' that target payments for vaccines and cervical cytology are causing GPs to put patients under undue pressure to consent, the BMA has admitted.

The association said it 'shared concerns' that GPs may be refusing to accept new patients on to their lists who are unlikely to consent to vaccinations or screening.

The fears were set out in a renewed BMA assault on the Government's refusal to agree to informed dissent for childhood vaccine target pay.

Its medical ethics department said: 'The main concern is that doctors may be encouraged to pressure patients to accept the intervention, fail adequately to explain the risks, or perhaps overstate the likely benefits for the individual in order to reach their targets and qualify for the payment.'

The concerns were highlighted in an updated edition of the BMA Medical Ethics

Today handbook, published last week.

A BMA spokesperson said it was impossible to quantify the scale of the problem as a survey had never been done to assess the effect of target payments on GPs' behaviour.

The handbook also suggests GPs may have a moral obligation to tell parents when vaccine uptake in the area has achieved herd immunity.

It asks whether, in such circumstances, GPs 'should inform their patients of the reduced benefits of vaccination ­ or whether doctors' duties to the broader population outweigh the strict observance of truth telling'.

Dr Mary Church, joint chair of GPC Scotland and a member of the BMA medical ethics committee, said: 'GPs would never go down the route of treating people for the money ­ and patients should be told that.'

GPC negotiator Dr Peter Holden said the Government was refusing to budge on informed dissent for vaccines: 'We will keep pressuring but there are more important fish to fry.'

A series of acrimonious partnership disputes has sparked a BMA warning that multi-partner practices should agree rules on issues that fall outside the scope of standard partnership agreements.

Practices should agree guidelines covering GPs' approach to patient care, research involving patients and the availability of chaperones for intimate examinations, urged the new medical ethics handbook.

Practice agreements should also contain agreed mechanisms for addressing a partner's failure to keep their skills up to date or ask for advice when unsure, said the handbook.

'When problems cannot be resolved within the practice, external bodies such as the LMC may need to be involved,' it added.

The Government drive for greater use of repeat dispensing 'must not be allowed to undermine' the quality of care GPs provide, the handbook warns.

It acknowledged a role for repeat dispensing but urged GPs to resist patient pressure for continuous repeat prescriptions without a consultation.

It added: 'In an increasingly consumerist society where individuals are seen as consumers of doctors' services, patients' demands for easy and convenient solutions to their health problems have led to some reluctance to take the time to visit a doctor.'

The handbook also said: 'For those who receive ongoing medication, there is often a feeling that a consultation is an unnecessary obstacle to obtaining their repeat prescription.'

The handbook offers GPs further support in their fight against drug dumping by hospital doctors, telling them they should refuse to take over prescribing of a drug initiated by a specialist if they have any doubts over the treatment or dose recommended.

'Shared prescribing happens quite frequently but both parties need to be happy with the situation. Where there is disagreement that cannot be resolved through discussion, the GP should refuse to participate in a shared prescribing arrangement and explain the reasons to the requesting doctor and the patient.'

The handbook stressed the legal and financial implications of shared-care agreements, pointing out that GPs are often asked to take over the prescribing of very expensive medication.

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