Don't abandon overseas doctors
Important changes have been made to the way insurance reports must be be completed all GPs should know about them, says Dr Simon Bradley
Dr Simon Bradley
GPs now receive £65 for each insurance report they complete for a life insurance company.
What many GPs may not know is that the consent procedure and content requirements of these reports have changed. This follows an agreement made between the Association of British Insurers (ABI) and the BMA in October 2003.
All reports should now conform to this new standard (September 30, 2004, was the deadline for compliance).
Another change that may have escaped the notice of many practices is the launch of a free service for GPs to receive requests and return the completed general practitioner report (GPR) electronically, speeding and simplifying the tedious manual processes it replaces.
GPs who manually fill in and return paper GPRs sent to them by an insurance company are unlikely to breach BMA guidance, provided they answer the questions on the form. But the 60 per cent-plus practices that produce GPRs directly from their clinical computer system risk breaching patient consent
and therefore confidentiality if they do not use an updated GPR proforma.
So the first question the majority of GPs need to ask when they receive an insurance request is has their GP system supplier updated their GPR tool and if so, is their practice using it?
If the answer is no to either of these questions then you should go back to using the paper form until the updated report generator is available.
Alternatively you should carefully edit out all the problem information.
The new GP contract and the associated Q&O targets mean that practices are routinely collecting and recording clinical information about patients exactly the information insurance companies need when assessing risk before issuing policies.
Practices are required by the new BMA/ABI agreement to document and submit this information on GPRs, whether paper or electronic. The collection of Q&O data, therefore, is an increasing burden on those GPs who continue to use the paper GPR form as they will have more and more data to enter manually.
For the past four years the eGPR project has been specifying and developing a secure system. This is designed to meet both insurance industry and BMA requirements for the secure request and return of GPRs electronically 'eGPRs'.
Fortunately, all the leading clinical system suppliers have been working hard on producing eGPR generators that comply with the new requirements and can return the report electronically.
How does it work?
The process is quite simple. The practice registers for eGPR at www.egpr.co.uk, and enters its preferred e-mail address. This address should be the one on which it wishes to receive eGPR requests.
It can be one address for the practice or individual ones for each GP.
These details will not be disclosed outside eGPR without the user's consent.
The practice then waits for an eGPR request e-mail. When this arrives the practice is asked to log on to the eGPR website.
There is no patient identifiable information in this or any other
e-mail communication with eGPR.
The practice logs on to eGPR through a secure connection that uses SSL technology (note the https at the start of address which donates the secure site, and the padlock in the status bar). This conforms to the NHS and BMA security requirements.
The practice can then view the report request, and must view the image of the signed patient's consent form known as an AMRA, before it can move on to uploading the patient's report to the website.
The next step is to use your clinical system's report generator to produce a report.
A member of administration team can do everything up to and including this point of producing the report.
The final check
The report, however, must be viewed by the GP and checked that it includes all the required information and no inappropriate information before it is uploaded to the eGPR website.
In some practices checking the report may be delegated to another trained member of the clinical team such as a practice nurse before final sign-off by the GP. The GP then can log on to upload the report or pass this to a member of clerical staff.
Having the report in electronic form allows it to be routed through the practice at the touch of a button.
This can mean that the only effort required by the GP is to check an already produced and refined report.
All other actions required in the production and submission of a report may be delegated to other members of the practice team.
For those GPs who do not like using the computer it is just as simple to print off a report containing all the required information from the clinical system.
The GP can check and amend a printed copy which can be posted back to the requesting insurance company.
This allows a practice to have a mixed environment for the production of electronic general practitioner reports for insurance companies that supports individual GPs' computer friendliness and ways of working.
There are clear benefits for patients from the use of eGPRs. Life and other insurance protection policies are usually required to support significant times in our patients' lives buying a house, moving employment or the need to support a new dependant such as the birth of a child.
Our patients are often in a hurry to get a decision, yet on average it takes around three weeks for the insurance company to get information back from the GP.
This delay has been more than halved by the use of eGPR. Some reports have been returned in just a few hours. This both improves the service for our patients and improves cash-flow for GPs.
In these days of Choose and Book and the National Care Record Service where technological demands seem to eat into GP time, eGPR is that rare innovation one that reduces the time the GPs spend on administration while maximising their financial return.
Simon Bradley is a GP in Bristol
Key changes from September 2004
The following should not be disclosed
·Lifestyle information (unless designated 'Conditions related to drug or alcohol misuse or smoking or chewing tobacco' ie, if the patient has been warned that they have a disease that is specifically due to their lifestyle or they have been specifically warned that they must reduce/stop drug abuse/drinking/smoking).
·Negative HIV, hepatitis B or hepatitis C test results.
·Instances of sexually transmitted disease without long- term health implications.
·Genetic test results which are unfavourable for the patient.
·Information about third parties which was not supplied by the patient.
BMA and ABI guidance on content
The Association of British Insurers
Good Practice Guidelines on General Practitioner Reports