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At the heart of general practice since 1960

Hep B coincided with my first MS attack

The new Freedom of Information Act opens up GPs to public scrutiny

and if they

don't comply they will get bitten, says

Dr Peter Stott

Yet another set of regulations has been introduced to tie us to the computer screen. And they need to be taken note of. The Freedom of Information Act is described on the NHS FOI website as 'openness with teeth' ­ open because it opens up all public organisations to public scrutiny, and teeth because if you don't comply you will get bitten.

The Freedom of Information (FOI) Act 2000 came fully into force in January. It provides ordinary people with the right to access all types of information held by more than 100,000 public bodies. This includes all GP practices. They now have a legal obligation to publish and share information on their activities.

The Act will allow members of the public to see what information is kept within the practice and to access it. The Act requires that a publication scheme to define what is available should have been in place in every practice by October 2004. The obligation not only falls on GPs. It falls on the Government, police, NHS trust organisations in community and secondary care, dentists, community pharmacists, opticians and optometrists.

Legal implications

FOI allows access to any written or electronic information kept by an organisation whether minutes of meetings, e-mails or letters from patients. E-mails are not exempt simply because they contain embarrassing personal information. So in future, do not mix business with pleasure.

FOI also concerns data collected for the purposes of management, audit, payment or (in our case) the quality and outcome initiative. In future, therefore, it is vital that all minutes and e-mails are written and stored in a professional and coherent way; and it is essential that systems are in place for staff to be able to access the information in a structured format.

We can expect solicitors to request minutes of practice meetings as they explore the practice's policy towards clinical governance, staff training and information systems. Charges of medical negligence and corporate manslaughter may be easier to prove against those practices whose minutes demonstrate lack of judgment.

Data Protection Act

FOI does not change the need for patient confidentiality. Information about an individual covered by the Data Protection Act is exempt. Patients' notes, for example, can only be requested by the patient whose notes they are.

Neither does information need to be released if it would cause significant harm, or would compromise competition or a fair tendering process. However, there is the presumption that the information will be released unless there is a good legal reason not to do so.

In order to get paid, the new GP contract obliges us to provide data to the PCO on the quality of services we deliver. From January this became publicly available data and PCTs have to provide it in their publication plan.

Already one astute businessman has begun to construct a website containing quality data for every practice in the UK. This means league tables for practices are now a reality, and we can expect extreme media attention concerning standards between practices and between PCTs. The implications of this are purely speculative but it is a fair guess that intelligent patients will migrate to practices that declare higher standards.

Practices with low standards will lose patients, lose income and will become less profitable. There is obviously a corollary with hospital league tables and the fear that this data will not reflect the population base of the practice and the difficulties some GPs face.

Declaring practice finances

There is also an obligation to declare practice finances, but no personal financial information need be included. Both the NHS FOI site and the BMA suggest that financial disclosure includes only the yearly total for NHS funding and the yearly total spent on drugs.

The Information Commissioner suggests that to avoid misunderstanding, GPs include a disclaimer to the effect that the total income does not constitute a salary and that business overheads are paid out of this total.

Most practices will already have publication plans in place. In 2004, the BMA published a model publication scheme together with accompanying guidance. Some LMCs were also instrumental in creating them and practices were advised to adopt one of these schemes rather than to develop their own.

GPs must also publicise the availability of information. Several PCOs have assisted their practices by providing standardised information on their websites. The Bebington and West Wirral PCT site is a good example.

Conclusion

The ramifications of this Act are only beginning to be explored. Much will depend upon the public's appetite for information and the media's reaction to it. But with patient participation and consumerisation of the NHS very much on the Government agenda, we can almost certainly expect the first attention to fall upon information allowing comparisons of performance between practices and that which has legal significance.

Access to information

The public will be able to gain access to the information in two ways:

·By asking for it directly

·Through the practice's formal

publication scheme

To comply with the FOI Act, the practice's formal publication scheme should detail:

·The classes (or types) of information that will be published

·The manner in which the information is to be published

·Whether the material is made free of charge or for a fee

·An explanation of the types of information the GP holds but

cannot make available (and why)

The production of a formal publication

plan avoids the danger that the public will request information that is protected by

the Data Protection Act.

Once a practice receives a request for information, this has to be provided within 20 days and in most cases people cannot be charged for the information, except perhaps for photocopying.

The FOI website carries details of the length of time for which data should be preserved.

Resources

Freedom of Information Act 2000: www.hmso.gov.uk/acts/acts2000/00036--d.htm

Information Commissioner: www.informationcommissioner.gov.uk

NHS Freedom of Information website:

www.foi.nhs.uk

Bebington and West Wirral PCT: www.wirralhealth.

org.uk/bwwpct

Department of Health (funding of GP): www.dh.gov.uk/

Home/fs/en

Peter Stott

is a GP in Tadworth, Surrey

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