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Can I charge for flu and travel vaccines and holiday advice?

Some practices appear to charge registered patients who are under 65 a private fee for a flu vaccine. Is this permitted under GMS2? We have always given a private prescription and vaccinated free of charge. Also, some practices appear to be charging for holiday advice. We allocate our nurse for 20 to 30 minutes to give free advice on vaccines and only charge for those immunisations for which we cannot claim under the NHS. Are we now permitted to charge for travel advice under GMS2?

Neither Pulse nor Wessex LMCs can accept any legal liability in respect of the answers given. Readers should seek independent advice before acting on the information concerned.

Do we meet 48-hour target?

Please could you clarify whether we have to offer normal routine appointments of a specific length in order to meet the advanced access requirements? Do emergency appointments on the same day count? Our PCT has told us we must offer a routine 10-minute appointment within 48 hours in order to meet the advanced access target.

We believe your PCT managers are wrong. The Blue book of 'Supporting documentation' in the section of Access to general medical services; Specification for a Directed Enhanced Service April 2003 in relation to 'improved access' does not stipulate that access to a routine appointment of a specified length must be provided on a 48-hour basis in order to

qualify.

Emergency 24-hour appointments with a health professional would certainly count toward the advanced access target.

The Department of Health documentation on 48-hour access indicates that all patients should be seen by a GP within two working days, or by another primary care professional within one working day, if they wish to do so.

Patients may choose to be seen outside the 48-hour target if that suits them better. This could include waiting longer for a normal appointment, with their preferred GP at a time that is more convenient both for the patients and for the doctor. Appointments systems should allow for this.

Section 4 of the Q&O framework provides the details relating to length of appointments in relation to patient experience. If you offer too many 'routine' appointments on a '48-hour' basis that do not conform to Q&O recommendations on consultation length, then your Q&O targets in this area may be more difficult to achieve.

Dr Christine Dewbury, Wessex LMCs

Neither Pulse nor Wessex LMCs can accept any legal liability in respect of the answers given. Readers should seek independent advice before acting on the information concerned.

Must we disclose dead patient's notes to the police?

A patient has been found dead and the police have started a major criminal investigation. They have asked for the patient's medical records. What should we do?

Provided there is no data in the notes that was given on the absolute understanding that it would never be disclosed under any circumstances, we believe you would be permitted to provide sufficient data from the records to assist the police with this legitimate and serious criminal investigation.

The Access to Health Records Act rather than the Data Protection Act in fact applies to the medical records notes of a deceased person and we were unable to find any specific evidence to support disclosure for this purpose under this law. But the Information Commissioner's Office was confident that disclosure would be permissible in these circumstances. In general you should always clarify what is the legal basis for the provision of the data.

BMA guidance on confidentiality and disclosure of health information ­ October 14, 1999 ­ sets out those situations where there may be a legal obligation to disclose the minimum information necessary to serve the purpose of the investigations. This would generally involve a court or coroner's order requiring disclosure.

The GMC says disclosures without consent may be justifiable in the public interest and where failure to do so may expose the patient or others to risk of death or serious harm. It sets out that in this situation you should disclose information promptly to an appropriate person or authority for the purpose of prevention, detection or prosecution of a serious crime, especially crimes against the person, such as abuse of children. The data should be limited to the minimum necessary for the purpose.

Section 115 of the crime and disorder Act 1998 sets out with regard to disclosure of information that any person who, apart from this subsection, would not have power to disclose information:

· to a relevant authority

· to a person acting on behalf of such an authority

shall have power to do so in any case where the disclosure is necessary or expedient for the purposes of any provision of this Act.

Although this provision allows for disclosure, it does not in fact require it. The GP retains control over the disclosure and it must only be made with due regard to all the relevant legal and professional constraints.

If there is any doubt about the disclosure of data you should always seek specific advice from your medical defence organisation before disclosure.

Dr Christine Dewbury, Wessex LMCs

Neither Pulse nor Wessex LMCs can accept any legal liability in respect of the answers given. Readers should seek independent advice before acting on the information concerned.

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