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GPs set to face flurry of requests from schools under new legislation

Exclusive GPs could see a spike in requests to provide reports, medical letters or certificates for schools as a result of new legislation, passed without consultation with GP bodies.

The Children and Families Act 2014 - due to come into force in September - places a statutory duty on schools to have formal arrangements in place for pupils with medical conditions, and supporting guidance for schools highlights GPs as an example of a health professional to approach in developing medical arrangements and training staff.

A Department for Education consultation on the guidance reveals that no GP representatives were consulted about the potential impact of the regulation, and the BMA have expressed their ‘disappointment’ that the changes have been so poorly communicated.

The GPC will now write to the DfE to clarify any additional work implications, and have warned that the legislation has the potential to exacerbate problems in the relationship between parents and GPs.

The legislation was highlighted by YORLMCs ltd - Airedale, Bradford, North Yorkshire and the City of Yorkshire – who posted in their newsletter that GPs should not take on any work unpaid following concerns from members.

The legislation states: ‘The appropriate authority for a school to which this section applies must make arrangements for supporting pupils at the school with medical conditions.’

The supporting guidance, which directs schools on how they should interpret the regulations, says: ‘Healthcare professionals, including GPs and paediatricians - should notify the school nurse when a child has been identified as having a medical condition that will require support at school. They may provide advice on developing healthcare plans.’

It adds: ‘School nurses can liaise with lead clinicians locally on appropriate support for the child and associated staff training needs.’

YORLMCS Ltd advise that practices have no statutory obligation to provide supporting information to schools, and where they do so, they are entitled to charge the individual or organisation making the request.

GPC deputy chair Dr Richard Vautrey told Pulse that for GPs their patients’ welfare is the chief concern, but that expectations to provide extra work should not go unresourced.

Dr Vautrey said: ‘GPs have always put children’s welfare at the top of their priorities and regularly work with other professionals in the community to make sure vulnerable children are properly supported.’

‘However, these new arrangements appear to have been poorly communicated to GPs and I suspect many will be unaware that they are coming into force in September. It is disappointing that GP representative bodies were not proactively consulted about these proposals.’

‘While we are keen to improve the care of children, we will be writing to the Department for Education for greater clarity on what work GPs will be expected to undertake and then seek to issue guidance to GPs.’

Dr Robert Morley, chair of the GPC’s contracts and regulation subcommittee, said: ‘It’s always been a problem anyway, with schools asking GPs to police the absences of their pupils from schools, and provide medical certification.‘

‘The old issues apply; firstly, it’s not NHS work, it’s extra-contractual. It takes away appointments from people who genuinely need them for medical reasons. It causes difficult consultations between GPs and patients, if GPs don’t feel it’s appropriate to issue certificates.’

‘And clearly they are chargeable as well, so there’s all sorts of issues and clearly it would seem that this legislation might make the problem worse.’

The DfE was unable to identify any GP bodies consulted in the proposals, and a spokesperson told Pulse: ‘Schools already have a legal duty to support pupils with medical needs and can work with health experts as part of this.’

‘From September, school governing bodies must make arrangements to support pupils with medical conditions and schools will continue to work with healthcare professionals to do this.’

‘It is for schools to decide how they put these arrangements in place, in consultation with health professionals and parents.’

A recent House of Commons work and pensions committee report said that GPs should not be relied upon for providing supporting evidence to benefits appellants, after Pulse found GPs were being asked for evidence to support one third of claims.

Readers' comments (38)

  • Yet another wonderfully thought-through idea!
    It's bad enough some schools have pupils waste GP appts for prescriptions for medicines that are available over the counter, as they refuse to give unless prescribed.
    Absolutely right, if schools want reports, like employers, they need to be paying for them.

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  • 1 - Issue invoice - i would say 140 pounds per care plan.
    If government says not acceptable:
    2 - all patients referred to secondary care (community paeds) to provide the care plan.

    I think the idea will be halted immediately if the taxpayer was paying 150 pounds per care plan.

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  • There is another objection to asking GPs to become responsible for detailing the support children with medical needs have in a school situation: GPs don't on the whole have either training in Occupational Health or education - and have no knowledge of the "workplace" (school) so would not be in a position to advise on the physical and organisational adaptations the school would need to make to accomodate the needs of the individual child.

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  • Now public health is under local authorities they have Doctors on tap who could privide these care plans.

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  • Define core GP work and pay accordingly otherwise bring fee per consult/item/time.This is the only way forward if not GPs are going to be drowned in all this or blackmailed.Cheers.

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  • So when a GP diagnoses a child with a serious or chronic condition that requires additional support at school, you honestly don't think it is part of your 'core contract' to develop a healthcare plan for that child...

    Really...?

    Just exactly whose job is it then..?

    It is clearly a healthcare responsibility and perhaps, if you are not prepared to give advice, you should refer to an appropriate paediatrician.

    This guidance is reasonable and you should either take the clinical responsibility or refer.

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  • "Really...?

    Just exactly whose job is it then..? "

    I doubt you understand the finer points of the GMS contract but yes, it really really isn't our job. And I'm not sure whose job it is - but it not being allocated to anyone else doesn't make it ours by default. Why on earth should we take clinical responsibility for this? It is no more our job than it is yours.

    This, like occupational health, doesn't fall under the NHS remit and the education system should find a way to fund it.

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  • All these arguments will disappear when paid per consultation and time based.Well- you require me to prepare a 10 page care plan-that will be one hour ie £150.I can do 10 care plans a day-thank you!! How many do you want?Want to add more pages to your care plan that will be £50 per page.
    You want a sick, discuss your wart and ingrowing toe nail-3 problems 30 mins £100.Thank you very much.No need to define core work as GPs will want to do these,the problem will be that they will start working more.

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  • For those who read this and feel that the responses are just GPs wanting more money then please think again. For anon 2.47 you do seem quite poorly informed and probably a tad ignorant.

    The issue is time and man power. If we see 40 patients a day. I am sure 10 will be children, 10 will be over 75, several will be at risk of admission all of which are, we are told, in need of a care plan. Each care plan takes at least 30 mins to write so that is an extra 10-12 hours of work produced on top of referrals and incoming mail.

    One of the political promises was of a reduction in paperwork but I see no evidence of a reduction in the relentless and utterly useless paperwork.

    So in response to anon 2.47, when would you like me to write these reports? and please tell who in school with have the time to read them and find them useful? plus provide me with some clear evidence that they help the child in question.

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  • Glad to see professionalism and patient-centred dedication alive and well in the BMA. This is why I stopped paying my subs.

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  • @GP registrar | 11 August 2014 7:00pm



    How's about your do the care plans for the sick children at the same time your children's teachers do their marking and produce their daily lesson plans to get your children a pass in their examinations.

    Here's a hint... teachers (who are professionals) work unpaid in the evenings and at the weekend and on their days off. Either you're a professional or you're not.

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  • This comment has been moderated.

  • to anon 1:110
    give us 12 weeks holiday a year and your on.
    PS they only spend 9 til 3 or 4 at school they don't start 730 am til 7 or 8 pm and in case you hadn't noticed GPs work out of hours shifts evenings weekends and nights as well you know despite the myth to the contrary. The problem is this work is likely likely pointless and time could be better spent

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  • Anonymous | Other healthcare professional | 12 August 2014 1:10am

    As above and when each teacher has 2000 pupils on their list and sees them individually and makes care plans individually. Then ok.
    These are different jobs and with different stresses. Nobody is going to sue a teacher individually for negligence or implied negligence as a care plan was not completed. Ultimately the society will get the professionals they respect and pay accordingly. Respect is not gained by agreeing to be a door mat nor is it appreciated if people think it is their right.

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  • Ok no need for item service or pay based on appointment time. Book 30 min appointments for care plans and all these paperwork soon see waiting lists soar and sick people complaining cannot see their GPs as already happening. One way or the other the sick patient will suffer. Need more GPs to do these care plans- they are not there. Give it to nurses then. Why are they shying away? Well they will not take ultimate responsibility. The problem is taking responsibility and there is as huge cost to it. You cannot measure that cost till something hits the fan and the courts will tell you the cost.

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  • This relentless **** and the attitude of "other healthcare provider" who has absolutely no idea about a GPs life is the reason I have quit.
    I am not alone and will never, ever go back to a partnership.

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  • This comment has been moderated.

  • We should stop whingeing and become more professional like Accountants/ Solicitors/ Dentists etc. Just charge a reasonable fee for items outside our GMS Contract.
    Even GMS should move away from a list based payment system with ever increasing consultations for the same pay, to a fee per appointment system.
    Otherwise, this ever increasing letter culture from bin collection, travel ,school medication and so on will just drown us. My first three consultations on friday were for letters of one type or another.
    The latest catch phrase - see your GP.

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  • "How's about your do the care plans for the sick children at the same time your children's teachers do their marking"

    Other HCP you're not doing yourself any favours.

    Firstly, this just isn't in our job description (the GMS contract) and no matter how much you want it to be, it doesn't mean we have to pick it up because everyone else thinks we're best placed to. It really is you who is ignorant, and no GPregistrar.

    But, humouring you, let's take a look at your somewhat poor comparison. The average teacher has a much shorter working day then the average GP - we remain open from 8am to 6.30pm and this is the time when we are actually seeing patients. This is generally much longer than the time that an average teacher actually teaches. I have no doubt that they work outside of this time in terms of marking etc but so do we. When do you think the letters get read, the results get checked, HR and staff issues get sorted out etc ? Finally, the teachers I know have time for marking in their job plans and so this is accounted for. What you are suggesting is adding unpaid work to an already full job plan. They aren't the same. (I'm not even doing to start on the long summer holiday).

    You also seem to imply that being a professional seems to be defined by doing unpaid work. It doesn't. It is perfectly possible to decline to undertake unpaid work whilst undertaking the work that you are being paid for. A whole raft of professionals manage this and it doesn't diminish their status.

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  • Peter Swinyard

    Am I being a little thick here - or are the school nurses not "ideally placed" to provide these care plans? They are integrated in to the schools and understand the environment and well enough qualified to produce a usable care plan written in language school staff can work with.
    Especially with the current and ongoing recruitment crisis in practices, there are not enough hours in the day to do lots of extra paperwork whether funded or not. Suggesting as some comments have that we should just "be professional" and work into the night does not cut the mustard. More GPs are burning out than ever before and working 12 hour days is not good for the GP or their patients.

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  • GPs are entirely to blame for the lack of respect of the profession.None of the patients understand the amount of work going into repeat scripts/homevisits/blood results etc.The only way is to bring patients back each time for a consult and get a consultation fee.It will inconvenience patients but slowly they will learn that they will have to attend and only by attendance can they get the script or results.Need a letter for the council/bin man/school-no problem it is a new consult and letter writing time included in consult.Want a long letter with examination then longer consult(who pays for this is a decision by the government-the GP will charge but the patient can claim from whichever place they need the letter-no charity letters-only if the GP is a charity worker) Yes there will be need for many more GPs but at least all this unrecognised work will be accounted for.If not make all GPs a salaried service with well defined working hours/home visit time and admin time included then see the true cost of primary care.What people are getting now is not appreciated but the cost is much low this is because GPs are taking high risk personal responsibility with all the scripts which were at one time secondary care responsibilities.The defence orgs know this and hence the year on year higher premiums.Health care professionals are cutting corners as a result of all the pressures.It is not good for doctors and patients.Training nurses or physician assistants seems good on a short term but they will never replace the lateral thinking of an experienced GP.All the best.

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  • You guys need to read carefully before jumping up and down complaining about how stressed you are.

    This guidance refers to long-term and complex conditions that will require additional support at school. Not coughs and colds.

    If a child is diagnosed with type 1 diabetes, or epilepsy, it is completely and entirely reasonable that the doctor in charge of that child's care provides advice (yes, read the guidance) to the school nurse on develoing a care plan. You don't have to actually write the care plan, or give the education, that's the role of the school nurse.

    If you really can't be bothered, I suggest you simply ensure you have referred the child to a pediatrician or other appropriate professional

    Here is the actual guidance, for those too lazy to follow the link.

    "Other healthcare professionals, including GPs and paediatricians - should notify the school nurse when a child has been identified as having a medical condition that will require support at school. They may provide advice on developing healthcare plans. Specialist local health teams may be able to provide support in schools for children with particular conditions (eg asthma, diabetes)."

    Doesn't sound too much to ask does it? Just how many children in this category do you have among your 2000 patients. Iif it was your child, you all know you'd expect and need this level of care and professionalism.

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  • "Doesn't sound too much to ask does it?"

    Actually it does. Perhaps you haven't read or understood what many have written above.

    This is NOT covered by our contract or core duties. If the education service wants this kind of work done, they should pay for it. I'd want an appropriately funded and staffed service if it was my sick child.

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  • 11:42 All I can say is I feel complete despair at your attitude and hope you are not my GP.

    Would you honestly refuse a request from a school, for a child with T1 diabetes, informing them of his or her insulin treatment so that the school nurse can draw up a care plan..?

    If so, you're in the wrong career mate.

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  • As GPs we have made care arrangements with the parents on what the needs are for the child. Do we write care plans for Saturdays and sundays and school holidays? Legistlation will always get interpreted and everyone will cover their backs.

    Standard letter:
    Dear School,
    Care Plan:
    Follow what the parent tells you.
    If child unwell call parent.
    If emergency care needed you are loco parentis, call 999.
    Much Love
    The Doctor.

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  • My niece developed type 1 diabetes a while back. The diabetic nurse specialist liaised with the school nurse about insulin regimes. I have little to do with children with type 1 diabetes other than write the prescriptions and give the flu jab and see whenever required as their care is taken over by secondary care. If we draw up a care plan with specified treatment regimes they will rapidly become out of date as child grows and requirements change. Should be diabetic nurse liaising with school nurse in this circumstance.

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  • "Other health care"

    Of course you are best place to tell GPs what qualities are required to be a GP because....... you are not a GP and have no insight into primary care. Yap, that really makes sense.

    Try and understand this - most of us is writing this from business owner's point, not a pure clinician. As such care plan has NOT demonstrated it's cost effectiveness, dividing resources for the pleasure of education system will take away the already stretched resources for other users of health care system.

    What's that you say? I should sacrifice my personal time for greater good? I already work 50+ hours/week every week (how much do you work?) and demanding a self sacrifice is not a sustainable or reproducible mode of care. It is perhaps you who needs to re-consider your career as what you are suggesting is not a professional commitment more akin to fanatic devote.

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  • "All I can say is I feel complete despair at your attitude and hope you are not my GP. "

    Similarly I feel sorry for your GP. I imagine you want your gym letters / insurance medicals etc all completed for free because they're vaguely healthcare related.

    If the school in question wished to know about a child's insulin requirements I'm sure they'd find it on the prescription or in the discharge paperwork from the hospital. I'm not quite sure why I'd have to give advice or assist in the formation of a care plan. Anyway, work is always easy when you're getting someone else to do it.

    And please don't call me "mate" - I don't think we'd get on as mates as you're obviously the type who thinks it's always someone else's round.

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  • The last thing that should happen here is for the gpc to be involved! They will negotiate some poor fee for this work which hangs around for the next 50 years and end up making the work statutory ! bma recommended fees for dwp work are a joke! Shows how much they value the profession!

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  • It's so sad to see that people still have no idea what the GP is currently doing and the amount of stress paperwork like this is placing on us. Calling work at home a professional obligation is bonkers. We all have paperwork already to take home such as referrals and incoming letters plus keeping up to date with medical training for appraisals all in the name of professionalism. Any new ideas such as this will either eat into my sleep or patient contact as I currently work 13 hours per day.

    The most professional thing when you feel that the amount of work you are expected to do is affecting the safety of your patients is to say no.

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  • Interesting to contrast the impression given to a layman by 'were not doing it, we're not paid for it' and actually being able to explain why you need pay (i.e. if you take on more work, you either need to pay to take on more staff or up hours or to do less of something else).

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  • 1:15 pm hit the nail on the head "most of us is writing this from a business owner's point not a pure clinician"

    All the comments neatly demonstrate how this clouds your judgement, humanity, humility (and probably literacy)! Glad I just get a salary for my job

    But you're all only too happy to drop being 'business owners' when times are hard. See 'at risk practices to be give two year funding reprieve' for an example.

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  • Sorry, your lack of understanding of anything other then being an employee is really showing now. I'm not going to bother writing a reply now as I doubt you've understood a word everyone have said here.

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  • I agree that teachers in this country are paid an appalling wage for the difficult job they do and the extra hours they put in. Like GPs, the are also stressed by top down re-organisation and a target driven culture.

    However, the point that is being missed by other health care provider ( whatever that may be?) is that this is one of many, many requests/demands on our dwindling time. We get paid a fixed amount of money for each patient on our list regardless of how complex their needs are or how frequently they consult. Clinical demand has increased well beyond capacity, let alone administrative demand. Our core contract has not been properly defined so it is easy for any number of organisations to pile on this extra work as we are the dumping ground.

    To you, we may come across as unprofessional and callous but the reality is we wouldn't still be working within an NHS if we didn't care deeply about the work we do within the NHS as there are less stressful ways of living.

    We are literally surviving at present and cannot allow any more work to tip the balance as many more practices will go under and you, my friend, may end up paying for all your healthcare and be even more badly off.

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  • 8:36
    Finally someone prepared to address the elephant in the room..

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  • Looking at both sides of the argument.
    Has anyone thought about those 'unqualified medics' in education that will be expected to translate and decipher the report?? spend unpaid time in meetings with parents, SENCO's, teachers. support assistants? Also they WILL definitely be OFSTED'd over it??
    Complain about extra workload - but it is the staff in education be it the Support Assistant or Teacher, SENCO that will be scrutinised. GPs will simply (with respect) write a report, time consuming yes, but have you thought about what happens next?? and then the 'fallout' of misinterpretation or poor/incorrect support?? How dangerous is that??
    For example a less sever condition like ADHD - common in schools, how on earth would GP recommend the correct support??
    Personally it should be provided if 'required.' NOT be made compulsory.

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  • Completely off track but due to rude 'we are greater than thow' comments here goes.

    "Anonymous | GP Partner | 12 August 2014 1:15pm

    "Other health care"

    Of course you are best place to tell GPs what qualities are required to be a GP because....... you are not a GP and have no insight into primary care. Yap, that really makes sense.

    Try and understand this - most of us is writing this from business owner's point, not a pure clinician. As such care plan has NOT demonstrated it's cost effectiveness, dividing resources for the pleasure of education system will take away the already stretched resources for other users of health care system.

    What's that you say? I should sacrifice my personal time for greater good? I already work 50+ hours/week every week (how much do you work?) and demanding a self sacrifice is not a sustainable or reproducible mode of care. It is perhaps you who needs to re-consider your career as what you are suggesting is not a professional commitment more akin to fanatic devote."

    Oh dear!!
    I wish I could work to a 'business plan'!! I am OFSTED'd ... AND...and at risk of being demoted/dismissed through annual observations. This is crippling and destroys you when you know you get results in achievement (yes evidenced through statistics).

    I went from full time some 60 hours a week (approx 20 at home) to part time - when my family REALLY needed me back. I am now 20 hrs a week (paid) with at least another 10 (this varies depending on 'extra unplanned work load) working at home.
    I may not be a GP but if it wasn't for people like us putting in the hours 'unpaid' your training would suffer!! ;)

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  • When people say 'GP is perfectly placed' it does not mean 'GPs are the most cost effective professional to do'.

    I am perfectly placed to do the typing in my surgery, being the fastest typist, yet I have a comparative advantage in delivering medical care, so that it is better for everyone that I spend my time delivering medical care, and a slower yet cheaper typist does the typing.
    Adam Smith identified this in 1776 and it explains why we are not all subsistence farmers, making our own clothes, houses and pins.
    GPs are often skilled at many things, but the public and politicians need to decide what they want these expensive highly skilled professionals to do.
    With regards to paediatrics, there are specialist nurses who job description makes them 'ideally placed' to help with this process, as well as school nurses who are probably the most 'ideally placed'.

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  • Hospital based nurse specialist clinics - they love writing care plans for their patients. Seems like a marriage made in heaven...

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  • Please will all the anonymous non medical staff take the time to read:
    GMC duties of a Doctor,
    Department of Health contracts for all three types of NHS purchased service
    and most especially the following:-

    http://www.gpcwm.org.uk/wp-content/uploads/file/A-Z%20DOWNLOADS/M%20DOWNLOADS/Making_a_Difference_cabinet_office_march_01.pdf

    Where we hit the root of the problem, that having acknowledged as National government policy not to approach GP's for any information available from other sources we still appear on "wish lists" .
    politicians calculate pester power will produce a result without a fee exchange.
    Which patient clinical need should I neglect to fill in useless paperwork given 24 hours in a day is a fixed constant?

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