This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

Gold, incentives and meh

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)

  • "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.

    Unsuitable or offensive? Report this comment

  • 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.

    Unsuitable or offensive? Report this comment

  • 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.

    Unsuitable or offensive? Report this comment

  • 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.

    Unsuitable or offensive? Report this comment

  • "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.

    Unsuitable or offensive? Report this comment

  • "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.

    Unsuitable or offensive? Report this comment

  • 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!

    Unsuitable or offensive? Report this comment

  • 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.

    Unsuitable or offensive? Report this comment

  • 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).

    Unsuitable or offensive? Report this comment

  • 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.

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page50 results per page

Have your say