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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)

  • 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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