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A faulty production line

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...


    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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