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GPs may have to assess mental health and mental capacity free of charge

A change in legislation could see GPs provide medical assessments for vulnerable patients with mental illness without remuneration, experts have warned. 

Under a new law introduced from 1 October 2020, the Government has said that in cases where there is no valid medical or capacity assessment of certain mentally ill patients in care homes or hospital settings, including dementia sufferers, 'we would expect this to be arranged through a person’s GP'.

There would be no extra payment to GPs because 'valid diagnoses is something a person needs as part of their care and we would expect GPs to provide this', the Government's impact assessment states.

These assessments now extend to people in the 'community', meaning that potentially hundreds of thousands more patients will need medical assessments.

It is unclear as yet whether GPs will have to provide these assessments themselves, but GPs and legal experts fear that this may be expected under the new legislation, which will create a large burden of work on GPs.

Earlier this year, the Government announced its intention to replace the Deprivation of Liberty Safeguards (DoLS) with the Liberty Protection Safeguards (LPS) from 1 October 2020.

The DoLS - contained in the Mental Capacity Act 2005 - allow hospital or care home patients suffering a mental health disorder and who are not in a position to make decisions about their care and treatment arrangements to be deprived of their liberty. 

A best interests assessor and a mental health assessor are responsible for assessing whether deprivation of liberty is needed for them. 

The Government has argued that the DoLS is 'complex, overly-bureaucratic and fails to provide safeguards for deprivations of liberty is certain settings'.

Instead, it has proposed to replace it with the LPS, removing the role of the mental health assessor and using existing medical evidence provided by GPs. 

The DHSE's impact assessment said: 'The government introduced an amendment to the Bill which means assessments cannot be carried out by someone who has a prescribed connection to the care home. This means assessments cannot be completed by care home staff. In many cases there will already be valid assessments in place which have been completed as part of a person’s care planning but in other cases a new assessment will need to be arranged.

'If there is not a valid medical or capacity assessment available, we would expect this to be arranged through a person’s GP. We would not consider this to be a new cost as having valid diagnoses is something a person needs as part of their care and we would expect GPs to provide this.'

According to Aasya Mughal, barrister and director of training provider Edge Training, an assessor currently receives between £150 to £400 for each assessment they perform.

Ms Mughal said with no funding attached GPs may bear the brunt of the legislative change. 

She said: 'At present, GPs are sometimes asked for their assistance with community deprivation of liberty cases, which means providing evidence to the Court of Protection.

'However, these cases are far fewer than the number of people expected to be under the new law, which the government predicts to be around 300,000 people. If there is no existing expert evidence of a mental disorder that can be relied upon, the Government is clearly directing professionals to go to a GP at zero cost to the responsible body.'

GPs have also told Ms Mughal that they do not feel being best placed to diagnose mental disorders in this setting.

She said: 'Some GPs we have spoken to feel ill-equipped to assess and diagnose mental disorder for the purpose of a deprivation of liberty. We are concerned that vulnerable people will be left without a proper assessment of their mental health which would stand up in court, falling short of the required human rights protections they are entitled to and the rest of us receive.'

Echoing her comments, North East London GP Dr Shahid Dadabhoy said: 'Protecting the liberty of the vulnerable in our society is and always will be cost-intensive and resource-heavy task. How we safeguard the liberties of those who cannot speak for themselves is a reflection of who we are.

'By stealth, the Government has decided to, completely un-resourced, unremunerated and with no training offered to general practitioners, burdened primary care with this enormous duty.

'Colleagues who look after the most vulnerable in our society as GPs will bear the brunt of this. What trained specialist assessors have done for a decade or more is being laid in the hands of wholly unprepared GPs.'

A DHSC spokesperson said: 'Under the LPS scheme, responsible bodies and care home managers are required to arrange all three assessments needed for authorisations, including medical and mental capacity assessments.

'We are working closely with stakeholders to update the impact assessment and will publish in due course.'

Readers' comments (33)

  • More unfunded, bureaucracy-laden work being dumped unceremoniously on GPs desks.....it is barely news any longer!

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  • Do not challenge this - do not look for funding - GMC advice is clear you have to be competent - GPs are unlikely to be so and therefore this will need be passed to those that can.

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  • Another thought - I cant see capacity assessment for LPS is a diagnosis or an illness as GPs only required to manage them if ill in a manner they determine

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  • Not trained so can’t do, ...refer to those who can.

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  • Mental capacity is about disability or impairment, not about diagnosis.

    For example two people have a diagnsosis of dementia, one has mental capacity, the other does not.

    Therefore the government's position is incorrect.

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  • oh Dear. DO we need any more evidence that payment per activity or fee for service is the only way forward. The work dump due to capitation knows no bounds. A mixed model between capitaion and payment per activity perhaps

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  • Surely this sort of mental health assessment is no different to Mental Health Act Section 2 or 3 assessments, where patients may be detained without consent. Those should be done by Section 12.2 approved doctors, who certainly do not do them for nothing or with no regular ongoing training. This needs to be knocked back to people that are properly rained, not dumped!

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  • and of course the BMA will be all for this as it chimes with their 'save the NHS' at all costs policy

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  • payment by activity is a pain in the arse of course doing the billing. its a shame the govenment cant just be fair about things and when asking more work to be done offer fair remuneration for it as said 150 to 400 pounds per assessment is the current fee as its probably quite time consuming.

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  • I decline to do these already because I'm not trained to do them. This will not change my practice.

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  • assuming there will be any GPs left to do them - do not do as a locum as not part of my contracted duties. this will backfire, end up with the PCNs and CCG who will end up paying for it and thus cut services elsewhere to fund it. Backdoor health cuts by the government - shameful

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  • And the RCGP said????????

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  • Who the duck advised the government that a diagnosis is the same as a mental capacity assessment - someone on secondment from the Brexit team??!!!

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  • "In other news: NHSE still unable to explain why GPs continue to leave the profession"

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  • David Banner

    General Practitioner
    The clue’s in the name.
    We’re generalists, not specialists.
    We’re not Psychiatrists.
    We will pass this work for which we are not qualified nor trained to those who are.

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  • WE ARE NOT QUALIFIED TO DO THIS.Do you think the head of the learning difficulties dept in NHSE qualified from a special school as part of the equality and diversity agenda.

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  • Those who recommend it, should have mental health assessment first

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  • You do know that all health care providers should be able to assess a persons capacity?
    Seems like a lot of GPs need to update.
    But agreed this is another major kicking for GPs

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  • To assess capacity, where as a matter of fact, it will vary day to day, you are asking the GP to take on risk without payment. This is not about diagnosis. It’s not about a one off assessment either. It’s nonsense. Refer psychiatry

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  • Diagnosis is not equivalent to impact assessment, As a GP diagnosing Angina does not make me responsible for the impact of that nor any therapeutic decisions made. Full assessment by the cardiologist covers this. Thus an assessment needs to be carried out by someone capable of performing such a multidimensional assessment.

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  • Capacity is assessed at the time of any procedure and is specific to that time and procedure. So no I will not be doing them on another's behest.

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  • Vinci Ho

    So , if we don’t do it , we all break the law ?
    So what , our prime minister loves to break the law , anyway .
    My two fingers are up 👿😈

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  • I will refer to all of them to psychiatry. Where is the BMA and RCGP on this? I think it is time we go the dentists way. Free only leads to more abuse.

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  • I think most GPs will agree they all feel rather vulnerable these days.
    Hit from all angles. Complaints, income going down, pension, Gross Negligence Manslaughter, CQC, GMC, NHSE, CCG, QoF, legal obligations, GDPR, PCNs, deprivation of liberty acts etc.
    We become doctors to treat disease, we are not social workers or lawyers. I wonder who would want to work in the UK these days.

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  • Dear All,
    Oh dear what a half brained assessment, and these people are supposed to be setting us systems to protect the vulnerable, what a farce! Nursing home staff can't do it, they are conflicted, obviously. So we'll get the GP to do it, probably the very same person who will be asked to prescribe the DOLS enacting medication, and of course the patients personal medical advocate, so no conflict there then!
    The GP cannot possibly do, they are hopelessly conflicted. Another GP can do it, but hey ho that will be non NHS so under GMS they can't do private stuff, so no that GP can't do it either. Looks like they've manoeuvred themselves into a situation where in fact no GPs can do this. Silver linings at last.
    Regards
    Paul C

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  • What's the mantra?
    No new work without new money

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  • Hardly news - no one else can be bothered to do it - oh I know let's dump it on GPs and make them drown in this too. Also, anyone else want to bet this isn't a core service covered medicolegally by the government's so called indemnity scheme if someone tries to disagree with any decisions made for this by a GP and a complaint about it gets made against us?! Have to say the billing of this would be my last concern and more a concern with the above!

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  • Agree with Vince ho!
    If we all refuse to do this work what can be done about it?
    NOTHING!
    Government functions only by consent, if there us no consent then I don’t think we could all be punished into doing this work...:..

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  • As a GP, I must provide all care to patients: including repair of minor wounds, which I cab suture myself, and hernia repairs, which I refer to a Surgeon;
    and including Capacity assessments, which I do myself for consent to suturing minor wounds, and which I refer to a specialist for general issues, such as DOLS and force-feeding!
    No problem

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  • In a system at breaking point, piling on more stuff is not sensible. Complex specilaisted stuff even less so. Policy makers are demonstrating how poor is their grasp of how things work and what's going on!

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  • Free of Charge is a FOC
    as in Off

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  • Just had a chat with a nitwit who wrote that BMA has agreed that GPs cannot charge even postal expenses for sending copies of notes. Ended up inviting him to collect and he reluctantly agreed to send a courier - the admin charge would have have been peanuts, but then, education doesn't give you intelligence - esp if you pop who is a lord paid for it!

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  • How easy it to say “ you do it for free “. Profession will grumble but every one else is happy so nothing will be done

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