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Independents' Day

GPs advised to refuse to carry out public health work without a fee attached

GPs have been advised to refuse requests to carry out public health services for which they are not being paid, to enable local representatives to negotiate appropriate fees.

The new advice comes after GPs in Lincolnshire were asked to:

  • administer chicken pox vaccines to the family of a patient who is having cancer treatment;
  • give the hepatitis vaccine to contacts of a patient with hepatitis;
  • prescribe antibiotics for contacts of a patient with suspected meningitis; and
  • prescribe antiviral medications to nursing home residents in a facility where there had been two or more suspected cases of flu.

In response, the BMA’s GP Committee warned that the GMS contract is not a ‘catch all' for 'everything that needs doing in the community' and urged CCGs to ‘commission GPs to carry out these services properly’.

Lincolnshire LMC said in a bulletin to practices that they should refuse all requests where ‘the treatment is preventative’, unless a fee has been agreed.

It said: ‘Practices across Lincolnshire have been asked to carry out various tasks on behalf of public health for which practices are not funded.  

‘The LMC is currently working with public health and CCGs to have an enhanced service commissioned so that practices can be funded for these tasks.’

The LMC added that while GP practices are ‘contracted to see and treat patients who are unwell or believe themselves to be unwell’, it is the role of public health commissioners to ‘prevent illness in patients who do not have an illness’.

The advice concluded: ‘If your practice is asked to perform these sort of activities, please agree a fee before acting. If all practices do this, then the CCGs and public health are more likely to commission an enhanced service.’

This is not the first time Pulse has reported on instances of public health commissioners requesting GPs to carry out work they are not contracted for, including a recent example where a practice was asked to trace all patients who had been in its waiting room at the same time as a patient who was later diagnosed with measles.

Lincolnshire LMC medical director Dr Kieran Sharrock told Pulse that GP practices have experienced ‘an increasing number of requests’ to perform public health activities, suggesting this was related to local authority funding cuts.

He said: ‘The public health departments’ funding has been reduced so much that they are finding it harder and harder to do their statutory roles.’

He added that practices demanding a fee to carry out work on behalf of public health teams had enabled the LMC to ‘engage the CCGs and public health departments to negotiate a services level agreement which will formalise this funding’.

‘This is still in the negotiation phase, and is currently progressing well,’ he said.

GPC clinical and prescribing policy lead Dr Andrew Green said: 'The GMS contract is not a "catch all" for everything that needs doing in the community, and where Public Health England recommends management which is not covered by our contracts it is vital that CCGs commission these properly.

'CCGs cannot assume GPs will be able to do this work, often for large numbers of patients at short notice, not least because arrangements need to be in place for the out-of-hours period when GMS contracts do not operate.'

A Pulse investigation earlier this year revealed that GPs were left to pick up the work after the public health grant for England was cut by almost 10% (£531m) from 2015/16 to 2019/20, in addition to reductions in other funding schemes that feed into public health programmes.

Budget cuts even forced a county council to nearly scrap the local infection control service for GPs, however the plan was rolled back amid risks of 'avoidable disability and death of residents’.

Readers' comments (12)

  • Damn right

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  • In our area a separate service was commissioned to deal with flu in a care home.

    They did a crap job, but at least there was an effort to commission the service.

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  • NHSE asked CCGs to commission this about 2yrs ago....CCG hasn't

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  • As a public health physician, I can understand this reluctance to do unpaid work, but in a specialty that has had massive funding cuts whilst the NHS has had the reverse and do many much unpaid overtime my sympathy is limited, especially when we have to negotiate essential public health intervention with an NHS that seems to increasingly devalue public health. What was the rebirth of public health in LAs and PHE has turned out to be the opposite with exposure to massive governmental cuts. The reality for public health may be 'will the last one out turn the lights off' rather than a flippant comment.

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  • Cobblers

    PHP @11:09. The public and the Government may rue the day that they cut PHE funds as prevention is better and cheaper (in the long run) than cure.

    That being said it doesn't make it a GPs job. So CCGs, let's see the colour of your money before GPs even consider doing it.

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  • i've just worked a duty day, over 10 hours and no break at all. its not that i can't do it but i just don't have time any more. when you are at the point where you have to decide if you have time to take a pee then the system is totally broken. the reduction of funding to PH by local councils was totally predictable - its just history repeating itself. we just have to wait for a major epidemic, 1000s of deaths and then PH will be restored back to the NHS and properly funded. If we survive that is.

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  • Public health physician, emotional blackmail no longer works when colleagues are devalued and have already had numerous pay cuts.

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  • Not bothered the country will reap what the lying tory b'stards have sown at all levels.It needs to hit them in the face.

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  • hitting them in the face = patient harm, better to work out how to account the politicians effectively rather than let anything happen to my people. is this discussion coming up at LMC conference? if so then it must be given full attention. PHP I feel your pain and I fully agree with you. The problem is that we are also maxed out too. we all are. let us work out how we work this out together.

    - anonymous salaried!

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  • Hang on! Loads of this stuff we have done for decades as part of core work. This is NOT new stuff we are being asked to do by public health. Before we start raging against our colleagues in public health let's get the facts straight please because if we start denying patients chemoprophylaxis, vaccinations where there is a medical indication, etc... it harms patients.I am disappointed by this article as all it does is gets us overworked GPs vexed and angry at the wrong folk over the wrong issue!

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