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At the heart of general practice since 1960

Patients get used to the out-of-hours changes

Three GPs share their approach to a practice dilemma

A charity wants a 15-page form filled in for free

Case history

You receive a letter from a charity requesting medical information about a patient.

The consent is correct, up to date and satisfies all legal requirements. The report runs to 15 pages and could take up to two hours to complete.

The covering letter states that the charity cannot pay you as it has insufficient funds.

Your patient has a rare disease and this report will help the charity decide if the patient merits a grant to provide him with equipment to make his life more bearable.

Failure to complete the form, according to the covering note, means that the patient could be disadvantaged.

The report must be returned in seven working days. What do you do?

Dr Iain Mclean

'Moral and social blackmail should be exposed'

This is not much of a dilemma. A business that asks for a report to help it make a financial decision must pay. An organisation that refuses to meet the cost of such work and that also indulges in moral and social blackmail should be exposed.

Failure to do so has a number of implications. It is unfair to organisations that do pay for the work they commission.

Different responses from independent contractors will send out mixed messages and cause a general erosion of practice finances. And to respond to such a request is contrary to advice, certainly from our LMC.

The best response here is to do nothing. The charity has obtained consent and has invested time and money in producing a 15-page report. It is likely that both they and the patient will be in touch in the near future. The response at that moment should be: 'Work done by the partners must result in payment to the practice.'

If the charity refuses help to your patient, it is entirely appropriate for you to seek help from NHS sources or patient groups. Remember that requests for health information on patients are often more to do with jobsworths justifying their position than the aims of the charity.

There is also an increased level of ignorance about general practices, which many regard as a public service or part of the NHS.

Work done for free is not acceptable. Bring such requests to the attention of your LMC and the BMA.

Iain Mclean is a GP in Wigtownshire, Scotland

Dr Nigel de Kare Silver

'We use software to create a patient summary with all the information'

Forms, forms, forms. Where would we be without them?

Why should a charity, or anyone else for that matter, bother being thoughtful about our paperwork and try to reduce our workload?

Most forms follow a similar pattern. First a number of fairly sensible questions on basic demographic and contact details. Then a few more about health, debility, care needs, medication and allergies.

And then ­ the other stuff! At this point the form's authors usually appear to look at their form and conclude it is not long enough to be authoritative, not long enough to include those deeply probing questions that make a form a really good form!

So they make up a series of long, difficult questions.

These are there simply for the sake of impressing their colleagues that they have worked hard.

There is no actual point to the questions. Pompous words, phrases and threats decorate the edges of the form. 'Failure to: respond by / complete all sections / be accurate ... will result in the application being delayed or the sufferer not receiving what they are entitled to.' Scary stuff.

It's all just so much bureaucratic window-dressing.

We get round this by using clinical IT to create a document we call the patient summary.

This is stapled to the form and 'please see attached' is stamped on the form. The patient summary contains everything we believe any agency may ever ask for.

This method deals with at least 99 per cent of all paper inquiries, regardless of their origin.

Supplementary information is only provided when it is specifically requested by the querying organisation.

We do not win every battle this way ­ emotive threats will force us to sit and fill a form 'correctly' when pressurised to do so. But we win most of our battles.

Nigel de Kare Silver is a GP in north-west London and a trainer and course organiser

Dr Deborah Hammond

'I would do it ­ you don't often get a form that's this important'

My conscience tells me to just get on and do the report, and do it I would. We're very well paid as professionals and to be able to help a patient with such needs, and support the work this charity does, is important, even if takes some of my free time. However, while I'd want to make sure my patient benefited to the maximum, there are several strategies I would take to ease the burden ­ for myself now, and for other doctors in the future.

For example, contacting the patient might help me with some of the finer points of the form. Indeed the patient might even be able to fill in a lot for me. Speaking to him might also help me find out if there is more we should be doing to support him. Does he need an occupational therapy assessment for equipment he might be able to get on the NHS, for example?

If I could do the report within the allotted time, I would do so. Perhaps I could do a little each day. If I knew I had a lot on that week I would contact the charity and ask for more time: I hardly see how they could say no. I could also see if other doctors at the surgery know the patient too, and we could share the load.

When sending back the form, I would consider enclosing a covering letter, suggesting how they could make the form shorter as some GPs may be put off by having to spend two hours on it.

Two hours is a long time but it's not often we get something of this magnitude. I just hope the patient gets the grant!

Deborah Hammond is a salaried GP, working for City and Hackney PCT ­ she completed the VTS in 2003

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