This site is intended for health professionals only

At the heart of general practice since 1960

pulse june2020 80x101px
Read the latest issue online

The waiting game

How to deal with requests for non-contractual work

Dr Fiona Cornish outlines five quick tips on how to say ‘no’.

GPs have the difficult job of trying to be both Mother Teresa and Lord Sugar. Patients don’t understand our funding arrangements, and why should they?

Here are my five tips:

1. Have a poster in your practice explaining that some consultations and reports require a fee because they are outside the GP contract – for instance, reports for exams, fitness to travel, fitness for sporting events.

2. Give a list of these on your website.

3. Give information about private GP services in your area (if there are any).

4. For the new school reports, there seems to be no information about who will pay or how they will be funded. A fee of £150 an hour is reasonable. One option is to refer all such requests to the community paediatricians or the public health service.

5. Be prepared to explain that it is not up to the practice to develop care plans for the pupils, but you would be happy to follow/implement them once they have been written. Suggest that the school might contact the Department for Education for information on protocols for the development of care plans.

Dr Fiona Cornish is a GP in Cambridge and a former chair of the Medical Women’s Federation


Rate this article  (4.8 average user rating)

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Readers' comments (3)

  • Bob Hodges

    6. Explain to people that 'fit for' forms (e.g. for a paracute jumps) are simply 'liability transference exercises' and that the private company is seeking to reduce their liability insurance costs by making the GP pay for the cover. This is one of the reasons why OUR liability insurance costs £6-7k per yea and we are passing the cost back tot he patient.

    Unsuitable or offensive? Report this comment

  • Return requests for blood tests from secondary private care back to the requestor. There is clear BMA joint GPC/Hospital Consultant guidance on not passing this to GPs.

    The incovenience the hospital clinician experiences sorting out the mess of their own creation soon encourages them to simply write the blood form when the patient is in clinic with them.

    Its even worse if the request is from a private hospital "trying to save the patient money" (perhaps the consultant could waive their fee???). This breaches DOH guidance about NHS/Private interface and reminding consultants of this usually embarrasses them into doing things properly.

    Unsuitable or offensive? Report this comment

  • I can recommend ganfyd. Google 'get a note from your doctor'. Brilliant info and template letters on here. Patient happy they have been given something and wording and mention of cost in letter to school/gym/employer I am sure stops most of these rediculous requests going further. Mind you a straightforward no from me yesterday: "can my daughter's school have a letter to get them to encourage her to drink more"! Last week it was something about school applying sunscreen .....never ends.0

    Unsuitable or offensive? Report this comment

Have your say