Can we say no to requests for medicals from a local school?
Our practice has been inundated by requests for medical reports from the local school. How can we put a stop to the demand?
Dr Tony Grewal: The LMC may be able to negotiate with the school authorities
This is a difficult question and the practice will have to balance its professional duty to ensure that schools attended by children with medical conditions have appropriate and necessary information with its duty to other patients who may suffer if the practice is overwhelmed.
The regulations do not help – the GMC requires us to communicate with other professionals and the contract regulations require us to have due regard to all relevant statutes and guidance.
However, the contract regulations also permit us to charge:
‘The contractor may demand or accept a fee
(a) from any statutory body for services rendered for the purposes of that body’s statutory functions;
(b) from any … school for a routine medical examination of persons for whose welfare the … school is responsible, or an examination of such persons for the purpose of advising the … school of any administrative action they might take’.
The practice should take advice from the local medical committee. It may be that the LMC could negotiate with the school authorities a solution which would ensure the safety of children with medical conditions, but avoid the risk of overwhelming practices. Agreeing which conditions (ie ‘requiring support at school’) which might justify information sharing or care planning would be a good first step.
Practices could then search their records and generate initial reports without too much additional work. Schools would need to obtain appropriate consent.
Dr Tony Grewal is a medical director at Londonwide LMCs.
Dr Richard Vautrey: Find out who is requesting the info
In an age when GP practices are under pressure from rising workload and contracting resources it is important GPs manage demand where they can while at the same time ensuring they are fulfilling their duty to protect a child’s welfare.
The BMA has produced guidance aimed at guiding GPs through these new arrangements. Unsurprisingly some of the proposals are already carried out in practice by GPs, such as liaising with schools and other healthcare professionals when necessary. The Department of Education’s guidance suggests that GPs should notify a school nurse about a child with a medical condition that will need managing in a school – bearing in mind patient confidentiality that is covered in more depth in our guidance. The reality of course is that some schools don’t have nurses but the onus is on the school’s governing body, not the practice, to ensure pupils with medical conditions are supported at school.
However, if a school contacts a GP practice directly about a child, GPs should in a collaborative way exercise their professional judgement in dealing with the case. It is not the sole responsibility of one person – and therefore one GP – to manage a child’s condition and GPs should involve other healthcare professionals where appropriate, including those linked to the school. The legislation specifically says that not all children need a healthcare plan and there may be simpler, more straightforward ways of dealing with a child’s condition. What is important is getting the care right, not drawing up needless bureaucratic plans that are produced more for appearance sake than for the good of the patient.
On the complicated area of reports, which are often an intensive process, GPs do need to be clear about who is requesting it. If it is a local authority then it would fall under collaborative arrangements and the NHS England area team would be responsible for payment. Once more it is worth managing this if possible with the school and authority directly to ensure that this kind of report is exactly what is needed to advance the child’s care.
Dr Richard Vautrey is deputy chair of the GPC.
Dr Christine Bradford: Arrange a meeting with the person responsible at the school
GPs may have seen an increase in requests from schools for medical information about child patients because of the Children and Families Act 2014 which came into force on 1 September 2014.
This imposes a statutory duty on the governing bodies of schools to “make arrangements for supporting pupils at the school with medical conditions”.
The aim is to ensure all children with medical conditions are well supported at school and that their wider needs are met. Schools are required to implement a policy for children with medical needs, including creating and updating individual healthcare plans (IHCPs) for some children.
All doctors have an ethical duty to “safeguard and protect the health and well-being of children and young people” and in some cases the advice of the patient’s GP may be key to ensuring that the child is appropriately treated and cared for while at school.
In many cases a school nurse or specialist community nurse may be the most appropriate professional to advise on the needs of the child. However, GPs may need to provide information on the diagnosis, treatment and possible emergency situations to assist the responsible person in creating the IHCP.
If it appears that a particular school in your local area is making unreasonable demands for reports on a large number of child patients, it may be helpful to meet with the person responsible for implementing the policy at the school to discuss the role that GPs are expected to play in providing these reports.
As with any report, it is important to ensure that it is factually accurate and within your area of competence. For example, if the child is being treated for a malignancy, the request for medical information may well be better directed to the relevant oncologist.
You should get consent from the child, depending on their age and maturity and/or the parent’s authority before providing the report. You should also ensure only relevant information is disclosed to the school.
Dr Christine Bradford is a medico-legal adviser at the MDU.