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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’.


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