Health bosses have warned GPs they could face medical negligence claims and threatened them with referral to the GMC if they refuse to deliver preventive flu treatment to care home residents as part of their usual contractual work, Pulse has learned.
NHS England South chiefs have warned GPs they should get advice from their medical defence organisation before refusing any request because no enhanced service is in place, in case a patient or relative should take action.
It also emerged that GPC has raised concerns about public health officials have threatening GPs with referral to the GMC if they refuse to comply with the requests to administer bulk Tamiflu prescriptions.
This is despite GP leaders repeatedly advising Public Health England (PHE) and NHS England over the past two years that GPs are not contracted to provide preventative care during flu outbreaks under GMS/PMS essential services, after they found practices were being bullied into prescribing bulk prescriptions at very short notice and without time to carry out the necessary precautionary checks in their patients.
GPC recently wrote again to PHE calling for a halt to the requests until a seven-day, round-the-clock national or local service has been commissioned.
In one case an email from the Head of Primary Care NHS England South, seen by Pulse, advised: ‘Our understanding is that the GP is the responsible clinician for their patients. If they assess the patient and for clinical reasons do not administer antiviral medication they should record in the Patient Record.
‘If they refuse to assess the patient based on non-payment grounds they should also record their decision in case a patient or relative takes an action because the patient suffered as a consequence, when there may have been an element of prevention. GPs may wish to check their position with their Medical Defence Organisation.’
Dr Paul Roblin, chief executive at Berkshire, Buckinghamshire and Oxfordshire LMC, has been leading the campaign to insist public health and NHS managers put in place a proper contract in the same way as in cases of flu, invasive Group A Streptococcus or Hepatitis A or other infectious disease outbreaks.
Dr Roblin told Pulse the email was among ‘what I regard as threats, issued by NHS England, saying if you don’t heed PHE we advise you to contact your defence society’.
The GPC also confirmed to Pulse it has seen evidence of GPs being threatened with GMC referral, although it could not provide details because of concerns around confidentiality.
However, the letter from the GPC, addressed to PHE medical director Professor Paul Cosford, stated: ‘The BMA is continuing to hear of examples where GP practices are being told by local public health officers that they must prescribe oseltamivir to all residents in a care home following a person contracting influenza within that home, in some cases we’ve seen evidence of GPs being threatened with GMC referral if they do not comply.
‘It is unacceptable that these requests continue and that there is still no properly commissioned service to fulfil this work.’
Dr Andrew Green, GPC clinical and prescribing policy lead, told Pulse the GPC has arranged another meeting with NHS and public health chiefs to try to sort out the dispute.
In the meantime, Dr Green advised that ‘to avoid potential difficulties when faced with an acute situation, I would recommend that all practices write to their CCGs making it clear that this is not a service they are in a position to offer, due to the adverse impact that this may have on their care of other patients, and asking them what alternative seven-day commissioning arrangements they propose to arrange’.
PHE said in a statement: ‘PHE’s medical director has been clear in correspondence it is for individual doctors to decide how best to apply the guidance and justify any substantial deviations from it when they treat their patients.
‘PHE also makes an assessment of each outbreak through our local teams in discussion with GPs and other colleagues locally and advises accordingly. We have seen no specific example of GMC referral being suggested for inaction on antiviral use.
‘Arrangements for the administration and commissioning of antivirals is an issue for the NHS and commissioners to resolve. PHE believes, along with many doctors, that we must treat patients first and deal with contractual issues separately.’
NHS England declined to comment but confirmed that it is due to hold a meeting with GPC to discuss the matter.