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Practice staff ‘at risk’ from violent patient contract confusion

Exclusive The GPC is ‘seeking urgent resolution’ with NHS England over delays in striking violent patients off GP lists unless practices provide a crime number.

The GPC told Pulse that the requirement, which forms part of NHS England’s contract with its primary care support services provider Capita but clashes with BMA guidance, is ‘putting public safety at risk’.

GPC contracts and regulation lead Dr Robert Morley said problems have persisted nationally since Pulse revealed last year that a practice in East Anglia was kept waiting over two weeks for a patient reported to the violent patient scheme to be removed from its list.

Violent patient allocation, or special allocation, schemes are a zero tolerance measure to protect anyone on practice premises from actual or threatened violence.

BMA guidance says that the threshold is at the practice’s discretion, and although the police must be informed ‘there is no obligation to ask them to pursue the matter’ – meaning a crime number may not be produced.

The guidance says that ‘the removal will take effect from the time the practice phones, sends or delivers notification to the PCO or NHS England’ though practices have to send written confirmation after.

But under the contract between NHS England and Capita the process is more stringent.

The service description says that Primary Care Support England (provided by Capita) ‘shall receive notification from a GP practice by phone of the patient removal and then followed up in an email/letter with a crime number’.

It also requests that practices ‘depending on the site – send/receive a completed violent incident form’;’put a flag on the patient record’; and ‘deduct the patient from the existing GP register immediately and add the patient to SAS list of patients’.

Capita confirmed to Pulse that they will only action requests after receiving a crime number, and said each case was then passed to NHS England to authorise removals.

A spokesperson said: ‘The robust and timely processing of all special allocation scheme requests remains a key priority for us.

‘When a crime reference number has been provided, PCSE processes requests within 24 hours. However, before we can remove a patient from a practice list we need authorisation from NHS England’s regional team.’

They added that NHS England had ‘recently reiterated’ to its area teams how important it was that SAS deductions are processed in a timely manner.

But, despite this, Dr Morley told Pulse that the GPC is ‘certainly hearing of many incidents from across the country where things are going wrong due to both Capita processes and an NHS England policy which does not comply with the regulations’.

He said: ‘There are two areas where NHS England’s policy breaches the regulations, firstly over the requirement to obtain a crime number, and secondly that the policy has a requirement to notify the removal by emailing a notification form…

‘This is a serious issue which is putting public safety at risk [and] GPC is urgently seeking resolution with NHS England.’

An NHS England spokesperson said: ‘There’s a careful balance to strike between patients having continued access to GP services and the protection of practice staff from violent patients.

‘The regulations require that police are contacted following which they will provide an incident number which is distinct from a crime number. We are currently talking to the GP sector to determine the appropriate protocols which should be operated in future.’

The GPC said that following a meeting in December, NHS England said it was ‘developing a common national policy’ which GPC hopes ‘will provide clear guidance’ going forward.

Support services disruption

Practices have been contending with significant disruption to payments, pensions, supplies and patient notes since Capita took over support services in March last year.

At the end of last year, the GPC warned that the service was still a ‘chaotic mess’ but practices have yet to be compensated for the disruption and additional workload they have suffered.

Last month, NHS England pledged that ‘significant improvements’ to general practice support services will be completed by April, as it seeks to return the services it outsourced last year to ‘acceptable’ levels.

But by then practices will have endured more than year of disruption, after Capita took over as NHS England’s national provider of primary care support in September 2015.

The move followed an NHS England cost-cutting drive where it slashed its £100m-a-year support services budget by 40% and has resulted in huge backlogs of patient records movement, delays registering new GPs and missed payments.


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