Dear Patient,
You will likely be aware that there is increasing pressure on general practice, with us being asked to do more with less. There are clear agreements set out to govern the responsibility of specialist doctors and other healthcare teams, but, unfortunately, there is still a significant push of their responsibility onto us. We simply do not have the capacity to do their work for them, and so we must decline. It is also usually better for patient safety and continuity of care that they do the work they are responsible for.
The local statistics show that there are 12 clinicians (doctors and nurses, etc.) in Oxford University Hospitals for every 1 in general practice. They have 7 patients per clinic compared to our 14. 19% of patients contact their GP practice every WEEK whereas 25% of patients are referred to the hospital every YEAR. General Practice accounts for about 5% of the NHS budget. We receive about £107.57 per year or about 30 pence per day for every patient registered with us.
Investigations:
Any tests ordered are the responsibility of the clinician who does them, regardless of who has advised them; our team will generally not organise tests on behalf of other clinicians nor interpret privately ordered tests. It is also safer for you, as the results will go directly to the person who requested them to interpret and reduce delays in response. We have an agreement that we will do some hospital blood tests IF they provide the labels to the patient. This ensures the results go directly to the person requesting them.
There is a principle of separation between the NHS and private care; the NHS should never subsidise a private service (for example, ordering tests on their behalf or doing administrative work). We will only do for private patients what we would do for NHS patients up until the point of referral. After referral, the private provider must conduct all further investigations as they have taken over this ‘episode of care’.
Prescriptions:
All doctors and some other health care professionals can prescribe, it is not our role to do this for them. A clinician is responsible for any prescription they generate regardless of who advised it. We will take on long-term (repeat) prescriptions based on their appropriateness and whether we are permitted based on a local formulary. There are complex rules regarding this. If we do this, then we are taking responsibility for prescribing. As such, we need time to review whether any prescription requested is appropriate for us to continue to prescribe. Urgent prescriptions should be given to you directly from the clinician you have seen. One-off (acute) prescriptions should be provided by the clinician who has recommended them. Some prescriptions must be issued by a specialist.
Referrals:
NHS clinicians can refer you on to another service if it is for the same issue or, if they determine an urgent referral is required for a different problem (e.g., to rule out cancer), or if it is part of a recognised pathway. Private providers can refer you directly to the relevant team in the NHS (including their own clinic) if you request your care to be transferred back and if it is for the same issue, if they determine an urgent referral is required for a different issue (e.g., to rule out cancer), or if it is part of a recognised pathway.
It is inappropriate for them to ask us to do this work for them, and it disadvantages you as a patient by putting you at the back of the queue. They have seen and assessed you and should write the referral. Access to an online referral system or proforma is not mandatory, and a simple letter or email is sufficient.
Sick/Fit notes:
According to the Department of Work & Pensions: “It is important that the healthcare professional responsible for the episode of care is the one who issues the fit note”. This means that the hospital specialist or surgeon should be the one to issue your fit note ‘for a period consistent with the anticipated incapacity’. Please ask the clinician who has most recently assessed you to comply with the guidance. A link to a reference guide for them is here:
Quick Reference Guide for Healthcare Professionals on Completing a Fit Note
As you will note, pharmacists, nurses, occupational therapists and physiotherapists can also provide these notes. It is inappropriate to ask a GP who has not recently seen you to provide a fit note.
If your specialist sends us a letter with an inappropriate request we will respond to them. Please feel free to share this document with them and signpost them to BBOLMC Interface for further information.
Deddington Health Centre