To all GPs and Practice Managers
Dear colleagues
We are aware that practices are repeatedly getting requests from Birmingham City Council to provide a whole host of services relating to the council’s responsibility across all areas inthe fields of Education, Social Services and Public Health. These include, for example, reports in child protection cases, fostering and adoption medicals, mental health act assessmentsand many other areas falling within the council’s remit. None of these services are obligatory for GPs to provide under their contracts, but if GPs do provide them, there is provision under the NHS Act for them to be paid under what are known as “collaborative arrangements”, and it is the GP’sPCT, not the council, which has an obligation to make these payments should a GP carry out one of these services at the request of the council.
Whilst Social Workers in child protection and involved in Mental Health Section assessments are generally aware of these arrangements, it remains clear that, despite the best endeavours of the LMC, most other council officers are not. The typical response when a GP makes a request for payment is that the council “does not have a budget” to pay for it. The LMC, in discussion with the council last year in order to clarify and improve arrangements around information sharing in child safeguarding matters, produced a revisedfee claim form. This form however is generic, and can be used to ensure the appropriate procedureis followedout for all services requested by the council and done by GPs under the collaborative arrangements. The form is available from the link at the end of this message for your information.
As it is evident that we cannot rely on the majority of social workers and other council officers to be aware of and follow the correct process for requesting and authorising the PCT to make payment, I would advise that when you find yourself in this situation you forward a copy of this form to the requestor and ensure that they understand the proper procedure. They should then complete section 1 of the form and return it to you. Make it clear to them that you will not carry out the work until this has been received (clearly there will be exceptions to this if there is a legitimate need to share information urgently in safeguarding issues, for example). Once you have completed the service then you should complete Section 2 of the form as appropriate and return to the council, who will then complete section 3 and forward the form to the SharedServices Agency for payment. Please ensure that the requesting council officer is made fully aware that it is the PCT that is responsible for, and obliged to, make payment and so any argument that “the council does not have a budget to pay” is completely irrelevant.
The one fly in the ointment to all this is that, for several years, no national fees have been set for services provided under the collaborative arrangements and it has been left to practices to set their own fees. The PCTs have arbitrarily set ceilings on the amount they are prepared to pay for these services. Unfortunately, as it is the council and not the PCT which has requested the services this puts the PCTs in a very strong negotiating position. Whilst practices can try and negotiate a higher fee with the PCT if they feel what is on offer is inadequate, hitherto these attempts have generally been unsuccessful. This leaves practices with the choice of either accepting a lower fee than they feel is appropriate for the work provided, or declining to carry out the work, which can have repercussions for doctor/patient relationships. And of course there are occasions, such as provision ofreports in child protection investigations, when GPs feel they have a professional obligation to provide the service in the absence of appropriate remuneration.
Please note that these collaborative services DO NOT include reports to support claims for exemption from liability to pay council tax for patients with severe mental impairment, nor any other servicescovered by the “List of Prescribed Certificates” under the GMS and PMS regulations, as attached). As recently advised by the LMC, your contract obliges you to provide these services free of charge.
Regards
Bob
Dr. Robert Morley
Executive Secretary
Bimingham Local Medical Committee