MSE News: Stop GPs charging people in debt crisis up to £150 for mental health forms

Martin, this is the first time I disagree with you about anything. You have to remember that this is not the only group of people who seem to think GPs should be working for free for them. GPs are barraged with dozens of forms relating to everything you could imagine. It is easy to have sympathy with this group of people, but the reality is that EVERYONE who attends a GP surgery with a form to fill in has some physical or mental health problem and most are "deserving" of similar sympathy. It's similar to someone who cancelled the holiday they had saved for 2 years for because their husband had a heart attack and needs their GP to fill in a travel claim form. The GP workforce is in crisis with the number of GP surgeries closed to new patients (even in "desirable" areas of the country to work in) rising from 10% to 60% in some places in the last 2 years. GPs are leaving the workforce in droves due to unsustainable workload, low morale, and accelerating movement of workload from hospitals to primary care settings without any accompanying movement of resources. GPs usually do these forms after 8pm when they have finished all their clinical work and dealing with urgent results. If these debt and mental health evidence forms are done properly for patients with complex mental health problems they can take 20-30 minutes trawling through old notes. Solicitors would not do these forms for free. As you point out, most GPs ARE doing this for free when they have no obligation to. GPs/primary care deals with 89% of the patient contacts in the NHS with 7% of the NHS budget. GPs provide a year of care for a patient for the cost of one hospital outpatient appointment (or a year of vet insurance for a hamster). How about launching a campaign for proper funding of general practice? If you return to this space in 2021 I imagine there will be problems a lot more serious with general practice than inability to get a form done for free if the current collapse in workforce continues.

Sanctioned...
Yes you have spotted correctly I am one of those GPs... Thanks for your thoughts. To clarify...
GP surgeries are, as you point out, mainly private companies which are "independent contractors" to the NHS. (If the government had to take over all the GP practices and fund all our premises the NHS would be broke).
We have a contract which specifies which NHS work we are required to do - starting with "providing health care to those who are ill or believe themselves to be ill" and including chronic disease management/health promotion, quality improvement work and all that goes along with this. Our contract also specifies lots of forms eg for DWP which we are required to do for free or for a specified charge. The practice as whole receives a block grant based on number of patients, weighted for age and disease prevalence, so it's not an "hourly rate" but for NHS work probably works out around £30/hr before tax for most GPs after staff/premises costs are covered. BMA suggests fees for private work (including the literally many hundreds of different types of forms which various organisations seem to think should be our work) implying a charge of around £260/hour. Pretty much all GPs charge vastly less than this and waive fees fairly frequently. Partners in solicitors' firms would usually charge more than this in my experience.
Core hours in our contract are 8-6.30 Mon-Fri. We are shunted in the direction of working 7-day weeks and longer hours by having large sums of our block grant removed then given smaller amounts back if we agree to work evenings and weekends for ROUTINE appointments, and none if we don't. For URGENT out-of-hours work we had a big pay cut in 2004 in return for the ability to opt out of doing emergency work at weekends etc, and could earn some of this money back by opting back in. Effectively the work is done by the same people but employed by the health boards rather than individual practices. The headline figures of ~£100K you read for GP salaries include the majority of GPs who have opted back into this work, and work overnight/weekend shifts in addition to the day job. The figures quoted are also prior to deduction of compulsory pension contributions of 29-30% which are the highest of any public-sector workers. (and more than twice those of MPs!)
What we don't have any control over is workforce planning (which is dictated by government policy), and the number of doctors, and GPs, trained in recent years has been vastly less that what is needed. There is a national shortage of GPs and most surgeries are having trouble when recruiting. Newly-qualified doctors are experiencing the realities of work as a GP during their training and voting with their feet to move into other specialties. So when faced with having to close their doors (happening all over the place) and stop seeing patients or charge for forms which are not part of our contract, sometimes GPs would do the latter. This is not in an attempt to make money - trust me GPs do not want extra work filling forms - but the only way we can limit workload, as if we do forms for free we could be spending 1-2 days a week filling in all sorts of things. Regarding this specific form, my understanding it that it is not an official NHS or government form, but originated from a debt charity/forum. Despite this, two thirds of GPs are doing this work for free. Your comment about double dipping is not correct - GPs are not receiving any NHS money for this work. I agree mental health and associated debt problems are worthy of sympathy but so are many/most of the situations (bereavement, cancer, dementia, sudden unexpected physical illness) for which GPs are asked to do unfunded extra paperwork.

As GP surgeries are mainly independent companies, not NHS employees, they can only be "required" to do these forms if there is an agreement between the government and the GP committee of the BMA that these forms are helpful and worthwhile, and an agreement by the government to pay GPs a flat fee for doing these forms. This seems like a sensible approach, however I suppose it needs to be considered that the form itself is not binding on any debtor and may not be useful to patients in all cases.

Sanctioned_Parts_List wrote: »

Marmotte - you seem to be somewhat familiar with how general practice works:

Given that so many GP surgeries now are basically limited companies contracted to the NHS (i.e. all the "GP-Led Healthcare Centres" that have been inflicted on us), how do these companies presently charge their time to the NHS? Surely they must have some invoicing mechanism that reconciles a doctor's time with a quantity of money?

And within their contract, are there not conditions for providing adequate staffing (whether directly employed or via locums) to ensure that all their needs, including 8am-8pm surgery, 7 day weeks and sufficient out-of-hours cover are met, lest they lose their NHS contract?

So while I appreciate that many GPs are under enormous pressure, working excessive hours and fulfilling many more functions than their 2003 renegotiation catered for, is this not actually the exact situation they've designed for themselves? After all, it is their own (GP-led) limited companies that are responsible for staff cover and invoicing.

I rather wish they were more like solicitors, whom I've found to be plentiful, punctual and cheaper by the hour than the local private GP

I suspect, and this may be an unfair accusation, that there's an element of double-dipping here - the GP is charging the NHS for his half-hour spent filling in the form. He's also charging the patient because the form doesn't have an NHS logo on the front.

Anyway - I don't have a problem with paying for lifestyle forms. I had to pay for a healthcare assessment to support a visa application. It was my choice to travel, so it seemed only fair that I pay and not the taxpayer. But forms to support the vulnerable should really be free at point of contact, and as much as I hate legislation-creep, if it takes a law to do that, so be it.