Medicopolitical digestBMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6937.1166 (Published 30 April 1994) Cite this as: BMJ 1994;308:1166
- Linda Beecham
GPs may remove violent patients from lists immediately
New regulations introduced this month enable general practitioners to require family health services authorities (FHSAs) to immediately remove from their lists any patient who has acted violently or behaved in such a way that doctors fear for their safety.
Doctors have always been able to require a patient's removal within seven days; the criterion under the new regulations (The National Health Service (General Medical Services) Amendment Regulations 1994, No 633) is the general practitioner's “reasonable fear” and so would include violent acts or threats of violence against the doctor's staff.
For a patient to be removed immediately the doctor must inform the police of the incident and the FHSA. Removal takes effect when the request, which can be made by telephne or fax, reaches the FHSA whether the office is open or not. Written confirmation should follow within seven dys. The general practitioner should also notify the patient of the decision but this can be done by post or the police can be asked to pass on the decision.
The Home Office had been consulted over the regulations, one of the GMSC's negotiators, Dr Brian Goss, reported last week, but he did not know what the police authorities had done to notify police stations of the new arrangements. He urged general practitioners to forge close links with their local stations.
The new regulations do not exclude the provision of “immediate necessary treatment” that general practitioners are expected to give to any patient whether on their list or not.
Last year the secretary of state for health set up a working group to look at violence against family doctors and their staff. Mrs Bottomley accepted the group's recommendations and guidance has been issued to FHSAs on good practice and local initiatives on combatting violence. The GMSC has also produced guidance for doctors, which includes advice from the Association of Chief Police Officers. This is published as an appendix to the committee's 1994 annual report.
GPs' chairman expects early progress on out of hours
Between the March and April meetings of the General Medical Services Committee its chairman has met the minister for health twice to emphasise the need for a speedy resolution to the out of hours problem in general practice.
Dr Ian Bogle reported last week that at the first meeting Dr Brian Mawhinney had been left in no doubt of the GMSC's strength of feeling (26 March, p 860). The minister had instructed his officials to find a quick resolution to the GMSC's wish for an amendment to paragraph 13 of the terms and conditions of service to make it clear that it would be for general practitioners to decide whether to invite patients to surgery premises for an out of hours consultation if the doctors believed that that was the most appropriate course of action.
After the second meeting with the minister, the day before the GMSC met, Dr Mawhinney said that “real progress had been made” and that it was his and the secretary of state's view that they were “close to signing off on an agreed basis.” Dr Bogle hopes to circulate amendments to the terms of service and accompanying guidance in advance of the May meeting of the GMSC.
Medical students reject screening for hepatitis B
At their first annual conference BMA medical students have called for the Committee of Vice Chancellors and Principals to withdraw their recommendation that applicants for medical and dental schools should be screened for hepatitis B and immunised where necessary. The recommendation was made on the advice of medical school deans, who said that students found to have the virus should be excluded from the clinical stages of their course. Students should then be counselled and advised on the implications for their careers. If appropriate they could be advised to transfer to other courses.
The medical students committee's chairman, Mr Mark Bailey, will report to the council and the annual representative meeting the conference's wish for the BMA to negotiate guidelines to protect medical students who are found to have hepatitis B.
Should local medical committees acquire union status?
A discussion paper being sent to local medical committees (LMCs) suggests that the committees should set up parallel organisations--local medical organisations--which become BMA union branches and be subject to the association's procedures governing industrial action. The paper does not represent GMSC policy.
If LMCs had trade union status they would acquire certain immunities from court action if they induced general practitioners to break their contracts by taking industrial action. Industrial action can range from a strike to refusing to cooperate with local management.
The discussion paper suggests separating off from the LMC the trade union functions and activities and creating a parallel body--the local medical organisation--with its own constitution and funds. The membership of both could be the same but, whereas the LMC could continue to raise voluntary or statutory levies, the new organisation would have to be funded separately and independently from the family health services authority or health board.
The LMC's relationship with the BMA would remain unchanged. The fact that local medical organisations contained non-members of the BMA should not cause difficulty. The constitution of the BMA's local negotiating committees, which represent the interests of hospital doctors working in NHS trusts and which have been accredited under the 1992 act, allows non-members to participate.
Services to patients should not be levelled down
Some general practices, which invested heavily in ancillary staff, computers, and premises improvements, are being penalised with the introduction of notional budgets, particularly for staff, as the reimbursements are not what they expected. General practitioners have had to cut down on ancillary staff and the chairman of the General Medical Services Committee, Dr Ian Bogle, has told the secretary of state for health about the inappropriateness of the levelling down of services.
Dr Eric Godfrey, from Manchester Local Medical Committee, initiated a debate at last week's meeting of the GMSC on what his committee considered was the illegality of a notional practice staff budget scheme being proposed by Manchester Family Health Services Authority. The GMSC decided that the legality of such schemes should be clarified and that advice should be prepared for general practitioners on how the ancillary staff scheme should be implemented in 1994.
Dr Godfrey believes that the scheme being proposed in Manchester falls outside the provisions of the statement of fees and allowances, which is based on prior approval from the FHSA for expenditure, submission of claims to the FHSA, and reimbursement. Under the proposed scheme, which Manchester LMC was told is now operating in over 30 FHSAs, each practice would be notified at the start of the year of a notional annual budget and would receive a twelfth of that figure each month. This could result in some practices losing money. Manchester LMC had been given legal advice not to cooperate.
GMSC members reported experience of similar schemes and that they had led to an equalising down. Dr Gareth Emrys-Jones said that this was a political issue and should be taken up with ministers. Dr Charles Zuckerman pointed out that general practice fundholders had accepted budgets and he did not want money from the GMSC defence fund spent on getting legal advice when everyone knew what the position was. But he agreed that the Department of Health should be told that funds were being cut. If they were not replaced services would be reduced.
British National Formulary will be published electronically
The British National Formulary, which is published jointly by the BMA and the Royal Pharmaceutical Society of Great Britain, will soon be available on screen and be accessible in general practices, pharmacies, and hospitals. Although available in the same page format as the published book, there will be additional search tools to allow the user to extract information more rapidly. Publication of the book version will continue on a six monthly basis.
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