Agenda item - Formal Member Involvement

(b) Written Questions from members

52(b)  Written questions from members

52.1       The Chair invited Councillor Hill to ask her following question:

“Following the Scrap the Fee Notice of Motion passed at Full Council in February 2018, please can the CCG confirm that they contacted all GPs requesting that they voluntarily provide letters free of charge to victims of domestic abuse to support applications for legal aid?”

52.2       The Chair thanked Councillor Hill for her question and gave the following written response from the CCG:

“The CCG is not in a position to request that GPs voluntarily provide letters free of charge to victims of domestic abuse, to support applications for legal aid. 

This is because the provision of such services is outside the General Medical Services contract, responsibility for which is delegated to CCGs from NHS England, and as such counts as non-NHS work. 

More details on why GPs charge fees are available on the British Medical Association website: https://www.bma.org.uk/advice/employment/fees/why-gps-charge-fees

On review, I asked the CCG to provide some detailed information about the role of the CCG and also GPs in dealing with requests for letters as I am sure it is an area of some confusion for many people.

As noted above, the CCG can only ensure that GPs provide services that are within the General Medical Council contract. Providing such letters is not part of the contract and therefore the CCG cannot enforce or request GPs to do this.

GPs already deal with many requests for letters. These include a wide range of areas including:

·                  school places on grounds of medical need

·                  housing

·                  bus passes

·                  welfare benefit letters

·                  letters to employers

Each surgery can decide what they will or will not provide. Some have decided they will not provide such letters due to time.

If the Board wishes me to do so, I will write a letter to the CCG asking GPs to provide these letters. Whilst the CCG has stated that it will forward this letter to each GP practice, it cannot ask or enforce this itself as this falls outside of its powers”

52.3       In response to the Chair asking if there was agreement among the Board to write to the CCG, Dr David Supple stated that there would be no objection and he would be happy to meet people outside of this meeting to discuss matter further. He stated that this was a complex subject and highlighted the pressure on doctors who needed support on this issue; that they would not want to charge on genuine cases however only as a deterrent for the GP time exhausted on private employee letters thus put in to a position where monitoring was necessary.

52.4       Jim Graham stated that the Local Medical Committee’s (LMC) response on this huge and emotive issue encompassed a great deal of thought and they should be involved to formulate a following response or continued discussion.

52.5       Dr David Supple stated that the LMC existed to represent GPs interests and whom many feel strongly on the issue of the provision of letters being in their right for refusal. He stated that the issue had parallels in other provisions whereby the additional resources taken from the service, in this case GP time, would be paid for by the Local Authority and not the NHS.

52.6       The Chair responded that the issue raised was in the specific context of domestic violence, however she did recognise the extensive workload of GPs and that everyone’s interests were with the patient.

52.7       Councillor Taylor stated that this issue was brought to the Council, a sovereign body, by the residents of the City and that the motion was unanimous and cross-party and that ongoing work of the issue should report to this Board.

52.8       Councillor Page stated that the letter to the CCG should include that violence against women was serious societal and other bodies that supported those particular issues should be included.