GP Services and Fees
Contents
What Services Do GPs
Offer?
Quality of
Services
Why Do GPs Charge
Fees?
What Services Do GPs Offer?
GP practices must include
information in their practice leaflet about the services that they
provide. This information must include:
- An explanation of the role and
services offered by other health care professionals such as
nurses and health care assistants.
- Different clinics offered by the
practice, including the times they are available and how patients
can access them.
- Details of how the practice refers
patients for specialist or hospital care, including information
about any booking systems used by the practice and any choice of
provision available to patients.
- How patients will receive copies
of correspondance relating to their care.
In 2004 a new GP contract came into
force in the UK, under which practices are paid according to the
quality and scope of services offered. The clinical
services provided by GP practices are formally classified into
three categories: essential, additional and
enhanced (see below).
Essential Services – All Practices
Every UK practice must provide
essential services covering the day-to-day work of general
practice. Essential services are defined as:
- The management of patients who are
ill, or believe themselves to be ill, with conditions from which
recovery is generally expected.
- The general management of chronic
disease.
- The non-specialist care of
patients who are terminally ill.
Additional Services – Vast Majority of
Practices
Most practices will offer the
range of additional services detailed below. However, where
practices are experiencing difficulties such as recruitment
problems they can opt out of the provision of additional services,
either temporarily or permanently.
Cervical Screening
(Smear Tests): A practice shall provide:
- Necessary information to assist
women in making an informed decision on participation in the NHS
Cervical Screening Programme.
- Cervical screening tests for
women who have agreed to participate and information on the results
of the test.
- Appropriate follow-up to test
results.
Contraceptive
Services: A practice shall make available:
- Advice about contraceptive methods
and the medical examination of patients seeking such advice.
- Treatment of patients for
contraceptive purposes and the prescribing of contraceptive
substances and appliances.
- Advice about emergency
contraception and, where appropriate, the supplying or prescribing
of emergency hormonal contraception.
- Advice and referral in cases of
unplanned or unwanted pregnancy.
- Advice about sexual health
promotion and sexually transmitted infections (STIs).
- Referral for specialist sexual
health services, including tests for STIs.
Vaccinations and Immunisations: A
practice shall:
- Offer to patients all vaccinations
and immunisations of a type and in the circumstances for which a
fee was provided for under the 2003-04 Statement of Fees and
Allowances other than influenza vaccination (see guidance
below).
- Provide appropriate information
and advice to patients about such vaccinations and
immunisations.
- Record refusal of an offer to
vaccinate; or, where the offer is accepted, administer the
vaccinations and immunisations.
Child Health Surveillance: A
practice shall monitor the health, well-being and physical, mental
and social development of children under the age of 5 years with a
view to detecting any deviations from normal development.
The child will be examined at a
frequency that has been agreed with the PCT in accordance with the
nationally agreed evidence based programme set out in the fourth
edition of Health for All Children.
Maternity Medical
Services: A practice shall provide all necessary
maternity medical services:
- Throughout the antenatal period of
pregnant patients.
- Throughout the postnatal period
other than neonatal checks.
- To female patients whose pregnancy
has terminated as a result of miscarriage or abortion.
Minor Surgery: The practice shall
make available to patients:
- Curettage.
- Cautery and cryocautery.
More complex procedures
(injections into muscles, tendons and joints; invasive procedures,
including incisions and excisions; and injections of varicose
veins/piles) will be covered by the minor surgery enhanced service
(see below).
Enhanced Services – Selected Practices
Enhanced services are optional
for GP practices and are essential or additional services delivered
to a specified standard; or more specialised services not provided
through essential or additional services.
Although optional for individual
practices they must be made available within the local
area by Primary Care Organisations (PCOs). Enhanced services
may also include services addressing local health needs, including
those for specific vulnerable groups. They include:
- Childhood immunisations.
- Influenza immunisations.
- Services for violent
patients.
- More complex minor surgery.
- Services for alcohol and drug
misusers.
- Anti-coagulation monitoring.
- Intra-uterine Contraceptive Device
(IUCD) fittings.
- Specialised care of patients with
depression.
- Immediate care and first response
care.
- Care of the homeless.
- Intrapartum care.
- Minor Injury services.
- Specialised sexual health
services.
- Specialised Multiple Sclerosis
services.
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Quality of Services
The GP contract offers financial rewards to practices for providing
high quality care, and uses a points system known as the Quality
and Outcomes Framework (QOF) to allocate such payments. It is
designed to raise organisational and clinical standards in primary
care, reduce morbidity and mortality, and improve the overall
patient experience.
Under this system all work converts to points and every point has a
monetary value. Achievement is measured against a scorecard of
clinical, organisational, and patient experience evidence-based
indicators. The contract also rewards breadth of care through
holistic care payments. The level of achievement at practice level
is available online (link below).
Quality and Outcomes Framework (NHS
Employers)
Practice-Level Quality
Achievement (England)
Primary Care Trusts (PCTs) are
responsible for the overall local management, resourcing and
delivery of primary care (GP) services in England. A body called
the Healthcare Commission runs an “annual health check” which rates
aspects of the performance of PCTs and other NHS Trusts, as
excellent, good, fair, or weak. You can check on the performance of
your own PCT via the
Healthcare Commission database.
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Why Do GPs Charge Fees?
The NHS provides most health care
free of charge. However there are a number of other services for
which fees can be charged. These are mainly for services not
covered by the NHS, such as medical reports for insurance
companies.
Doctors are involved in a
whole range of non-medical work, largely on the basis
that they occupy a position of trust within the
community, and are in the position to verify the accuracy of
information. If a GP signs a certificate or completes a report, it
is a professional duty that s(he) checks the accuracy
of such information. This may involve examining the patient's
entire medical record.
How Much Can GPs Charge?
GPs should tell patients in
advance if they will be charged for a service and by how much. The
BMA recommends fee levels but these are guidelines only and a
doctor is not obliged to charge the suggested
rates.
Which Certificates Must be Provided
Free?
There are a number of
certificates which GPs are obliged to provide free of charge. These
include certain certificates supporting claims by patients for
social security benefits.
If a patient is off work for
seven days or less the GP does not have to provide a sick
note. A patient can be refused a note or charged for a private one
for illnesses of seven days or less.