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Secret Diary of a PM: When Things Aren’t as They Seem…

Our anonymous blogger reflects on a pair of incidents that made them question whether some of the day-to-day aspects of general practice are really as straightforward as they may first appear.

I would have thought that when a patient opts out of the NHS to go and see a private consultant all of the costs related to their care and tests would be for the private consultant, either through the patients’ health insurance or the patients’ personal responsibility.

This is not the case, and I am surprised at the increase in requests from private consultants for us to do blood tests or samples on the NHS and then let them have the results.

In my view it is very unfair that the NHS has to subsidise private consultants and patients, and the extra work that it brings for the surgery cannot be claimed for.

Often when we get such a request we mark the test request ‘private consultant’ and the laboratory will invoice either the patient or the consultant. This inevitably causes a round of telephone queries and arguments about who is going to pick up the bill - patient, insurer or GP practice.

Upon checking with our CCG, they say that we should not be entering into any discussion and we should just accept it and take the responsibility for the fee, even though they fully understand where I am coming from,

This still does not sit well with me - we cannot even recover the costs of sending the reports to the consultants. The NHS is already overstretched and should not be subsidising the private sector.

This also can be used as a technique for ‘queue jumping’ - how many people, after the first consultation, then go ahead and ask the consultant to go back on the NHS? As they are already being seen, they are transferred.

It has crossed my mind and I wonder how many private patients or insurance companies are also being invoiced by the consultants for the same blood tests.

Another strange thing happened to me a few days ago when I was contacted by the Teaching Trust to discuss one of our registrars’ status, and it set me off thinking. As a teaching practice, we are used to taking on registrars for a short period of time during their training. As all the admin is done by the Teaching Trust, our paperwork involvement is minimal as we are assured that everything has been checked out. 

You can imagine my surprise when I was told that one of our current registrars had not renewed their visa and that they were not allowed to continue working until it had been renewed. They went on to say that they would not be paying the registrar for the best part of the last two weeks.

Now don’t get me wrong, this is ultimately the responsibility of the registrar and there can be no excuses. However, should this not have been flagged up to us earlier? I am also wondering about the indemnity of the registrar during this period and hope we have no issues from the period in question, but who knows. What will happen if there is a claim?

Thinking about this even further what would have happened if CQC had visited us and did a spot check - would we have been blamed as well?   

The registrar cannot work until this visa had been renewed, and fortunately they were on a study leave day or we would have had to stop them working there and then.  With surgeries planned it has been a great deal of extra work to reschedule the clinics and, because we have no possible date to get this rectified, it has left a hole in our planning.

There are questions to be answered but it leaves me with the action in the future of insisting that we do get copies of all the paperwork for our records in the future, minimising the chances of something like this happening to us again.

Have you had any recent events that have made you think twice about processes or procedures are really as straightforward as they appear? Let us know your stories in the comments section below.


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Closing Date: 30 November 2019

Salary: £32000pa (pro rata)

Practice Manager - London, E14

Closing Date: 21 November 2019

Salary: £40-55k (dependent on skills and experience)

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Salary: Negotiable

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