The provision of services beyond those covered by the GMS contract or PMS agreement, or beyond the clinical skills of the doctor, cannot be forced upon a contractor. If a GP determines that such a service or assessment is required, a referral to a specialist service should be made.
Practices that are providing care to residential patients or to patients in intermediate or continuing care institutions should ensure that the level of service required by the institution is not greater than that defined as essential services. If practices are concerned, they should raise the issue with their commissioner and LMC. If this is the case, then on an entirely voluntary basis, the practice may seek to enter into a contractual arrangement over and above the normal GMS/PMS one through negotiations with their commissioner.
Practices may also enter into private arrangements to provide administrative services to institutions, for example regular ward rounds, completion of institution medical records and drug charts, providing advice to the institution management etc. but must not charge for any services which would constitute the provision of treatment to individual registered patients.
GPs should not allow themselves to be coerced or contractually threatened to provide services beyond their contractual obligations or the level of primary medical services they normally provide.
In providing care GPs must always:
- recognise and work within the limits of their professional competence
- consult colleagues if they have any concerns (e.g. LMC Officers, colleagues in practice, MDO advisors)
- be competent when making diagnoses and when giving or arranging treatment, this includes requests to prescribe medication that is out of their usual clinical experience
- ensure they are properly indemnified for the services provided
- consider the case for raising any concerns with their CCG, NHS England or the CQC
Patients receiving NHS continuing care will often need an increased level of care such as the input of a specialist or GP with a Special Interest.
Institutions and commissioners should be made aware that asking GPs to provide services outside their competency can put patients at risk and that failing to provide proper care for patients could lead to enquiries by the relevant regulatory bodies and referrals to the GMC.