I have challenged the payment first approach in the following scenario:
A report is requested.
The practice requests payment in advance
Payment is made in good faith that a report will follow which addresses the
points raised in the request.
The report fails to address the points (I ask for medical facts not a GP's
opinion)
The GP is challenged that either they overlooked the questions asked or they
have fraudulently obtained a fee for a service that they were not going to
deliver, a practice that the GMC would be interested to hear about. "I trust
that there will be no charge for this clarification" was added just to make
the contract clear.
GP writes further information as requested.
Also one of the employers I work with set their own policy regarding fees
they pay (it is about negotiating a contract basically) and so each request
reflects this "The [organisation] is able to offer you a fee of up to £xx
for your report, please enclose an invoice with your report." This is rarely
refused by the GP, occasionally a specialist will ask for more and then some
negotiation occurs before the service is provided. This is a private
organisation but a quasi-public body -the approach may not work as well for
a fully private profiteering company - more negotiation may take place in
that scenario.
I also agree that £125 is excessive for a brief GP report. We need to make
clear in requesting a report whether we are commissioning a further
consultation - I indicate "a brief factual report based on your medical
records" or "prepared by extract from your records." Watch out for
psychiatrists who more often than others feel the need to see the patient
again and are generally expensive, in my experience, when they do that. It
may be of more value to get an independent psychiatric assessment in that
scenario - for the same price and you choose a psych with OH understanding
e.g Dr Gareth Vincenti (see on web) (other psychiatrists are available.)
Be wary of opting out of the report gathering altogether - they are useful
in many ways, including medicolegal, if you request the report in the right
way. Also the request letter allows the opportunity to feed some useful info
back in the other direction, about the company, work, adjustments and your
clinical findings. This may avoid the clash between your advice that the man
with an ingrown toenail is fit to watch the monitors and the GP providing a
security guard with another 13 weeks sicknote whilst he awaits surgery!
Enough already
Dr Kevin RH Smith FRCS AFOM
-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]] On Behalf
Of Glenn Raybone
Sent: 13 June 2007 14:09
To: [log in to unmask]
Subject: Re: [OCC-HEALTH] GP Reports
Hi Nicky
I have refused to pay previously. The reason was that the member of staff
had been seen and treated in the NHS, but the Consultant wished to write
his report 'from his rooms' for £150, and then a further £50 if we
questioned the report or anything contained within!
What a cheek.
Regards
Glenn
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