Forums » Open clinical » General clinical » Should doctors' fees for signing forms and reports be capped?
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Should doctors' fees for signing forms and reports be capped?
posted at 25/10/2012 10:44 AM BST
on bmj.com
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*Moderator*
Posts: 1448
First: 7/4/2011 Last: 23/5/2013 |
In his latest BMJ column, Des Spence writes about charging patients to sign letters and documents: “I don’t charge for simple certificates, passports, referrals, housing letters, and the like. With medicals it would depend on whether or not patients were paying for themselves, and if so I would charge only a token fee. I do not take cremation fees. Now this might seem nauseatingly pious, just Champagne socialist posturing. But I think that we are already extraordinarily well paid and many of the people we charge are those who can least afford it. And my approach makes it easier to square the uncomfortable circle that is our high pay.” http://www.bmj.com/content/345/bmj.e7078 GPs are private companies and the NHS does not cover the cost of signing and processing these letters. The BMA has guidelines for what fees to set – but the majority of these fees are only guidelines and this means there is practice to practice variation. Is that fair? http://bma.org.uk/practical-support-at-work/pay-fees-allowances/fees/why-gps-sometimes-charge-fees In addition, Spence also makes the point that if you charge for certain administrative services this erodes the reputation and goodwill associated with the practice. The profits gained from this sideline are “negligible compared to overall practice income, which is mainly based on NHS capitation: the number of patients that we have.” If patients get the hump from having to pay extortionate fees then they might not recommend the practice to friends and this could have a knock-on effect in terms of attracting new patients, the overall reputation of the practice, and future funding. Should the fees be capped, means tested or even scrapped altogether? |
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Re: Should doctors' fees for signing forms and reports be capped?
posted at 25/10/2012 11:19 AM BST
on bmj.com
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Posts: 1266
First: 13/4/2010 Last: 21/5/2013 |
Not for the first time I disagree with Des. I am assuming he is a GMS GP rather than an NHS salaried practitioner. In that case he is self-employed and contracts himself to the NHS on the basis of the nGMS contract. Things that come outwith the bounds of that contract (such as private reports) are non-NHS work and therefore non-reimbursed by the NHS. To do them all for free actually devalues our professionalism. Charging a fee demonstrates that we are giving a professional opinion on a non-NHS matter. Des' practice might have the luxury of being able afford foregoing such fees. I don't. Our practcie income is now at the same level it was in 2004 - a fall in real terms of 25%. I now earn the equivalent of 20% less than the average Scottish GP and 40% less than the average English GP so I cannot to let all these additional fees slip through my hands. GMS GP partners are running a business and should act as though they are otherwise what is the point of being a GMS GP? One final point Matthew is that the BMA is forbidden from recommedning fees in law as to do so would potentially create a cartel which is illegal. |
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Re: Should doctors' fees for signing forms and reports be capped?
posted at 25/10/2012 3:43 PM BST
on bmj.com
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Posts: 92
First: 20/3/2012 Last: 25/10/2012 |
I have no issue no disagreement with GP's charging for services rendered that are not NHS-based (after all, an NHS Surgeon seeing someone privately can charge £150 or more). However, I do have issue with the charges for these services at times. My experience of this personally is only once (though I have had many patients talk to me about this issue over the years) and that was 6 months ago when I was unable to attend a medical for my Diasability and Living Allowance as the travelling would cause too much pain. So, I was in need of a letter from my GP stating that my pain was too much for travelling the distance (GP knows me well as I see him every couple of months for the last few years with the same issue). After being stated it would be £20, I was unhappy to be told it was actually £30 when I went to pick up the letter. Ordinarily I would not have an issue with paying this amount as it is not a huge amount but, when you are on DLA and (once bills and rent are covered) have £5 left per week for food etc, £30 is a huge deal. My GP does not make any allowances for income which I disagree with as, if it wasn't for my Mother, I would have had to suffer excruciating and debilitating pain travelling to the medical and then suffering for the next week. To be fair, I wouldn't have minded if it was a substantial letter but, as it was, it was 2 lines and probably about 30 words meaning I was paying £1 per word (that was typed up by a secretary). Interestingly, I see the recommendation for this type of letter on the BMA site is £16.50 which is now annoying me even more (maybe it's to cover some of the cost of the new medical centre they have just moved into!). I think a lot of the issues people have with this charging is that you often see articles in newspapers talking about GPs who earn £150,000 + a year and I think people just assume that they are being taken advantage of by greedy doctors (I know doctors aren't doing it just for greed but I am sure that is the perception). Personally, I feel there should at least be a discounted rate for those who are on a limited income (unless it is for something like holidays or insurance things).
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Re: Should doctors' fees for signing forms and reports be capped?
posted at 25/10/2012 3:44 PM BST
on bmj.com
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Posts: 7
First: 31/8/2011 Last: 31/1/2013 |
I think it is important that we work as managers or businessmen ,measure out time and work in units. We don't do any thing for nothing . Time and work done by my doctor in units are imprortant . As a matter of facts, not all GPs are rich and they have a lot of commitements to fullfil. |
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Re: Should doctors' fees for signing forms and reports be capped?
posted at 25/10/2012 6:57 PM BST
on bmj.com
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Posts: 5
First: 25/10/2012 Last: 5/3/2013 |
personally i am not in favour of capping what is a non NHS charges for private work i forego charges for housing letters and some letters for DWP appeals with the enormous cuts -pay freezes and the future freeze under the pretence that everyone will have to workmore for less and now the onslaught on QOF there is no reason to reduce charges all this work needs the GPs personal time and in this day and age no one should work free the solicitors don't and so are other professions so why GPs should work for free in fact that sends a wrong message that the doctors are super affluant and disunited but then those are my personal views i am only a retired GP |
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Re: Should doctors' fees for signing forms and reports be capped?
posted at 25/10/2012 8:10 PM BST
on bmj.com
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Posts: 1
First: 25/10/2012 Last: 25/10/2012 |
As I understood, some of the reasoning for the high fees are to discourage people and companies from needing forms signed that could be signed, instead, by someone who isn't a doctor (e.g. passport photographs for driving licenses). Making it free to sign forms may have the unintended and unwanted side effect of increasing numbers of companies wanting GPs signatures, including insurance companies, drug companies trialing new treatments, travel agents or even local gyms. Besides, who would want piles of forms requiring signatures stopping someone needing urgent healthcare coming through the door? If we fail to charge, does that mean we would not be liable for an incorrectly filled in form? I doubt that would be the case. My view is that signing these forms is a professional service, and should be paid for as such. Cremation forms, for example, are not simply a signature, but require looking through hospital notes and examination of a body, a job that takes time. |
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Re: Should doctors' fees for signing forms and reports be capped?
posted at 25/10/2012 9:58 PM BST
on bmj.com
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Posts: 322
First: 12/11/2010 Last: 20/5/2013 |
I am sure this was debated on doctors net some years ago. If I remember correctly, it was suggested there that a cap on charges would mean a refusal to do a letter - which would in the end be worse for the person wanting the letter. There was also a very long debate about the necessity of many letters: the GANFYD (Get-a-note-from-your-doctor) demands that many GPs received were often bizarre. |
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