After reading Derek Bernadi's tweet and the replies to it about problems with a client’s GP surgery refusing to provide a letter regarding their needs as a disabled person I thought I would write something about this issue. It’s one of a number of serious problems which I experience in dealing with GPs and their surgeries. I hope to write GP related other problems such as how they are sometimes failing clients with mental health problems. To keep this post to a reasonable length though I will focus here on problems I have experienced in obtaining reports from some surgeries.
I frequently have to ask GPs to provide me with reports on clients who have medical problems. The most common reasons for doing so are to establish whether someone has a medical condition which might
- Make them vulnerable if homeless for the purposes of being rehoused under Part 7 of the Housing Act 1996
- Mean that accommodation which they have been offered by a council unsuitable for them.
- Amount to a disability for the purposes of Equality Act 2010
Most GPs are very helpful and provide reports addressing the points I have raised within a couple of weeks of receiving my request. However there are some surgeries where the staff refuse to provide reports. This can be a major problem for the client. It is common for landlords, local authorities and judges to require clients, or lawyers acting for them to provide medical evidence in support of assertions that clients have medical conditions relevant to their case.
I should add here that thanks to Data Protection Act 2018 I can obtain copies of a client’s medical reports for free from GPs within a month of requesting them and that almost all of the GPs I deal with comply with their obligation to provide these. The problem is that if the client has not been requesting medical assistance the records will be of little use and a report is needed perhaps following an urgent appointment with the patient to assess their current condition.
It seems that some GP surgeries adopt the policies of not providing reports because they have become fed up with receiving requests from patients for lettres needed for get rehoused. These are often referred to as “housing letters” and GPs feel that writing these is a waste of their time.
Here are two examples of letters I have received from GP surgeries explaining their policies. I would like to name the writers and which surgeries they are with but it is probably best not to do so.
In this first example from 2022 the surgery had refused to write reports for patients but said that they would do so if requested to do so by the local authority. I wrote asking them to reconsider this policy as I was concerned that it would leave clients such as the one I had written to them about being unable to be rehoused from unsuitable accommodation. In this case the local authority had asked me to provide them with medical evidence. The response from the surgery included the following;
While I understand your concern, the situation remains these letters are outside the remit of the NHS contract and as such, practices are not obliged to provide them. I appreciate some practices do, however, there are many practices that do not and I am afraid due to operational necessity, we are have taken the decision not to provide letters of this nature.
In place of GP letters, patients are encouraged to use their ability to access their medical records, so they can then provide the medical details to substantiate the grounds for their application. I understand you have been provided with copies of the patient's records for you to provide in support, but that is as far as we can go with this issue. If you require medical input to the application, then you will need to instruct a private GP to assist, as this is not a service we can provide
In this older example from 2020 the surgery responded to my request for them to reconsider their no reports policy by stating
Private medical reports do not fall under our GP contract and GPs have to complete them outside of their paid NHS working hours. We do not have enough clinicians who are willing to work outside of their contracted time to complete these requests especially, in the volume we receive them therefore, the practice has stopped providing this service.
The Practice complies with all the subject access requests under the GDPR law.
Third Party organisations acting on behalf of our patients often commission a private GP to prepare the medical report based on the records provided by us under SAR. We still provide the essential reports as set in the policy which also have been side-tracked by many GP practices at the moment while we are dealing with the pandemic. This also includes any court orders made directly to the Practice.
Bothresponses refer to writing reports not being part of the NHS contract. There is a reference in the second exmaple to the pressures caused by Covid 19 which may have been what the surgery in the first example meant by operational necessity. Reference is also made in both responses to instructing private GPs. It is worrying that clinicians working at the second surgery are not prepared to provide reports. It is also worrying that as with the first example the response to a high volume of requests - ie patients needing reports - is to refuse to provide them. I appreciate that if surgeries feel that they are unable to provide medical services because their doctors are spending all day writing reports this may be a problem. I would have hoped however that a solution might be to refuse to provide more than one report for a patient within a certain time or to refuse to provide reports unless requested by a solicitor or advice agency even if it is difficult for patients to access the few organisations left who are providing such advice.
What Is To Be Done?
I think that this is a significant problem. As previously stated, most GPs are providing a very good service so I can’t claim that problems are arising in more than a small number of cases. However, I do not think the problems should be arising at all. When they do arise they can have serious consequences in terms of clients / patients losing their homes or having to remain homeless or living in unsuitable accommodation. I am not familiar with the rules of GP contracts and/or the standards of client are they are expected to comply with. I would be be grateful if anyone who reads this can help me understand the following issues:-
- What the limits of a GP’s NHS contract are that such that it should not require them to write what might be a very important report impacting on the health and wellbeing of a patient.
- What the “operational necessity” might be that prevents a GP writing a report requested by or on behalf of a patient when they are prepared to write reports requested by the council. I don't think Covid 19 is enough at the present time.
- How likely it is the patients, or their solicitors are able to prepare their own medical reports based on their reading of their medical records.
- What a private GP is and how these differ from what we generally think of as ordinary GPs.
- What if anything can be done to pursue complaints about and/or require GPs to provide reports for patients or whether it really is the case that the patient is not entitled to a report from their GP.
I would also like to hear from GPs who may be able to help to stop this sort of blanket refusal policy being adopted by surgeries and/or to understand the difficulties caused by requests for these kind of reports.