GPs directing patients away from your flu service? Here’s what to say

Andrea James: A number of the communications from GP practices that I have reviewed contravene aspects of current guidance

Lawyer Andrea James sets out some of the strategies pharmacists can use in a flu service dispute

This year I have received quite a number of enquiries from community pharmacists regarding what might be termed the ‘vaccination wars’.

It is a sad reflection on the current state of NHS funding that the need to generate extra practice income has resulted in a small number of GP surgeries making statements about the community pharmacy flu vaccination service that are – at best – misleading.

If you are affected by a GP practice issuing an inappropriate statement about flu vaccinations, I would suggest that you try firstly to resolve the matter amicably by speaking with the GP(s) involved. It’s rarely helpful for matters to escalate to a formal dispute – and you don’t need me to tell you that effective working relationships between community pharmacies and GP practices are essential.

If informal, amicable resolution doesn’t resolve the problem, you may wish to consider a complaint to NHS England and/or the General Medical Council (GMC).

A number of the communications from GP practices that I have reviewed contravene aspects of current guidance: the GMC’s good medical practice and its supplementary guidance, the Department of Health's code of practice for the promotion of NHS-funded services’, and also the NHS England General Medical Services (GMS) and Personal Medical Services (PMS) contract terms.

This is not an exhaustive list, but it includes:

GMC Good Medical Practice

Communicating information

You must be honest and trustworthy in all your communications with patients and colleagues.

When advertising your services, you must make sure the information you publish is factual and can be checked, and does not exploit patients’ vulnerability or lack of medical knowledge.

Honesty in financial dealings

You must be honest in financial and commercial dealings with patients, employers, insurers and other organisations or individuals.

You must not allow any interests you have to affect the way you prescribe for, treat, refer or commission services for patients.

GMC financial and commercial dealings and conflicts of interest

You must not try to influence patients’ choice of healthcare services to benefit you, someone close to you, or your employer.

Target payments are used to encourage general practitioners to increase the number of patients involved. Although you may wish to recommend treatments and invite patients to participate in assessments, you must not put pressure on patients to participate because of the financial benefits for you.

GMC  leadership and management for all doctors

It is essential for good and safe patient care that doctors work effectively with colleagues from other health and social care disciplines, both within and between teams and organisations. Whatever the composition of the teams you work in, you must respect and value each person’s skills and contribution.

NHS code of practice for the promotion of NHS funded services

No promotional activity should be undertaken that undermines the reputation of any individual providers, clinicians or other health professionals or otherwise brings the same into disrepute.

No marketing communication should mislead, or be likely to mislead, by inaccuracy, ambiguity, exaggeration, omission or otherwise.

Comparative claims are permitted in the interests of vigorous competition and public information. They should neither mislead nor be likely to mislead.

NHS England standard GMS and PMS contract terms

Vaccines and Immunisations

The Contractor must... provide appropriate information and advice to patients about vaccines and immunisations.

These are some of the requirements made of doctors that you may wish to cite if you feel forced to proceed with a formal complaint. However, please do remember to exhaust the option of informal, amicable resolution, in the first instance.

Andrea James is a partner at law firm Knights 1759, and specialises in representing healthcare professionals. 

10 Comments

A Hussain, Senior Management

I think that we as a profession are defeatist.  I remember reading a story on here last year about a successful pharmacist Paul Mayberry.  His recommendation for a successful flu service was to basically not step on the GP's toes and know your place!!

Ilove Pharmacy, Non Pharmacist Branch Manager

This is fantasy stuff.

A James, Senior Management

Hi there. Please see reply below to Valentine. 

Valentine Trodd, Community pharmacist

"... firstly to resolve the matter amicably by speaking with the GP(s) involved"

Thats is if you can be bothered to wait the 10 to 30 mins for them to answer the phone, speak to the surly receptionist and be told to leave a message and that the doctor is busy. Chances of doctor calling back? Eh... no.

Get on the phone to the GMC? You're having a laugh right?! I can picture the faces up at GMC HQ, when some bloke puts the phone on mute and shushs everone in the room to say he has a pharmacist on the line that wants to complain about a GP bully! They'd be rolling around the room.

Andrea, get real.

A James, Senior Management

Hi Valentine. Thanks for your comment.

I should perhaps have mentioned that I spent three years as in-house Legal Advisor to the GMC itself and I also have many years experience representing doctors before the GMC. Hence I am very familiar with the GMC's processes and am not "having a laugh" with the suggestions above! If serious or persistent breaches of the GMC's core guidance are brought to its attention, it will act.

Your idea of some bloke putting the phone on mute whilst everyone rolls around laughing is completely misplaced (and also, if I may say so, rather defeatist. Would you prefer to do something about the problem or just complain about it?) 

Dave Downham, Manager

Defeatist or realistic?

A James, Senior Management

Yes to defeatist I'm afraid. Giving up without even trying is defeatist!

Ilove Pharmacy, Non Pharmacist Branch Manager

Leaving community pharmacy altogether is very positive in my view as well as warning students of the potential ruins ahead for them. I'm sure all is well at Ivory Towers though. 

Nat Mitchell, Community pharmacist

Well I've not received many flu jab referrals, let's put it that way!!

Charles Whitfield Bott, Pharmacist Director

Calling Nat Mitchell - any of these that your lot does not do!?

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