My attempts to post a comment on NHS Choices

25/05/2015

NHS Choices have a webpage to support patients who want to choose a GP practice where they do not reside. They do not have a list of practices offering this option (it is voluntary), patients have to research this themselves.

One paragraph reads as follows:

Because of the greater distance to your home, the GP you register with is under no obligation to offer you a home visit. If you are not well enough to go to the practice yourself then other arrangements will be made. NHS England (the body responsible for buying GP services) ensures that there is access to a service either near your home or at home (if required). When you register with a practice away from home you will be given information about what you should do in those circumstances.

However, if you are too ill to attend the practice in person, or the practice is unable to help you over the phone, call NHS 111. The NHS 111 service will be able to tell you about access to local services or, where necessary, arrange a home visit.

However, at the end of January 2015 I rang 3 different London NHS 111 centres (covering east London, north London, and central London) and none of them were aware of the new policy and none of them had in place a way of dealing, in hours, with patients who were not registered with a local GP. I was told that the patient would be advised to go to a walk in centre or to A+E.

[I rang NHS 111 for central London this morning, to see if things have moved on. I spoke to a first line adviser and then the supervisor. The supervisor thought a person could register with a GP in the home area, and then also register with a practice near their work or wherever else they chose. I told her this was not the case and I read her the text above. She said NHS 111 could not arrange this, and that the patient would be advised to attend a walk in centre or A+E.]

Elsewhere in the NHS Choices webpage is the following sentence:

This means that you are able to register with practices in more convenient locations, such as a practice near your work or closer to your children’s schools.

This idea of registering near your children’s schools has been a constant declared benefit of the policy since it was first broached in September 2009. But such a choice would not actually work, and would create problems for the parents and children. I have made a modest video explaining why.

I wrote a comment for this webpage; it was rejected; and an email exchange is in progress:

The proposed comment:

“I am a GP in Tower Hamlets. I think it is important that people thinking about registering with a GP practice away from where they live check carefully whether they will have in hours GP cover if they are ill at home and unable to travel to their registered practice. The cover throughout England is patchy. In London, there is no cover at all (at the time of writing this, 3/3/15).

I have written to Jeremy Hunt, the Department of Health, and NHS England so hopefully they will put this right.

Another issue: it is not a very good idea to register with a practice near your children’s school, it will actually cause problems, so beware. For details, see my video on YouTube:

http://bit.ly/1tzoP7S

*

The subsequent email exchange:

From: NHS Choices [thechoicesteam@nhschoices.nhs.uk]
Sent: 19 March 2015 10:11

To: Farrelly George (NHS TOWER HAMLETS CCG)

Subject: Your review has been rejected

Dear George Farrelly,

Thank you for contributing to the NHS Choices website. We have removed your contribution because we feel it is unsuitable for publication on this page. We do not allow comments which actively seek to dissuade other site users from following the evidence-based health advice provided. Please see the site Terms and Conditions or refer to the Moderation Rules policy. http://www.nhs.uk/Commentspolicy/Pages/Moderationrules.aspx

Please click the button or follow the link below to submit a new review of the service. etc etc….

*

From: Farrelly George (NHS TOWER HAMLETS CCG)

Sent: 27 March 2015 07:18

To: NHS Choices Service Desk

Cc: Farrelly George (NHS TOWER HAMLETS CCG)

Subject: RE: Your review has been rejected | 219186RL

Dear NHS Choices,

I do not accept the reasons you have given for rejecting my comment to the page http://www.nhs.uk/nhsengland/aboutnhsservices/doctors/pages/patient-choice-gp-practices.aspx

I will remind you of my comment:

“I am a GP in Tower Hamlets. I think it is important that people thinking about registering with a GP practice away from where they live check carefully whether they will have in hours GP cover if they are ill at home and unable to travel to their registered practice. The cover throughout England is patchy. In London, there is no cover at all (at the time of writing this, 3/3/15).

I have written to Jeremy Hunt, the Department of Health, and NHS England so hopefully they will put this right.

Another issue: it is not a very good idea to register with a practice near your children’s school, it will actually cause problems, so beware. For details, see my video on YouTube:

http://bit.ly/1tzoP7S

*

I can see why you would prefer not to include this comment, but I do not accept that your reasons are valid. You say that you do not allow ‘comments which actively seek to dissuade other site users from the following the evidence-based health advice provided’.

In my comment I make 2 main points: 1. there is no cover in London for patients registering with a practice at a distance from where they live should they fall ill and not be able to get to their registered practice; this is a matter of fact, and introduces a safety risk for these patients; you are offering a service which has a very basic flaw and patients should be aware of it.

2. registering with a practice near your child’s school: this simply does not work and offering this as a benefit to patients is misleading and irresponsible. I illustrate why in this video: https://www.youtube.com/watch?v=JMllmAcg9II

Would you please explain in what way this advice to register near your child’s school (or the policy as a whole) is ‘evidence-based’?

Best wishes,

George

The Tredegar Practice
35 St Stephens Road
London
E3 5JD

*

From: NHS Choices Service Desk
Sent: 02 April 2015 09:17

To: ‘Farrelly George (NHS TOWER HAMLETS CCG)’

Subject: RE: Your review has been rejected | 219186RL

Dear George,

Thank you for contacting the NHS Choices Service Desk.

We have now assigned your query to the Subject Matter Expert (SME) within NHS Choices. A member of our service desk will be in touch as soon as we receive a response.

If you require an update at any time, please feel free to respond to this email quoting the reference 219186RL in the subject line.

Kind Regards,

Rachael

The NHS Choices Service Desk

*

From: NHS Choices Service Desk [servicedesk@nhschoices.nhs.uk]
Sent: 10 April 2015 12:21

To: Farrelly George (NHS TOWER HAMLETS CCG)

Subject: RE: Your review has been rejected | 219186RL

Dear George,

Thank you for contacting the NHS Choices Service Desk.

Please see the response below from our user generated content team.

” Dear George,

Without making any judgement on the validity of your arguments I have to tell you that NHS Choices is not the correct forum for your concerns.

Choices’ comments section was set up to offer patients the opportunity to rate and comment on their NHS care and treatment. Our comments policy does not permit campaigning of any sort.

The moderator used the correct rejection category though they should have paid more attention to the wording used in the automatic notification sent when that category is used.

Kind regards “

Please get back to us if you have any other queries.

Kind Regards,

Rachael

The NHS Choices Service Desk

*

Dear Rachael or Colleague,

Thank you for your reply.

I have three questions:

1. if a patient, non-‘campaigner’, were to point out on your page that he/she is unable to find ‘at-home’ GP cover in London, would that be acceptable? Or if a patient were to point out that registering with a practice near their child’s school did not actually work, would you accept that comment?

2. If someone like me, with specialist understanding about how a frontline service works, finds a flaw with a ‘choice’ you are promoting, what is the ‘correct forum’ for my concerns?

3. What is the governance for ensuring the ‘choices’ you are offering on the NHS Choices website are safe and workable? If it is pointed out that a ‘choice’ you are offering does not work or is unsafe, do you have any responsibility to look into this or is it ok to simply leave it unchanged?

Best wishes,

George

The Tredegar Practice
35 St Stephens Road
London
E3 5JD

*

From: NHS Choices Service Desk
Sent: 15 May 2015 09:57

To: Farrelly George (NHS TOWER HAMLETS CCG)

Subject: RE: Your review has been rejected | 219186RL

Dear George,

Thank you for contacting the NHS Choices Service Desk.

Please see the response below from our user generated content team.

” Dear Dr Farrelly,

As I explained to you a while ago when you last tried to post your comment NHS Choices comments policy prohibits all campaigning of any sort.

This is no reflection on the aims of your campaign or any judgement regarding its merit, merely that Choices is not the correct forum for your concerns. We are very strong on not supporting or endorsing any campaigns. Furthermore providing health advice is not permitted.

Choices is meant to be a platform whereby patients can comment and rate their NHS care and treatment.

Choices comments policy is explained here:

http://www.nhs.uk/aboutNHSChoices/aboutnhschoices/termsandconditions/Pages/commentspolicy.aspx

Kind regards “

Please get back to us if you have any other queries.

Kind Regards,

Rachael
The NHS Choices Service Desk

*

From: Farrelly George (NHS TOWER HAMLETS CCG)
Sent: 15 May 2015 16:09

To: NHS Choices Service Desk

Subject: RE: Your review has been rejected | 219186RL

Dear Rachael,

They have not answered my questions. They are in plain English; there are three of them.

Please ask them to answer them, one at a time, directly, without evasion or obfuscation.

Many thanks,

George

*

[I will add their reply when I receive it]


The Department of Health’s ‘reply’ to my email to Jeremy Hunt

25/05/2015

In mid-February 2015 I emailed Jeremy Hunt raising concerns about the policy allowing patients to be registered with participating GP practices even though they live outside the practice area. The policy was implemented on 5/1/15. It is a deeply flawed policy which sounds good on paper (unless you understand how general practice works), but when transferred into the real world is a mess. (It is as though someone asked an architect to actually build a building according to an Escher lithograph).

Just one of the problems in the real world is to provide cover for patients who get sick at home and cannot travel to see their registered GP. (A patient registered with a local GP would walk to their GP or, if unable to leave their home, be visited by their GP). So NHS England area teams were given the Herculean task of organising this cover. The October 2014 launch of the policy was put forward to 5/1/15 because they had not yet put in place the infrastructure for this cover. What I discovered in January 2015 was that there was still not blanket cover across England; in fact in London there was effectively no cover. So the situation was unsafe for London patients registering with a practice at a distance from their home.

This is the reply I received from the Department of Health:

Our ref: DE00000920945

Dear Dr Farrelly,

Thank you for your correspondence of 15 February to Jeremy Hunt and Norman Lamb about GP practice boundaries. I have been asked to reply.

As you are aware, the GP contract agreement for 2014/15 brought in a measure allowing GP practices to register new patients from outside their traditional boundary areas without a duty to provide home visits for such patients, as they previously had to do.

With this change, provisions such as home visits need to be in place for patients should they need urgent care at or close to home and cannot attend the practice they are registered with. NHS England is responsible for making sure this happens. Its area teams are currently working with GPs and the NHS 111 service to make sure these services can be provided.

As you are aware, it was originally planned that the measure would come into effect from October. However, in order to allow its area teams more time to put services in place, NHS England took the decision to put the date back to 5 January. It believes that this decision was in the best interests of GP practices and patients.

I note that you have written to NHS England directly about your concerns. I hope that you receive a response soon.

Whilst I appreciate that this may be a disappointing reply, I hope it clarifies the situation.

Yours sincerely,

[I have removed the name to protect the innocent]
Ministerial Correspondence and Public Enquiries
Department of Health

*

Attentive readers will notice that this is a non-reply. This is typical of replies I have had from the Department of Health: a bland, entirely unnecessary, description of the protocol but ignoring entirely the issue of patient safety and the proper working of this policy.

I did in fact email NHS England (they were copied into my email to Jeremy Hunt as well), but I have not received a reply.


A Question for the BBC

01/03/2015

A question for the BBC, but journalists in England as well.

On March 20, 2014 a research team at the London School of Hygiene and Tropical Medicine, headed by Professor Nicholas Mays, published their report on the Government pilot on patients registering with GP practices at a distance from where they live.

The afternoon before I was contacted by BBC London 94.9 asking if I would comment on the policy the next morning. Here is the interview:

 

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I said in the interview that as the policy was actually implemented the problems would become evident; I said that it would be ‘a mess’.

The scheme was meant to start in October 2014. At the last minute, NHS England announced that they were going to delay the implementation. Why?

A spokesperson for NHS England, said: ‘This has been an ambitious piece of work designed to increase the flexibility that patients have in choosing their GP. With such a change, we have to be completely assured that robust arrangements are in place across the country should patients who register with a GP outside their area need urgent in-hours primary medical care at or near home.

‘This has been a big undertaking and we have taken the decision that more time is needed to ensure these arrangements are fully bedded-in – a decision that has been taken in the best interests of GP practices and patients.’  (my emphasis)

The policy was implemented (very quietly) on 5 January 2015. The only media report or comment I could find was a post on the ConservativeHome blog.

I subsequently found out that ‘robust arrangements’ were not in place across the country, and the worst affected was London where there are NO ARRANGEMENTS in place. For details, see my piece in Pulse, and a subsequent Pulse article.

I wrote to Jeremy Hunt about this, copied to various media outlets, including BBC London 94.9. And yet this story has not been reported in the mainstream press. I also wrote to NHS England and NHS England London, and the CQC, the King’s Fund, the Patients Association, and the Nuffield Trust. I have not heard from Jeremy Hunt, the Department of Health, or NHS England; in fact, I have not heard from anyone.

Since September 2009 when Andy Burnham announced this policy at the King’s Fund, the press has reported only the positive sounding spin coming from the politicians, entrepreneurs, and the Department of Health, and have been universally silent about the numerous problems inherent with this policy. It is as though there is a news blackout…

Why?


There is no cover in London for out of area patients; how many other areas affected?

16/02/2015

 

 

 


My email to Jeremy Hunt on a significant risk with the GP Choice scheme

15/02/2015

Dear Jeremy Hunt,

I am a GP in Tower Hamlets. I sent you three successive emails (7/9/13; 13/10/13; 11/1/14) warning of the risks of your government’s flagship policy to abolish GP practice boundaries. I received 3 non-replies from the Department of Health (see links below).

I am now writing to bring to your attention not potential future risks but a significant current actual risk. As you may know, the policy was rolled out (very quietly) on 5 January 2015. The intended start was for October 2014 but this was postponed until 5/1/15 because, in the words of a spokeperson for NHS England in September 2014.

‘This has been an ambitious piece of work designed to increase the flexibility that patients have in choosing their GP. With such a change, we have to be completely assured that robust arrangements are in place across the country should patients who register with a GP outside their area need urgent in-hours primary medical care at or near home.

‘This has been a big undertaking and we have taken the decision that more time is needed to ensure these arrangements are fully bedded-in – a decision that has been taken in the best interests of GP practices and patients.’

I have discovered that there are no ‘robust arrangements’ in place in London; in fact there are no arrangements. I have sampled three separate NHS 111 London sites and none of them were aware of the policy having been implemented, and none of them had a list of local GPs who had signed up for the out of area Enhanced Service. I was told that a patient not registered with a local GP would, if they needed to see a doctor in hours, be advised to go to an urgent care centre or to A+E. If the patient was too ill and needed a visit, one of the supervisors told me, they would have to use SOS Doctor Direct and then bill the patient’s GP surgery for the cost.

This is an unsafe situation. Why has this been allowed to happen? I have emailed NHS England about this but have not had a reply.

*

Incidentally, in 2 of my emails to you I asked a number of quite specific questions about the alleged benefit of parents registering near their child’s school; the Department of Health did not answer these questions. I have now created a video illustrating how this proposal, which might sound attractive on the surface, simply does not work and would actually create problems for a family. That you, the Department of Health, and NHS England should be encouraging people to sign up to something fundamentally flawed is truly surreal.

I do not expect you to do anything about this; I expect, at best, a ‘non-reply’ from the Department of Health. But I am writing so that it is at least on the record.

Yours sincerely,

George Farrelly

The Tredegar Practice
35 St Stephens Road
London
E3 5JD

@onegpprotest
#gpboundaryscam

 

Links:

1 My emails to Jeremy Hunt and Department of Health non-replies

2 NHS Choices webpage on Choose Your GP

3 My video on the consequences of registering with a GP near your child’s school

 

 


My emails to NHS England about the new GP boundary-free policy implementation

15/02/2015

[Names have been redacted to protect the innocent]

From: Farrelly George (NHS TOWER HAMLETS CCG)
Sent: 09 January 2015 18:26
To: ***** (NHS ENGLAND)
Cc: Farrelly George (NHS TOWER HAMLETS CCG)
Subject: out of area patient registration

Dear ****,

I am a GP in Tower Hamlets. At present, on the NHS Choices website, there appears to be no clear guidance as to which practices are actually opting into this service. Unless I am missing something, patients have no way of knowing which practices are offering this without ringing practices one by one.

We are not offering this because we do not feel it is workable, but if patients approach us we would like to have something to offer them in the way of signposting participating practices.

Best wishes,

George

The Tredegar Practice
35 St Stephens Road
London E3 5JD

*

From: ****** (NHS ENGLAND)
Sent: 15 January 2015 09:33
To: Farrelly George (NHS TOWER HAMLETS CCG)
Cc: ****** (NHS ENGLAND); ***** (NHS ENGLAND)
Subject: FW: out of area patient registration

 

Dear George

Thank you for your e-mail and please accept my apologies for the delay in responding to your query.

We currently don’t hold a central list of those practices that have expressed an interest in delivering out of area registration for patients, however, area teams have been provided with information via the e-declaration of those practices that indicated an early interest in the scheme so you may wish to contact NHS London who should be able to provide you with further information of local practices who may register patients out of area.

If I can provide any further assistance please do not hesitate to contact me or one of my colleagues.

Best wishes

******

******
******NHS England | 4E60| Quarry House | Leeds | LS2 7UE

High quality care for all, now and for future generations

 

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Email George Farrelly to NHS England, London; 23/1/15; 08:22

 

Dear NHS England London (North East Area Team),

I sent the following email (see above) to NHS England and you can see from this email thread that they have suggested, for the situation in London, that I contact you. I have a number of reasons for wanting to know how patients are to find practices that are signed up to registering patients who do not live locally (one is to direct patients who enquire).

“I am a GP in Tower Hamlets. At present, on the NHS Choices website there appears to be no clear guidance as to which practices are actually opting into this service. Unless I am missing something, patients have no way of knowing which practices are offering this without ringing practices one by one.

We are not offering this because we do not feel it is workable, but if patients approach us we would like to have something to offer them in the way of signposting participating practices.”

Do you have a list of London practices (or north east London practices) who have expressed an interest or have signed up to registering patients who live out of area?

You can reply to this email, or if you prefer my mobile is ***** *** ***.

Best wishes,

George

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Email George Farrelly to NHS England, London; 23/1/15; 09:08

Dear NHS England London,

I now have an additional question which relates to the other side of the coin: that is, patients who are resident in Tower Hamlets but have registered with a practice in, say, Ealing near where they work.

If that patient gets ill and is stuck at home on Tower Hamlets, the new arrangement is that they access a Tower Hamlets GP who is providing an enhanced service to these sorts of patients. But who is providing this in Tower Hamlets? (A recent Pulse article has suggested that the Out of Hours service might be called upon to provide this service, but that would mean they would have to be operating In Hours as well….). I will be speaking to our out of hours service shortly….[I spoke to the Tower Hamlets out of hours service; they had not been approach to provide in hours cover]

My understanding is that NHS 111 would have that information.

I have just rung NHS 111 covering Tower Hamlets but the helpful nurse advisor I spoke to was unaware of the new policy; she could only suggest that a Tower Hamlets resident without a local GP would have to go to a walk in centre or to A+E. She spoke to her supervisor who was also unaware of the new policy and where such a patient might be directed.

Can you help? (Can I say I sympathise with your situation: you did not dream up this policy but you have been given the task of implementing it….).

Again, my contact number is ***** *** ***.

Best wishes,

 

George

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15/2/15: I have not had a response from NHS England London.

I have since contacted NHS 111 for Islington where I live and they also did not know about the policy and they gave the same answer as NHS 111 for Tower Hamlets. I then rang NHS 111 for central London (this includes Chelsea and Westminster, Camden, Hammersmith, and others); they too are were unaware of the new policy and did not have a list of local GPs who could offer In Hours care for patients not registered locally.

*

12/6/15 update: I still have not had a reply from NHS England. I emailed Jeremy Hunt about this problem as well. The Department of Health gave a characteristically evasive and meaningless reply, but noted that I had written to NHS England.

A few days ago, I checked again with NHS 111 for Central London. The supervisor did not have an accurate understanding of the GP Choice Policy, and said there was no infrastructure in place to provide primary care services to local residents not registered with a local GP. They were not in a position to arrange visits to those requiring them, or consultations with local GPs. They would be advised to go to a Walk In Centre or to A+E.

 


Warning to GPs & public about ‘Choose Your GP Practice’ scheme

02/02/2015

The ‘Choose Your GP Practice’ scheme started on 5 January 2015. Under this scheme GP practices can register patients who do not live in their practice area. This is voluntary. The practice does not have to visit or care for these patients if they are sick at home and unable to get to the practice. According to the scheme, NHS England area teams will have put in place cover for these patients local to where they live for in hours urgent care.

In London, this does not seem to have happened. I spoke to 3 separate area NHS 111 teams and none of them were aware of the new scheme and none of them had a list of local GPs that would offer patients not registered locally. Their advice to patients in this situation is to go to a walk in centre or A+E. One of the supervisors said that if someone required an urgent home visit that they would call SOS doctors (a provider I have not heard of) and send them; they would have to pay for this service and they would charge the registered GP practice for this call. This did not seem likely, but it gives you the idea of the shambles we are in.

So if you are thinking of registering out of area patients, make sure they check if there is robust cover where they live, otherwise they will be left without primary care cover if they are ill and unable to access their registered practice.

See my opinion piece in Pulse.

See my video on this issue.