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Department of Health reply to my email to Jeremy Hunt 2/7/15 on the #gpboundaryscam

17/07/2015

I received the following from the Department of Health on 15/7/15, in reply to my email to Jeremy Hunter earlier this month:

Our ref: DE00000945045

Dear Dr Farrelly,

Thank you for your further correspondence of 2 July to Jeremy Hunt, Jane Ellison and Alistair Burt about GP services. I have been asked to reply.

I was sorry to read that you are not satisfied with the Department’s response of 29 June to your previous email (our ref: DE00000940960). I note your continuing concerns about patients registering with GPs outside of traditional practice boundaries.

As stated in my colleague’s previous reply, NHS England will continue to review this policy to ensure that it is meets the needs of the patients who are using the service and who may wish to use it. In addition, it will address the operational issues that have arisen since the introduction of the agreement to ensure that the system remains functional for GP practices.

I note that you have not yet received a response to your correspondence to NHS England, but, as it is responsible for primary care in England, I can only suggest that you continue to raise your concerns with it.

I am sorry I cannot be more directly helpful.
Yours sincerely,

[name removed]
Ministerial Correspondence and Public Enquiries
Department of Health

————————————————————————————————————————-

Please do not reply to this email. To contact the Department of Health, please visit the ‘Contact DH’ section on the GOV.UK website.

Of course, this is not a true reply, just another text masquerading as a reply.

Scoundrels.

Leave a Comment » | Department of Health, Department of Health Responses | Tagged: Choose Your GP, NHS, Patient Registration | Permalink
Posted by gpprotest

The Department of Health’s response to my last email to Jeremy Hunt about #gpboundaryscam

02/07/2015

Our ref: DE00000940960

Dear Dr Farrelly,

Thank you for your further correspondence of 14 June to Jeremy Hunt, Jane Ellison and Alistair Burt about GP services. I have been asked to reply.

I appreciate your ongoing concerns. As you know, the GP contract agreement for 2014/15 allows 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.

This arrangement is designed to make the system more flexible and give patients greater freedom in choosing a suitable GP practice – for example, commuters may wish to register with a practice close to their workplace, as opposed to where they live, and people who move house may wish to continue to attend their existing practice.

The agreement was introduced in January and there are currently over 14,000 patients registered with practices away from their home since. All NHS England regional teams have arrangements in place to ensure that those patients are able to access services should they require primary medical care whilst at home.

Those arrangements vary across the country. Many regions commission the national enhanced service model, while some use the local out-of-hours services, and others commission a range of services. However, all have ensured that, should the patients registered in their area require care, they are able to provide it.

To date, NHS England has received no patient complaints or concerns about this matter through its customer contact centre or operational teams in the regions. However, it is aware of some concerns from GP practices about registration and operational issues that it has worked with them to resolve.

NHS England will continue to review this policy to ensure that it is meets the needs of the patients who are using the service and who may wish to use it. In addition, it will address the operational issues that have arisen since the introduction of the agreement to ensure that the system remains functional for GP practices.

I am sorry I cannot be more directly helpful.

Yours sincerely,

[name removed to protect the innocent]

Ministerial Correspondence and Public Enquiries
Department of Health

Please do not reply to this email

For my next email to Jeremy Hunt and comments on this response

Leave a Comment » | Department of Health Responses | Tagged: Choose Your GP, NHS, Patient Registration | Permalink
Posted by gpprotest

My latest email to Jeremy Hunt on #gpboundaryscam

14/06/2015

Dear Jeremy Hunt,

I am a GP in Tower Hamlets. I have emailed you on a number of occasions regarding the Government’s policy on allowing patients to register with a GP at a distance from their home. My last email pointed out that there are actual serious flaws in the way you have implemented this policy which went live on 5/1/15.

I have received a reply from the Department of Health, which was typical in that it does not address the fundamental issue of safety and avoided mentioning the rather large elephant in the room: that the policy simply does not work, and that for people who are actually too ill to get to their registered GPs it is unsafe. This is something the Health Select Committee should look into.

Incidentally, I complained to the Parliamentary and Health Service Ombudsman about the Department of Health’s wholly inadequate replies to my emails. They replied, politely, saying they are not able to deal with my complaint because, by law, they are prevented from investigating complaints about policy decisions taken by government departments.

In addition, I have an email exchange going with the NHS Choices website who are, understandably, reluctant to publish my comment on their webpage dealing with this policy.

So we have an interesting situation: successive governments have promoted this policy since 2009, apparently unaware of the foolishness of their claims and promises. My GP colleagues and I, as frontline workers who have to deal on a daily basis with the practicalities of delivering general practice services, have tried to warn you but you do not listen. And when you actually implement a policy which is operationally unsafe, I cannot find a way to make a complaint. I have of course emailed NHS England (two separate threads, click here & here) but I have had no reply.

Normally, under these circumstances, one might expect the media to pick up this story: ‘Government pushes through flawed policy by misleading the public’ etc etc. But the mainstream media seem to have singular approach to this issue: they will publish the Department of Health’s fanciful promises, but when it comes to the multiple flaws in the policy they are silent. They behave as though they have been paid off. Or perhaps it is the Emperor’s New Clothes dynamic. Strange.

I will close with a question which I am sure you and the Department of Health will not answer: if a citizen, a frontline worker, discovers a significant flaw or flaws, in a Government policy and the Government and the relevant civil service department (and the Health Select Committee?), pretend it is not happening; and if a complaint cannot legally be investigated; and if the media will not ask some awkward questions–what then is the citizen, the person on the ground, to do next?

Best wishes,

George

The Tredegar Practice
35 St Stephens Road
London
E3 5JD

“For a successful technology, reality must take precedence over public relations, for nature cannot be fooled.” Richard Feynman, Physicist

Leave a Comment » | Department of Health, Emails to Jeremy Hunt | Tagged: Choose Your GP, General Practice, NHS England, NHS England London | Permalink
Posted by gpprotest

I complained to Parliamentary & Health Service Ombudsman about DoH non-replies to my concerns; they are legally not allowed to investigate

25/05/2015

In September 2013 I sent Jeremy Hunt, Secretary of State for Health, an email pointing out the problems inherent in the Coalition Government’s flagship policy to make it possible for patients to register at any practice they wished in England. I received a non-reply from the Department of Health. So I wrote again and received a similar response. So I wrote again and received a reply saying they had nothing to add to the previous emails and that unless I had something new to ask they would not reply to any further emails. For links to the emails and non-replies, click here.

So I sent a complaint to the Parliamentary & Health Service Ombudsman; in its essentials, my complaint was that Jeremy Hunt and the Department of Health had failed to address the issues I raised and respond to each of the issues raised.. I sent ample documentation to demonstrate the problem.

This is the Ombudsman’s reply:

Ombudsman Reply 1 PNG

Leave a Comment » | Department of Health Responses | Tagged: Choose Your GP, GP practice boundaries, NHS | Permalink
Posted by gpprotest

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 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]

Leave a Comment » | Department of Health | Tagged: Choose Your GP, NHC Choices | Permalink
Posted by gpprotest

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.

Leave a Comment » | Department of Health Responses | Tagged: Choose Your GP, GP practice boundaries, whistleblower | Permalink
Posted by gpprotest

5 + 47 + 3 + 17 = 8? Not in the world I work in

29/11/2014

How to cut through the Kafkaesque Government smoke and mirrors to get at what is wrong with their flagship policy to improve the NHS by giving patients the ability to choose their GP practice, anywhere in England? This was to have come into effect in October 2014 and is now due to start on 5 January next.

5 + 47 + 3 + 17 = 8: this is one way of getting to the heart of the problem. The politicians, health ministers, the Department of Health, & NHS England will tell you that 5 + 3 = 8. This is true enough. The only problem is that the numbers that need to be added up are 5 + 47 + 3 + 17; in the material world I work in these numbers do not add up to 8.

When I have pointed out to the Department of Health that they have got their sums wrong, they in essence reply by saying 5 + 3 = 8. NHS England have done the same.

Others also behave as if they are unable to do basic arithmetic: the King’s Fund, the Patients Association, health editors at the mainstream news outlets, the BBC, even the Health Services Journal.

In the world I work in you really have to respect the numbers. Ignore the numbers and the building falls over.

Watch this space.

Leave a Comment » | Department of Health, Kafkaesque | Tagged: Choose Your GP, General Practice, GP practice boundaries | Permalink
Posted by gpprotest

It is now crystal clear: the Choose your GP Pilot ‘independent evaluation’ in no way evaluates the actual policy

12/04/2014

Yesterday the practice manager of a large Tower Hamlets practice (and CCG Board member) and I went to meet with Professor Nicholas Mays and two other authors of the Evaluation of the choice of GP practice, 2012-13 at the London School of Hygiene and Tropical Medicine.

We outlined the reasons why abandoning practice boundaries in Tower Hamlets would not be in the interests of our aim to provide good quality primary care services to our local communities. Quite to the contrary, why it would be harmful and destabilising.

We had an interesting conversation about the pilot, about the various competing aims, about unintended consequences, about politicians, and about pilots.

I believe their report is well written and contains a number of important points, and they have done a serious piece of work. But they were clear that their evaluation only evaluates the pilot, and not the policy. The pilot had small number of patients and in no way ‘tested’ the policy; in fact, the sorts of risks I have highlighted in my Submission to the Health Select Committee are not revealed by the pilot, they are hidden. (I expressed these concerns in an article for Pulse in December 2012.)

It is as though you invited smokers over the age of 70 to meet you at the top of a tall hill, and you asked them if they liked smoking and if it had impacted negatively on their health. It is likely that they would say that they enjoyed smoking, and it caused them no problems (hence their age and ability to get up the hill). You might conclude that smoking was a harmless pleasure.

Leave a Comment » | Department of Health, Government Pilot, GP practice Boundaries | Tagged: Choose Your GP, GP practice boundaries, NHS | Permalink
Posted by gpprotest

A question for NHS England (London) on GP boundaries and patient access

31/01/2014

I have read a draft version of your Primary Care Commissioning Intentions for London 2014/15 London Region (v 1.1) and the following caught my eye:

….access to primary care services continues to be problematic for many Londoners. We are sure that the reaction and response to Call to Action will enable us to develop plans to improve access and the patient’s experience of access. Already, as part of the GP contract settlement for 2014/15, we will see a number of changes designed to improve access:

Choice of GP practice. From October 2014, all GP practices will be able to register from outside their traditional boundary areas without a duty to provide home visits. This will give members of the public greater freedom to choose the GP practice that best meets their needs. Area Teams will need to arrange in-hours urgent medical care when needed at or near home for patients who register with a practice away from home.

Can you explain how boundary-free general practice is going to improve patient access? Here in Tower Hamlets we cannot see how this will help.

Please leave a comment below.

Leave a Comment » | But does it work?, Department of Health, NHS England | Tagged: Choose Your GP, GP practice boundaries, NHS England, NHS England London | Permalink
Posted by gpprotest

If abolishing GP boundaries is such a good idea, why won’t the Department of Health answer some basic questions?

25/01/2014

I have written on three occasions to the Secretary of State for Health, Jeremy Hunt, copied to the Health Select Committee members (and miscellaneous media outlets) about some very basic problems with the Coalition Government’s flagship policy to abolish GP practice boundaries.

On each occasion, I have had replies from the Department of Health. None of these replies have remotely addressed the warnings I have raised.

It is as though an able seaman were to send an iceberg alert to the officers, and receive in reply the rota for cleaning the toilets on Deck C. Not once, but three times…

In the third reply, the Department of Health official writes:

“I note that you have contacted the Department of Health previously on a number of occasions about this issue. The information given to you by my colleagues is the most up-to-date and accurate available, and there is nothing further I can add to this. The Government’s position remains as set out in previous letters.I am sorry if this is not the reply that you were hoping for, but as there is nothing further that the Department can add, we must now consider this matter to be closed. ”

First email to Jeremy Hunt

Department of Health response

Second email to Jeremy Hunt

Department of Health Response

Third email to Jeremy Hunt

Department of Health Response

NHS England have done no better; see their reply, and my second attempt to get them to answer my questions.

Leave a Comment » | Department of Health, Department of Health Responses, Emails to Jeremy Hunt | Tagged: Choose Your GP, GP practice boundaries, whistleblower | Permalink
Posted by gpprotest