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

Ombudsman Reply 2 PNG

 

 

 

 

 

 


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.


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.


How does registering with a GP near your child’s school benefit you? Question to CEO of Patients Association

28/06/2014

28/6/14

Dear Katherine Murphy,

I am a GP in Tower Hamlets and have been following the Government’s policy regarding GP practice boundaries with some bewilderment over the past 4 years. I became aware that the Patients Association was also keen to abolish GP practice boundaries in the interests of giving patients more ‘choice’. You will of course be aware that the policy will be rolled out in England, on a voluntary basis, from October 2014.

My difficulty has been that the proponents of this policy do not seem to take into account some very practical problems inherent in the policy, and have made claims for the benefits of such a model which simply do not add up.

One suggested benefit will be that patients will be able to register at a practice near their child’s school. The Department of Health mentioned this in their December 2011 launch of the Choose Your GP pilot, you mentioned it in your Huffington Post posting in March 2013, it is mentioned in the first section of the Proposal by the team who then evaluated the pilot, and it has been repeated in the press.

I question the wisdom of this proposal and have asked Jeremy Hunt, the Department of Health, and NHS England the questions below, but they have not answered me. Because you have also gone on the record publicly proposing this as one of the incentives, can you please give an answer to the following questions:

a. what benefit accrues to a child or parent(s) by registering with a GP practice near their child’s school? What might they be hoping to gain from this? Does this mean a parent registering with the practice, or the child, or both? Would all the children of the family register with the practice? Would both parents, in two parents families, register with the practice?

b. how would this work from a practical point of view? When would they want to be seen? How would they make appointments?

c. what, if any, are the possible risks or drawbacks with this arrangement?

I would be grateful for your comments on this.

 

With best wishes,

George

The Tredegar Practice
35 St Stephens Road
London
E3 5JD

*

24/7/14

I have not heard from Katherine Murphy or the Patients Association. I wonder why….

Is it the same reason why the Department of Health has not answered these questions, or NHS England?

*

12/10/14

I have just sent the following email to the Patients Association:

Dear Katherine Murphy,

I sent you the email above on 28/6/14. I have not received a reply, so I am trying again. I will send this in the post as well in case there is some glitch in the system.

Best wishes,

George

The Tredegar Practice
35 St Stephens Road
London
E3 5JD

[the above items sent in Royal Mail 24/10/14]

*

My email to The Patients Association in June 2011.


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.

 


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.


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.