Clinical Issues

Generally speaking we do not give advice about clinical areas unless there are controversial issues which we feel need clarification. We would recommend that doctors use more robust up to date websites for clinical advice such as NICE Guidance, the Scottish Intercollegiate Guidelines Network (SIGN) the BMJ (for BMA members) or similarly respected sources. Those issues on which we have information on are to be found in the website library folder ‘Clinical and Prescribing Issues’.

  • Library
8382Beds and Herts Priorities Forum
added 6 years ago
11022Controlled Drugs
added 5 years ago
25418Ebola
added 3 years ago
10754Prescribing
added 5 years ago
5270Private Treatment
added 48 years ago
5283Sick Pay & Fit Notes
added 48 years ago
5284Smoking
added 48 years ago
6269Summary Care Record
added 6 years ago
6767Vaccinations and Immunisations
added 6 years ago
7077National Institute for Health and Clinical Excellence
Type: html, added 5 years agoNICE guidance sets the standards for high quality healthcare and encourages healthy living. Our guidance can be used by the NHS, Local Authorities, employers, voluntary groups and anyone else involved in delivering care or promoting wellbeing
AuthorNICE
AudienceHealth Care Professionals
PurposeLink to Website
SynopsisNICE guidance sets the standards for high quality healthcare and encourages healthy living. Our guidance can be used by the NHS, Local Authorities, employers, voluntary groups and anyone else involved in delivering care or promoting wellbeing
16003Personal Health Budgets Statement
Type: html, 24856, added 5 years agoRoyal College of General Practitioners' position statement
AuthorRCGP
AudienceGPs and Practice Managers
SynopsisRoyal College of General Practitioners' position statement
7078Scottish Intercollegiate Guidelines Network (SIGN)
Type: html, 11000, added 5 years agoThe Scottish Intercollegiate Guidelines Network develops evidence based clinical practice guidelines for the National Health Service in Scotland. SIGN guidelines are derived from a systematic review of the scientific literature and are designed as a vehicle for accelerating the translation of new knowledge into action to meet our aim of reducing variations in practice, and improving patient-important outcomes
AuthorSIGN
PurposeLink to Website
SynopsisThe Scottish Intercollegiate Guidelines Network develops evidence based clinical practice guidelines for the National Health Service in Scotland. SIGN guidelines are derived from a systematic review of the scientific literature and are designed as a vehicle for accelerating the translation of new knowledge into action to meet our aim of reducing variations in practice, and improving patient-important outcomes

Interface between private and NHS services

A large number of patients opt to have some or all of their investigations and treatment privately. Some use private health insurance, while others are willing to pay to be seen more quickly, or for the added convenience or comfort of receiving their care in private facilities. In these cases, treatment in the private sector is used to substitute treatment within the NHS. Patients are entitled to choose freely between NHS and private treatment, whether provided as a private service by an NHS body or by the independent sector, at different points in their overall care.

This document from the BMA gives useful guidance and advice to doctors on the rules and ethics regarding the interface between private and NHS treatment, and includes information about private prescriptions and referrals.

Secondary to Primary Shift

The LMC is very well aware that there has been an inexorable shift of secondary care work into the primary care setting putting the responsibility firmly on the shoulders of GPs. The 2004 contract was sold on the grounds that there would be ‘no new work without appropriate resources to deliver it’ but this has turned out to be a very weak promise and we have witnessed workload rising year on year. The LMC continues to battle on behalf of patients and GPs to ensure that any shift onto general practice is appropriate, does not put patients at risk and is accompanied by the resources necessary, so that other services for patients aren’t over-stretched and, therefore, jeopardised as a result. It is this shift, without adequate appropriate resourcing, that has led to much of the patient dissatisfaction with GP access as GPs time is taken up more and more with patients with very complex, interacting, multiple pathologies – a fact not recognised by government and the senior NHS managers, blinkered by financial constraints.

We understand that treating patients in settings closer to their own homes (or even in their own homes) is, frequently, not only what patients want but also reduces the risks of hospital settings and may have better outcomes. However, we also recognise that as the elderly population rises and people live longer with on-going chronic illness, the pressures on primary care and General Practice, in particular, to absorb this workload will only escalate. Therefore, this needs to be addressed urgently by emerging Clinical Commissioning Groups as it quite clearly poses one of the most critical challenges faced by the NHS as a whole. This is one of the reasons why the LMC is engaging fully with the CCGs in order to ensure that the pressures on General Practice are clearly recognised and addressed and that the expectation that General Practice can continue to expand without adequate resourcing is countered.

Working within one’s capability

The GMC document, Good Medical Practice is very clear that a doctor should work within the limits of his or her competence. It reads:

“Patients must be able to trust doctors with their lives and health. To justify that trust you must show respect for human life and you must: Knowledge, skills and performance

– Make the care of your patient your first concern.

– Provide a good standard of practice and care.

– Keep your professional knowledge and skills up to date.

– Recognise and work within the limits of your competence…”

The pressure for GPs to undertake more and more work from the secondary sector stretches this requirement often to its limit. We therefore, support any GP who believes that an inappropriate request breaches this requirement.

If you are not able to find an answer to your query, please contact the LMC office on 01438 880010, to see if we can help further.

Last reviewed on 8th December 2015 (HB).