This is further to my thread here (but can't seem to post there for some reason): https://www.keepbritainfree.com/forum/activism/what-care-is-the-nhs-a-gp-legally-obliged-to-provide
Just written to the Royal College of GPs: I have been trying to find the answer to this, but have been unable so I wonder if you can help me. Could you tell me what specific aspects of the law GP practices are following when they say that patients cannot be seen in person, and must only be seen by telephone or digital appointment please? The CoronaVirus Act was revoked and replaced on 3rd July with Part 2 and it’s unclear exactly what applies to medical care? https://www.legislation.gov.uk/uksi/2020/684/regulation/1/made Matt Hancock has since said all healthcare apts will have to remain remote / digital for the foreseeable. On what authority has he done that? And on what legal basis are GP practices enacting it?
Secondly, could you point me at what rights patients have during this time? If, say, GP practices are enacting guidance as if it was law, and are rationing, reducing or cutting services to patients, what recourse do patients have?
Thirdly, could you let me know, are GP practices and care providers still subject to PSED duty, equality impact assessments and risk assessments? I assume they are obliged, when working out what services to offer, to ensure they are not discriminatory. E.g. telephone appointments could be exclusionary to hard of hearing and deaf people, and zoom or digital appointments are difficult to access for those who are elderly, don’t have access to technology or are learning disabled?
My local practice, I hear anecdotally, are asking patients to take photos of body parts and text and email to them the surgery. I assume that practice is not consistent with good risk assessments, GDPR, or patient dignity, privacy or confidentiality? it would only take one nefarious person in the practice to upload intimate photos to a p0rn site, or share them outside the practice for that to be quite a serious breach I assume?
I’ve looked at your website, and I notice that you have plenty of information about GPs assessing the risks to themselves, but I can’t find anything about assessing risks to patients by withdrawing care in this way? Could you tell me what GPs are obliged to do?
I assume that GP practices are assessing the risks to their patients when they are not seen in person, and each practice is obliged to carry out such a risk assessment? This article on risk assessments is useful, http://laworfiction.com/2020/07/risk-assessments-an-important-chink-in-the-lockdown-armour/ In law, Covid19 does not represent a clear and imminent danger. I assume therefore, when risk assessing remote services, GPs are obliged to balance risks? Such as missed diagnoses, late diagnoses, missing symptoms by relying on the patient to self report them, late referrals etc?
I also note RCGP is recommending GP practices enforce the wearing of masks when people do have to come into the practice, and enforce social distancing (which is not law). Here is the law on masks: http://laworfiction.com/wp-content/uploads/2020/07/Face-Covering-Exemption-Notice-with-Law-Explained-24-July-2020.pdf I assume GP practices have been given clear guidance on the exemptions that apply to face masks and are clear that they cannot refuse care to anyone who is legally exempt from wearing one?
The reason I ask all this is my local GP practice is refusing to see my elderly dad, he’s getting very threadbare care by telephone, and access to care is policed by over zealous receptionists who are giving out advice that I believe is neither lawful, enforceable, nor accurate. I want to know on what basis are NHS providers withdrawing care from their patients like this?
Any update on this?
Bec....go on yersel girl! Whoop! Let us know what they say cos I'm p'd off GPs hid while working class served all their food and deliveries . I also want our dentist back cos my teeth have gone downhill since this lockdown and if I a chambermaid or shop keeper can work, then these health workers can too.
I wrote to Sir Graham Brady, chair of the 1922 Committee, copying him in on my reply to NHS England (suggest everyone writes to Sir Graham, Tory backbenchers must be in despair!):
Sent: 25 August 2020 08:27 To: 'firstname.lastname@example.org' <email@example.com> Cc: 'Philip Dunne MP' <firstname.lastname@example.org> Subject: Lockdown - NHS care query
Dear Sir Graham
I wonder if, as Chair of the 1922 Committee, you could help me. I’ve gone around the houses of NHS England, BMA, RCGP, CCG, CQC and nobody seems to know the answer. On what authority has Matt Hancock ordered GPs to triage patients remotely, and who is responsible for Risk Assessments and Public Sector Equality Duty?
My email to NHS England below. Lawyers are increasingly concerned at the way the government have blurred the distinction between law and guidance and I think the crux of the matter for statutory services will be Risk Assessments and Equality Impact Assessments. HSE’s risk assessment guidance (linked by NHS England from their guidance document to GPs) is not lawful. Please see here: http://laworfiction.com/2020/07/risk-assessments-an-important-chink-in-the-lockdown-armour/
If citizens knew the answer to the questions I raise below, they could easily write to their local service provider and bring this situation to a close. It would apply to schools, doctors, hospitals, local authority services, care homes, environmental health etc. Local businesses, currently terrified into thinking they have to choke their business with reams of regulations, could actually trade unfettered.
I think the government faces a legal reckoning, and when people truly understand the degree to which they were misled about what they ‘had’ to do, and what was merely ‘guidance’ dressed up as rules, there will be a huge backlash. I’d be grateful if you could help me untangle who is responsible for what, before these unevidenced non pharmaceutical interventions wreck our country.
Sent: 25 August 2020 08:11 To: 'CASEWORK (NHS ENGLAND & NHS IMPROVEMENT - X24)' <email@example.com> Subject: RE: Legal query
Thanks for getting back to me and sending me the links. Unfortunately they don’t answer my questions. What I want and need to find out is the following: 1. What is the legal basis for Matt Hancock ordering GPs to change the way they deliver care? GPs are contracted to NHS England, not the DoH, has there been a contract change? What bits of legislation (partic in the Coronavirus Act Pt 2) underpins this change?
2. Who is responsible for Risk Assessments and PSED – is it you, or is it individual practices?
3. There’s plenty in what you sent me about risk assessing for staff, and none about risk assessing for patients. Risks have to be balanced. As I said in my original email, HSE guidance on risk assessments – which is linked from the docs you sent me – is not lawful. Risk has to be actual and evidenced, in law covid is not a serious and imminent danger, so you cannot risk assess it on risk of transmission, only the actual risk (of illness, death etc) so that would require looking at the actual stats on hospital admissions, ICU beds, deaths etc in your local area. It’d also need to be risk assessed balanced against other risks and illnesses – missed treatment, screening, difficulty accessing changed care, isolation, etc. See the section here on HSE risk assessments: http://laworfiction.com/2020/07/risk-assessments-an-important-chink-in-the-lockdown-armour/
For instance, the BMA link you sent me says “Doctors are being asked to triage and treat patients by remote consultations where possible to protect staff and patients from infection of Covid 19” – that is not a sufficient legal reason, or indeed risk assessment basis, to change the way care is delivered, the risk is not infection (and cannot be lawfully risk assessed as so), the risk is the actual risk of harm (which is nigh on zero, on the evidence). Someone somewhere is responsible for this guidance, and it’s legal basis. Who is it?
4. By law public sector providers have to follow PSED – public sector equality duty. There’s nothing in what you sent me about Equality Impact Assessments, and these are legally required. Who is responsible for that? DoH? NHS England? The CCG? The individual practice? This requires a full, frank and evidenced assessment of the impact of these changes, services, and guidance on each protected characteristic in the equality act. In particular sex, age, pregnancy and maternity, and disability. Services are legally not allowed to be discriminatory. I cannot find anything in what you sent me about ensuring services are fair and equitable. Who is responsible for that?
I’d be grateful if you could get back to me urgently, patients have had 6 months of missed care, hospitals are way under capacity, nationally deaths are now about zero, and excess deaths from other causes are up, and ‘cases’ (positive tests, which at this level of prevalence are pretty much statistical noise) are not translating into an uptick in admissions or deaths. It’s important therefore that patients, the public etc are clear on the basis on which they are being denied access to full and usual care, and that their rights are upheld.
Hi All No reply from my CCG (will chase), and no reply from CQC but did have a reply from NHS England: Thank you for your email.
I can provide you with the following link to the Guidance and standard operating procedures for GP practices that has been updated this week.
You may find that this answers your questions, in particular the advice that: