Collaborative Arrangements

Since 1974 the collaborative arrangements have enabled local authorities to secure primary care medical services essential for the provision of education, social services and public health at no charge to the patient.

Requests from Local Authorities

We know that practices are regularly receiving requests from local authorities to provide a whole range of services relating to the council’s responsibilities across education, social services and public health.  These include child protection, mental health assessments, fostering and adoption reports to name but a few. None of these are obligatory for GPs to provide under their contracts but, if GPs do provide them, then there is provision under the NHS Act for them to be paid under ‘collaborative’ arrangements.  It is the Area Team, not the local authority, who is responsible for making these payments should a GP carry out one of these services at the request of the local authority although in some areas, the local authority will pay the practice and then re-charge the Area Team.

Some social workers are familiar with these arrangements but we know that others are not.  We have therefore developed the following fee form template which is generic and can be used to make sure the right procedure is followed for all services requested by the local authority and done by GPs under the collaborative arrangements. We recommend that you forward a copy of the form to any local authority officer who requests a procedure but does not use the form initially (they should complete Section 1 and then return it to the practice).  The only exception may be if you receive an urgent request (such as a child protection issue). In such cases, it may be more appropriate to undertake the work without reference to the form.

Under locally agreed arrangements, the practice was paid a fee that was fixed by the DDRB.  This is no longer the case and the DDRB has not recommended fees for some years.  Practices can set their fee levels but they must be reasonable, transparent and subject to scrutiny.  They should preferably be notified to the Area Team in writing for agreement.

GPs are often the only individuals who can provide these services and the rate of pay may, on occasion, be of secondary importance, especially in cases where ethical considerations or maintaining the doctor-patient relationship imposes particular professional obligations, especially in relation to children.

Please remember that collaborative services do not include  any services covered by the ‘List of Prescribed Certificates’ under the GMS and PMS Regulations ­ you are obliged to provide these free of charge under your contract. For more guidance on what these are, go to: Mandatory Certificates

List of address/contacts details for Local Authorities and Area Teams

Area Teams:

NHS Commissioning Board (Wessex) 
Finance Department
Oakley Road
Southampton
Hampshire SO16 4GX
                                  

NHS Commissioning Board (BGSW)               NHS Commissioning Board (BGSW)
Finance Department                                       Finance Department
Bewley House                                                 Sanger House
Marshfield Road                                              5220 Valiant Court
Chippenham                                                   Brockworth Business Park
Wiltshire SN15 4JW                                        Gloucester GL3 4FE

(Wilts Practices)                                             (Swindon Practices)

Local Authorities:

Swindon Borough Council                              Wiltshire County Council
Finance Department                                      Finance Department
Civic Offices                                                   Bythesea Road
Euclid Street                                                  Trowbridge
Swindon SN1 2JH                                           Wiltshire BA14 8JN

Dorset County Council                                   Borough of Poole
Finance Department                                      Finance Department
County Hall                                                    Civic Centre
Dorchester                                                     Poole
Dorset DT1 1XJ                                              Dorset BH15 2RU

Bournemouth Borough Council                       Hampshire County Council
Finance Department                                       Finance Department
Town Hall                                                        The Castle
Bourne Avenue                                               Winchester
Bournemouth                                                  Hampshire SO23 8UJ
Dorset BH2 6DY

Portsmouth City Council                                 Southampton City Council
Finance Department                                       Finance Department
Civic Offices                                                    Civic Centre Road
Guildhall Walk                                                 Southampton SO14 7LY
Portsmouth PO1 2RY

Click here for Medical Fee Claim Form Template

Fee Setting & Competition Legislation

Competition legislation and the Office of Fair Trading (OFT) prohibit the BMA, LMCs, LNCs etc from advising on fees.
It is illegal for individual doctors or staff to discuss their fees outside their practice. 
Penalties for breaching this law are severe and can be up to 10% of organisation/practice turnover (not profit).

Wessex LMCS is, therefore, unable to provide specific advice to practices on fee levels.

Please see below an update from the BMA regarding attendance at child protection case conferences:

Members will be aware of ongoing problems around the obligations and entitlements of General Practitioners who are asked to attend child protection case conferences or to prepare written safeguarding reports for use at them. It has been brought to our attention that some CCGs, while noting the GP contracts contain no provisions requiring them to contribute to the safeguarding process, have nonetheless suggested that GPs would need to justify non-compliance with regard to their statutory safeguarding duties if a report was not submitted and that non-compliance could justify a referral to the GMC with the implication that disciplinary action could be taken against defaulting GPs. Alternatively, it has been suggested that a CCG could contemplate taking action for alleged non-compliance by means of a breach/remedial notice.

The approach of GPC has been to encourage practices to engage with safeguarding processes but to agree a fee in advance of attending conferences or providing reports. The provision by GPs of the relevant safeguarding services falls outside the scope of the range of essential, additional or enhanced services provided for in parts 8 – 12 of the standard GMS contract. Clause 19.1.2 (a) of the GMS contract specifically permits the contractor to demand or accept a fee or other remuneration ‘from any statutory body for services rendered for the purposes of that body’s statutory functions’.

GPC is aware of some confusion among GPs, local authorities, regional teams and CCGs as to who is now responsible for payment to GPs for work that falls under the term collaborative arrangements and while it works well in some parts of the country, in others, GPs are not being remunerated for this work. GPC is continuing to discuss with NHS England how this situation can be best resolved and it forms part of the ‘Urgent prescription for General Practice’ published earlier this year. We have emphasised that a fee is needed to cover the costs of the workload done and to ensure the practice has the capacity to do this work properly. Failing to fund this area of work leads to poorer quality services and local authorities should not be making cost cutting efficiencies in an important area such as the safeguarding of children and vulnerable adults.

GPC has obtained external legal advice on the issue, in which we asked for a view on the best way forward if it was not possible to reach a resolution through negotiation with NHS England. GPC’s position, having taken such advice, is that GPs do have an obligation to comply with their statutory safeguarding duties, but equally that they are entitled to a fee.

GPC’s advice is therefore to provide the relevant services, but on the basis that a fee will be sought for the same, indicating the rate of charge ahead of the provision of the report or attendance at the case conference as the case maybe. The commissioner of the service would be notified that acceptance of such services will be treated as signifying a willingness to engage the GP on the stipulated terms. In the event of non-payment a claim for the fee could then be pursued.