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.
The main areas covered by collaborative arrangements (involving certificates or reports) are:
- Those in relation to children in care or being considered for adoption and fostering, together with certificates and reports on prospective adoptive or foster patents;
- Psychiatric examinations for the sectioning of patients (under the Mental Health Acts);
- Priority housing reports requested by local authorities;
- Attendance at case conferences and other meetings arranged by Social Services;
- Sessional work commissioned by family planning clinics under local authorities or ICBs.
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.
Fees Under the Collaborative Arrangements
Services under the collaborative arrangements are provided without charge to the patient. On 1st April 2015, responsibility for collaborative arrangements transferred to ICBs. The mechanisms and responsibility for the reimbursement of fees are agreed locally between the parties concerned.
In its evidence to the 2006 DDRB Report, the BMA highlighted its concerns that the level of fees payable to doctors under the collaborative arrangements were no longer economic and lacked consistency with rates paid for other work outside a doctor’s Terms and Conditions of Service. The fees were also discouraging medical participation in these areas. The BMA therefore recommended that these fees should be linked to GP remuneration and that if this could not be recommended, doctors should be allowed to charge their own market rate. In 1997 the DDRB had recommended that fees under the collaborative arrangements should be established by market rates and the BMA supported a return to this recommendation.
Following the DDRB’s recommendation in the 2006 Report, the BMA’s advice to individual doctors and GP practices was that they should establish their own fees for work under the collaborative arrangements. They should also have notified their primary care organisation (succeeded by NHS England and now ICBs) in writing that, as there is no longer a DDRB recommended fee, any request for collaborative work received after a set date would be charged at their own fee rate – at the time, the BMA recommended a notice period of three months.
The BMA is very aware that doctors are the only individuals who can undertake many of the items of work under the collaborative arrangements. Therefore, doctors need to strike a balance in setting their own fee, making sure their remuneration levels and overheads are charged on a time basis, but fee levels must be reasonable, transparent and be subject to scrutiny where necessary. The BMA strongly advises that fees should be set out in writing and agreed in advance of the work being undertaken and has produced a template letter for practices to use:
Collaborative arrangements funding used to be held by PCTs and when they were disbanded, it transferred to NHS England area teams, who were advised to maintain collaborative arrangements. In Wessex, NHS England transferred responsibility for this function to ICBs either on 1st April 2015 or 1st April 2016.
Subsequently, processes for claiming fees under the collaborative arrangements have been unclear, leading to confusion as to how practices claim for work carried out within collaborative arrangements.
There are basically two mechanisms as to how a practice could claim payment:
- If you carry out one of these services at the request of the local authority, invoice the ICB;
- The local authority pays the practice and then re-charges the ICB.
Some ICBs have produced and offered a Local Enhanced Service for some services, notably those around safeguarding reports and attendance at case conferences and where a practice has signed up to the LES then no further collaborative fee is claimable.
Safeguarding – Updated GPC Guidance 13th October 2016
The following updated guidance was provided by GPC in October 2016:
‘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 ICBs, 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 ICB 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 ICBs 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 in April 2016′. We have emphasised that a fee is needed to cover the costs of the workload undertaken 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.’
This was further confirmed by a letter from David Geddes, Head of Primary Care for NHS England on 11th July 2019
Services Attracting a Collaborative Fee
Collaborative arrangements can include:
- family planning
- psychiatric work
- reports for adoption
- children in care and priority housing
- community service certificates for offenders who fail to attend
- visiting medical officers to local authority-maintained establishments
- attendance at case conferences arranged by social services
Collaborative fees cannot be determined or agreed across Wessex as this is seen to be contrary to the Competition and Markets Authority Regulations.
However, it is possible to calculate a reasonable charge by using the Wessex LMCs costing template: Costing a Service.
Some ICBs have confirmed what they believe to be a reasonable fee for certain reports etc eg £135.20 for a safeguarding medical and report (taking 45 minutes in surgery) but it is up to the practice to agree their fee based on their own calculations of the resource needed.
Next Steps for Practices:
- Establish your fees for services within collaborative arrangements.
- Notify your ICB finance department and Local Authority of your fees.
- Agree the mechanism for claiming fees with your ICB and Local Authority (direct invoicing to ICB seems to make more sense than the LA paying and then re-charging but it is recommended you agree this).
- Be mindful of your safeguarding obligations but confirm to the ICB / LA in advance of providing these services what your fee will be.
Additional useful BMA links: