What are collaborative arrangements?

Collaborative arrangements can include:

• family planning
• psychiatric work
• reports for adoption
• fostering
• 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

Setting and agreeing fees for collaborative arrangements

Except for family planning, there are no other nationally-agreed fees for collaborative arrangement work.

Services provided under 'collaborative arrangements' should be decided at a local level, and depend on the needs of an area.

Doctors are advised to set and agree their own fees for this work.

However, basic factual health information provided by GPs for community care purposes does not attract a fee. Any community care work that goes beyond the provision of basic health data, such as explanation, opinion, or prognosis, does.

Collaborative arrangement funding

Funding for collaborative arrangements can be included in CCGs' budgets.

Otherwise, this is a matter for local area teams pending the development of a longer-term solution.

It can also be the case that local authorities make direct arrangements for collaborative fees.

GP practices and local medical committees may wish to contact their area team for clarification of arrangements.

It has been accepted by NHS England that collaborative work is not part of GMS. Therefore in the absence of an acceptable fee, there is no obligation to undertake such work. It is unacceptable for the local authority to ask the patient to seek the information either directly or through a GDPR request.

Safeguarding reports and case conferences

The GPC (general practice committee) is aware of ongoing problems around the obligations and entitlements of GPs who are asked to attend child protection case conferences or to write safeguarding reports.

Some CCGs, while noting the GP contracts contain no provisions requiring them to contribute to the safeguarding process, have suggested that GPs would need to justify non-compliance.

If a report is not submitted, that non-compliance could breach a doctors’ safeguarding obligations and justify referral to the GMC and possible disciplinary action.

Furthermore, it has been suggested that a CCG could order a breach or remedial notice.

GPC has obtained external legal advice on the issue and we encourage practices to engage with safeguarding processes, but to agree a fee in advance of attending conferences or providing reports.

Our advice on charging

There are no agreed fees for completing safeguarding reports or attending case conferences.

GPC’s advice is therefore to provide the relevant services, but on the basis that a fee will be sought, indicating the rate of charge ahead.

Based on the legal advice we have received, we have produced a template letter to support you in your discussions with the local authority.

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.

GPC recently applied for judicial review on the current arrangements and establish whether safeguarding partners were failing to discharge their statutory obligations in meeting the cost of GPs’ work on safeguarding cases.

Although the judge found against us and dismissed the application, he supported a number of points:

• safeguarding partners are empowered to pay GPs
• GPs are not under a statutory obligation to provide information in aid of safeguarding investigations and case conferences
• GPs do have a professional obligation to assist with safeguarding investigations and conferences
• the obligation on safeguarding partners to pay GPs for these services depends on application of the ordinary common law principles of the law of contract and the law of restitution as they may apply from case to case
• safeguarding partners can reasonably be expected to agree suitable arrangements to pay GPs, and if they don’t, GPs may well take legal action to force them to.

The BMA has sought permission to appeal the judgement.