Exclusive: Practices face costs as occupational health funding cut

Practices could face bills of tens of thousands of pounds for occupational health services after NHS England said it would no longer fund them.

It is also sad to see that NHS England places so little value on the importance of occupational health services

Individual GPs also face costs for health certificates before they can begin working.

A review into occupational health services will report some time in December, but GP leaders have criticised a decision to push further costs onto overburdened practices.

NHS England revealed that GPs will be required to supply an occupational health ‘clearance certificate’ to area teams in order to join the performers list - a move slammed by one GP leader as ‘ridiculous’.

Occupational health services for practice staff, meanwhile, will have to be funded by practices.

Performance related services will continue to be funded by NHS England.

Deputy chairman Dr Richard Vautrey said GPC had repeatedly questioned why it was necessary to require GPs to supply health certificates, which could cost up to £70, to area teams.

‘It's yet another shifted cost on to GPs and we are yet to understand from NHS England on what medical grounds it would bar someone from being admitted to the national performers list but be allowed to work as a doctor elsewhere in the NHS,' he said.

‘It is also sad to see that NHS England places so little value on the importance of occupational health services previously provided to practices by PCTs. This is a service that should have been enhanced, not simply pushed on to practices as an additional unfunded cost.’

The discretionary occupational health services previously provided and funded by PCTs were rolled over and continued by area teams for a year from April 2013 while NHS England carried out a review. 

A practice manager told GP the costs for practices could be anywhere between zero and tens of thousands of pounds.

Sarah Longland, general manager at the Midlands Medical Partnership GP organisation, said: ‘A large practice like ours with 150 employees could see costs running easily into thousands, if not tens of thousands in a single year if there is high recruitment activity or sickness issues.’

A single recent occupational health report cost £750 pounds, she said, for an employee with long-term health problems.

Birmingham LMC’s executive secretary Dr Robert Morley said services in his area had already seen 30% funding cuts. He said he feared practices being forced to fund services. ‘Considering everything else practices are having to contend with at the moment, it would be very bad news’, he said.

Avon LMC’s Dr Simon Bradley said making practices fund services would be ‘another cut from the primary care budget by stealth’.

Practice staff were under stress, he said, and the NHS should ‘shoulder its responsibility’ to look after employees, ‘and resource that through reimbursement’.

Wessex LMC chief executive Dr Nigel Watson said the requirement for GPs to pay for occupational health certificates would not guarantee anything and was ‘ridiculous’ and would be ‘tough on young doctors’.

Occupational health services for staff were important, he said. ‘The problem is, we are not funded either to pay for it’. It’s all very well saying ‘now it’s the GP’s responsibility’. In other services you could increase your price list to cover the costs, but we are just told ‘you need to practice your responsibility’.

An NHS England spokeswoman said: ‘NHS England as a whole is reviewing the occupational health provision for primary care providers (i.e. those on the national performers list) and staff employed by primary care. A draft paper for comment (within the NHS) will be available this month following an audit performed earlier in the year.

‘Providers wishing to join the National Performers List (NPL) will be required to supply an occupational health clearance certificate to the area team with whom they intend working. The occupational health profession is working with NHS England to improve the current forms and make them profession specific. If a form cannot be supplied as a result of some occupational health concern then a more detailed assessment will be funded by NHS England.

‘In respect of occupational health assessments for staff employed by primary care, we expect that area teams will continue to secure the occupational health services under contract but that any use of these services made on behalf of primary care staff will be funded by their employer.

‘Finally any requirement for ongoing health intervention or treatment as a result of this assessment will be managed the same as for any patient in need of health interventions.’

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