PI Brief Update

Do GPs make Reasonable Adjustments for Disabled People? - Dr Mark Burgin

30/12/19. Dr. Mark Burgin BM BCh (oxon) MRCGP considers what is a reasonable adjustment in General Practice and the recent vote on home visits at the GPC.

“England LMCs conference backed a motion calling for the GPC to negotiate with NHS England to remove home visits from the contract.”

General Practice is poorly resourced to provide transport for disabled people so many require home visits particularly when they are ill.

More concerning is that home visiting is the only reasonable adjustment that is in the contract and GPs can delegate visits to other staff anyway.

If GPs are saying publicly that they are unhappy about complying with their duties under the Equality Act 2010 what are they doing in private?

Section 29 Provision of services, etc

GPs can fall foul of many of the provisions in section 29 for instance if an appointment was offered the same day but a home visit the next day.

If a patient was struck off because of behavioural problems that have substantial and long-term adverse effects on the activities of daily living.

If a GP repeatedly contacts a disabled patient who declines preventative services (the GP suffers a financial loss) then this may well constitute harassment.

At a time when the NHS is under intense pressure GPs it is perhaps understandable that complying with the Equality Act is not a high priority.

Responsibility for follow up

GPs typically respond to requests from their patients and rely upon the patient to return if necessary assuming that if they DNA they are better.

Whilst this is likely to be unavoidable due to financial constraints there are a number of steps that could be taken if the patient’s disability would put them at a disadvantage.

An electronic flag could be put on the record, a telephone appointment could be arranged, the tests could be checked online or follow up from another member of staff.

Serious consequences are a possibility in a small percentage of patients and a small percentage of appointments so the overall cost would be moderate.

Mental Health Treatments

GPs should not put patients suffering mental health problems at a disadvantage when compared with those suffering physical problems.

This becomes an Equality Act 2010 issue when the person with mental health problems is disabled (which is common occurrence).

Despite the near equality of physical and mental health problems in Primary care few GPs and few GP trainers have done more that the mandatory 8 weeks training in psychiatry.

There is a desperate need for a diploma in psychological medicine or psychiatry to recognise those who have developed high level skills in this area.

Conclusions

Some inequities are due to failures in the system (average 9 years training in physical conditions v 1 year in mental health conditions).

Others are due to old fashioned systems and failure to use the computer recall functions to take responsibility for the most vulnerable patients.

The most concerning issue is that patients with ‘hidden’ disabilities are often unrecognised and no adjustments are made for them.

Although GPs write millions of fit (sick) notes a year few have ever received formal training on disability analysis which may explain the low priority of this area.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website drmarkburgin.co.uk

https://www.gponline.com/lmcs-vote-remove-home-visits-gp-contract/article/1666629

Equality Act 2010

Section 13(1) A person (A) discriminates against another (B) if, because of a protected characteristic, A treats B less favourably than A treats or would treat others.

Section 29 Provision of services, etc. (2)A service-provider (A) must not, in providing the service, discriminate against a person (B) (a)as to the terms on which A provides the service to B; (b)by terminating the provision of the service to B; (c)by subjecting B to any other detriment. (3)A service-provider must not, in relation to the provision of the service, harass— (a)a person requiring the service, or (b)a person to whom the service-provider provides the service.

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