Doctors’ fees

Press, 9 July 1986, Page 16

Doctors’ fees

Sir,—ln the correspondence concerning practice nurses noone has told us exactly what the duties of a practice nurse are, so we cannot judge if this service paid for by the Health Department is being abused or not. The second point on which I would like enlightenment is whether the general practitoner is entitled to claim from the Health Department or Accident Compensation Corporation for every dressing, injection, etc., which the practice nurse does? If no claim is to be made why, after having been treated, is the patient told to wait for the doctor to put his head around the door to ask, “has nurse dressed your finger?” It seems completely wrong if he is entitled to (and does) claim when the nurse is paid for by the Health Department.—Yours, etc., R. STOCKWELL. June 21, 1986.

[Mr G. R. Boyd, director of clinical services, Department of Health, replies: “Your correspondent has drawn attention to a sensitive and delicate matter.

There are really two separate issues involved. First, that of responsibility. A doctor, as the employer, must take responsibility for the treatment provided by the practice nurse, and so there will be some instances when the doctor will want to check that proper treatment has been provided and that the treatment is to the satisfaction of the patients. The second relates to practice costs. Although the department has provided 100 per cent subsidy of the salaries of practice nurses (reduced to 75 per cent from July 1, 1986) there are still costs to the doctor in employing a practice nurse, such as accommodation, uniforms, heating, telephones and in some cases the use of a car. However, a condition of the 100 per cent subsidy has been that there shall be no direct patient charge for the service of its nurse. These costs must, however, be recouped somehow and this may be by building them into the doctor’s general medical service fee charged to the patient or to the Accident Compensation Corporation for each consultation. This is only legally permitted if the doctor has personally provided some form of service direct to the patient. Some doctors evidently interpret this rule in the way described by your correspondent. When the treatment is for an accident patients have every right to ask what the Accident Compensation Commission has been charged on their behalf.”]