Adults with Incapacity (Scotland) Act 2000

SGPC Guidance


SCOTTISH GENERAL PRACTITIONERS COMMITTEE GUIDANCE NOTE

Adults with Incapacity (Scotland) Act 2000

These notes are for LMCs to distribute to GPs to assist in answering queries from GPs regarding the implementation of part 5 of the AWI Act which comes into effect on July 1st 2002. They are not intended to be comprehensive guidance and we understand that guidance will shortly be issued on the SHOW website www.show.scot.nhs.uk/sghd/. At present you may wish to reference the Justice website for guidance relating to this legislation www.scotland.gov.uk/justice/incapacity/medicalCertificates.asp

Further guidance from the BMA ethics secretariat will be available on the BMA websitewww.bma.org.uk/ by July 1st.

  1. Fees

    Where a GP is required to carry out an assessment and issue a certificate to allow the GP or member of the Primary Health Care Team to treat the patient no fee is payable, as this duty falls within the GPs Terms and conditions of service.

    Where an independent health professional seeks confirmation that a certificate of incapacity is in force

    a) Following negotiation between the SGPC and the Scottish Executive Health Department regarding fees under Part 5 of the Act, it is anticipated that the SEHD will issue guidance clarifying that, where a medical certificate of incapacity already exists for a patient to permit GPs and staff acting on their behalf to treat a patient, an independent health professional may be permitted to draw upon this existing medical certificate to treat the patient in question. In such circumstances it has been agreed that the health professional should contact the practice to verify the existence of a completed certificate for the patient in question by telephone. Under this arrangement GPs would not charge a fee.

    b) If the health professional seeks written confirmation from the GP that a valid certificate of incapacity exists for a patient, then the GP would be entitled to charge the health professional for writing a letter of verification. This would be a matter for the GP to negotiate with the health professional or their employer. LMCs may wish to issue guidance to their constituents on the appropriate level of fee.

    Where a GP is requested by an independent health professional to carry out an assessment

    In cases where the GP has not issued a certificate of incapacity, and one is required by another health professional to treat the patient, then the charge for an assessment and certificate would be 98.50 and this would be detailed in the SFA. If for any exceptional reason a GP is required to undertake a second assessment and produce an additional certificate for an independent health professional, having already issued a certificate which enabled the GP to treat his or her own patient, then the SFA would also support the payment of the 98.50 fee to the GP for this additional work.

    Assessments under all other parts of the Act except Part 5

    GPs can charge fees under all other parts of the Act. The fee is payable by whoever requests assessment/certification. No official fee level has been set. In deciding personal remuneration levels there are many factors to take into account, such as, scarcity of resource, length of training, professional skill and experience, as well as the time required to complete the activity. Most doctors condense all of these factors into an hourly professional rate and then base their fees on an estimate of the time taken. Examples may help in determining the level of fee based on an hourly rate of 152.50. - 49.50 per 15 minutes, 76 per 30 minutes, 114 per 45 minutes.

    SGPC anticipates that the work involved in assessment/certification of incapacity will be between 30 minutes and an hour. Certificates to grant continuing powers of attorney and welfare powers of attorney may be completed either by a lawyer or a doctor. It is likely that less time will be required for this exercise than in assessing an adult who is incapable of giving consent and the fees charged should reflect this.

  2. Completion of Certificates under Part 5

    The intention of the Act is to facilitate, not impede access to treatment for incompetent adults. It is also intended to avoid inappropriate invasive or other treatment. While there will be instances where a certificate is required for a specific treatment, e.g. where written consent is normally required from a competent adult, the Code of Practice on Part 5 of the Act does allow for a certificate to be completed to cover a range of treatments. To avoid unnecessary bureaucracy doctors are likely to want to use relatively general wording on the certificate to allow for flexibility.

    The certificate gives authority for GPs or any member of the healthcare team acting on their behalf under their instructions, or with their approval or agreement, to treat a patient incapable of giving consent. Certificates may also be required to give other health care professionals, such as dentists, authority to treat where they are acting independently of the GP.

    Interventions including the offer of oral nutrition and hydration,skin care and integrity, elimination, relief of pain and discomfort,mobility, communication, eyesight, hearing, and oral hygiene need not belisted separately on the certificate. These could be encompassed under a general heading of "fundamental healthcare procedures" to which could be added as relevant, "and routine treatment of chronic diseases and intercurrent illness as detailed in the GP medical record". Such certificates can remain in force for a maximum period of one year.

    < P>For adults in residential or nursing care for whom a care plan has been written an option would be for the certificate to specify "fundamental healthcare procedures and treatment as outlined in the care plan".

  3. Treatment to preserve life or prevent serious deterioration in a patient's medical condition

    It is important to remember that the Code of Practice on Part 5 of the Act is clear that there is no need to go through the steps in Part 5 of the Act " in order to give treatment for the preservation of the life of the adult or the prevention of serious deterioration in his or her medical condition". (Paragraph 2.3) The Code goes on to say: "It would be contrary to good practice to risk prejudice to a patient's health through any delay in providing necessary treatment, in order to give effect to the procedures under Part 5 of the Act". (Paragraph 2.4). Interpretation of what would constitute 'serious deterioration' in medical condition will be up to individual GPs and could include for example, treatment of a chest infection in a frail elderly patient # in a nursing home, where without early treatment that patient might die.

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