Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 80 - 99)



  80. Do you pay them any other expenses if they have to go back having been overbooked and are not able to have their examinations that day?
  (Mr Raja) There are offers of transport available. We do offer a facility where if the claimant is asked to come back the expenses will be paid.

  81. So they are only paid travel expenses if they have to come back, they are not paid travel expenses on the first visit?
  (Mr Raja) Yes, they are. If it is the case that we cannot see them on the day they are offered a transport facility, a taxi, if it is convenient for them to come back on a different day.

  82. So on the first day they have to come by public transport but if they have to come back you give them the chance of a taxi?
  (Mr Raja) No, they can request a taxi in the first instance. They need to ring up and ask for a taxi, make a specific request. Normally we would encourage them to come by public transport.

  83. So there is no extra compensation of any sort given if they have to come back having been overbooked and not getting in the first time?
  (Mr Raja) There is no extra compensation, no.

  84. Does that not seem a little bit unfair because they may have wasted a lot of their time that they could have used for other purposes? Should there not be something in the contract perhaps next time, even if there was not this time, that says if SEMA fails to get people through the first time they have to pay some form of compensation? It might be a way of encouraging SEMA not to overbook.
  (Ms Lomax) SEMA already have quite a strong incentive not to waste people's time because they do not get paid unless people are seen.

  85. Sorry?
  (Ms Lomax) They do not get paid unless people are seen. It is medical reports that they get paid for. It is an output based contract.

  86. If I may say so, if they have allocated space to see 16 people and book in 20 and see 16 but 18 turn up, there is not much incentive to worry about the extra two. I am suggesting that there should be an incentive of that sort as well.
  (Ms Lomax) We will take that away and think about it.[10]

  (Mr Haighton) It might be helpful to add that there are many reasons for people being turned away unseen. The fact that we have booked too many is only one of them. For example, there are a significant number of people who turn up and who are not in a good state to be examined. There are a number of types. We need to clarify that it is only where they are true overbookings that we need to consider.

  (Ms Lomax) Of around three per cent of people who get turned away unseen, about one or one and a half per cent of them are turned away because they are either drunk or under the influence of drugs.

  87. I accept that there may be other reasons.
  (Mr Raja) We accept there is a percentage of claimants who are turned away unseen. We are instituting a number of initiatives and we believe that fee per case, which we have piloted in our Leeds centre for a number of months now, has shown that asking doctors to work on a fee per case basis does lead to a reduction. There are initiatives like that in place which we believe will reduce the number of people we turn away.

  88. When SEMA sets up a session to bring people in to see a doctor, is the session for a fixed time or is the doctor expected to see a fixed number of people? How does it work?
  (Mr Raja) The process we are moving to gives the doctors more flexibility, hence the movement to fee per case. Initially the contract was based on fixed sessions in the morning and in the afternoon but we are trying to bring flexibility into the working practice so we do not have three and a half hour sessions, you can go longer than that.

  89. So will you be able to guarantee that in the future everybody who turns up will be seen if they are capable of being seen? I quite understand there may be some people who turn up incapable of being seen.
  (Mr Raja) I cannot give you that guarantee now but I can certainly assure you that we are working towards reducing the number of people we turn away.
  (Ms Lomax) One of the Department's targets for SEMA is to reduce the number of people who are turned away unseen who turn up on time to three per cent. This is one of the targets we are attempting to get written into the contract. You are actually acting as if we have done, I think that is correct. We are focused on this issue, possibly not as strenuously as you would wish but we are focused on it.

  90. I am pleased to hear you are focused on it but I am sorry that you are still prepared to accept that anybody can be turned away. It seems to me that you could write into the contract, at least the next contract, that these people have got to be flexible enough to make sure that the doctors, if necessary, will stay on later and see an extra person or two.
  (Mr Jones) I think you have to put it into the context that was mentioned at the beginning of the current shortage of doctors and the difficulty of getting doctors to do this work. We would very much always like the doctor to stay on and see the people who have turned up, it is not at our instigation that it does not happen, but it is not always possible for the doctor to stay on and do that because he has got other commitments.

  91. Can I ask another question about the home visits. Are doctors who go on these home visits for examinations always accompanied by chaperones if they are seeing people of the opposite sex?
  (Dr Hudson) I can answer that. No, they are not.

  92. They are not?
  (Dr Hudson) They are not. We make every effort to inform people who are to be examined by a doctor that if they wish to have a friend or a carer with them then that is very welcome. The doctors do not routinely take chaperones with them.

  93. Do you tell them in advance if the doctor is going to be of the same sex as them or not?
  (Dr Hudson) I think there is an area whereby if an individual wishes to have a doctor of the same gender, and certainly this is something that we are aiming to improve, then we will do everything we can to offer a doctor of the same gender. One of the difficulties we have is particularly in the area of home visits. I assume you are talking about women wanting to have women doctors?

  94. It could be either way, yes.
  (Dr Hudson) In the case of women wishing to see a woman doctor we do have some constraints about the gender spread of the doctors, not only who work for us but in the profession generally as a whole. Something like one in six of the doctors who do home visits are female. Given the time constraints because people are waiting for their benefits we are not really in a position to offer everything to everybody. A number of people are happy to have a carer or a friend with them to act as a chaperone.

  95. My understanding is that it is seldom in GP surgeries now that they act without chaperones if they are seeing somebody of the opposite sex in any examination that might be at all personal. Have you had any problems with clients who have later complained about the doctor having acted inappropriately on a home visit?
  (Dr Hudson) Yes, we have, and when we have had complaints those complaints are taken extremely seriously and we treat them as—we have a term—special complaints investigations. An accusation of an assault, whether it be a sexual assault or otherwise, is treated as a serious complaint and is investigated.

  96. One of the reasons why it might be unattractive to doctors is if you do not send chaperones they are under threat all the time.
  (Dr Hudson) Some of the doctors are concerned. Some of the doctors who are experienced in carrying out home visits in general practice as their primary role are not as concerned about the outcomes as others. I am not saying they are cavalier about it in any way but they feel confident enough to cope with that.

Mr Williams

  97. Is there anywhere on the application form for a member of the public to indicate whether they specifically want a doctor of the same sex?
  (Dr Hudson) At the present—I think somebody may have to help me on this.
  (Mr Haighton) We have developed a statement covering a whole range of things like complaints, interpreters, same gender doctors, and so on, into a standard set of words which we are incorporating in all the forms, not just the ones issued by SEMA to invite people to examination, but also to benefit forms themselves so there is a standard and prominent offer of a same gender doctor if required.

  98. And that is now on all forms going out?
  (Mr Haighton) The wording is agreed and is going on all forms as they are reprinted and running to their cycle. It is certainly on many of them and within the next two or three months it will be on all of them. It is just the cycle of reprinting.

  Mr Williams: Thank you. Mr Love?

Mr Love

  99. Good afternoon. It is rather unusual to have so many of you in front of us, it is a little imposing—and we thought that it was the Committee of Public Accounts that was meant to be imposing! Can I start with you, Mr Jones. The first thing I did when I received this Report was ring up my Citizens' Advice Bureau, with whom I have a very good relationship over cases of this nature, and the first thing they said to me of the very many complaints (and I will come back to the numbers in a minute) that they get most people complain, first and foremost, that the assessment is short and rushed and there is not enough time given to finding out about the client. Taking into account the recommendation of the Select Committee Report last year, is there any recommendation about the amount of time that the doctor should spend with a client?
  (Mr Jones) I do not think there is a definite recommendation on the amount of time that is spent with the client.

10   Note by Witness: Of around 3 per cent of people who are turned away unseen, around half are due to overbooking. The remainder are turned away for a variety of reasons, some of which are beyond SEMA's direct control, including customers who will not wait to be seen, or who are unfit to be seen." Back

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