Boarding & registering with school GP issues

[ohapples]

We are having trouble with the school GP and trying to get nhs care. We are not rich and there’s no private insurance. Nhs is our only route.

Does anyone know, When these boarders are registered with the school GP. Does the GP get funding for them like a normal family GP? Am I wrong in expecting the same care he would get from our family GP?

The school med centre has told me to contact the GP but the GP is ignoring calls, emails and requests for copies of letters. It’s been five months now.

A school's medical centre should only deal with minor ailments. For major things, parents are called to take child home to see family GP or child taken to local hospital as appropriate. Have you taken your DC to your local GP? Your GP will request notes if he/she requires them or wants to have a full picture. No medical practitioner will force you to use private services when those services are available on the NHS.

Our local boarding school definitely has a GP. All girls are registered if they board. Have you spoken to the school?

Our boarders were all registered with the school GP.
If they needed medical treatment in UK during the school holidays they were seen by their guardian‘s GP as emergency patients.
Children who are resident in UK have an entitlement to NHS care.

A decent boarding school should have a contract with a GP surgery. All UK full time boarders register and are seen on the NHS. Schools frequently then pay to have surgeries held at the school for ease and convenience, although if it's a boarding school in a village, there's sometimes no need and they are taken there by a matron, etc.

My teen is registered at a GP's surgery where her school is and sessions are in her school two times a week for standard stuff.

If she needs to see one in the holidays, she goes to our local one as a "visitor".

He is registered with GP surgery the school choose like all the students, the school insist on it if they are boarding. I can only take him back to our family GP as a guest for minor emergencies, ear infection etc or reregister him at family GP

Issue is we are 2hrs away from the school. If I have to register him with the family GP that’s time I have to take him away from the school.

My question is, is he registered the school GP like anyone else living locally? can and should they make referrals to paediatricians? And deal with long term health conditions? Am I being unreasonable to expect this? Is this why the GP surgery ignore me?

If he’s registered with the school GP then your family GP generally won’t refer him to a specialist e.g paediatrician unless it’s very urgent because he’s only registered temporarily.
It’s all about money and who’s funding it!
The school GP who’s registered with, least he should be registered with unless he’s a very part time flex boarder which from your comments sounds like he isn’t are being paid to manage long term condition e.g asthma, ensure vaccinations are done according to schedule etc. Some GPs are slow/reluctant to refer some long term conditions paediatricians as they either have the experience or knowledge or like to think they have or employ someone who hopefully ha the experience or knowledge to manage it. So for example some practice nurses will have completed an asthma course and will know more about the long term management asthma than many GPs

Sorry posted to soon they’ll also be nurse prescribers and can manage the vast majority of asthma in both adults and children very well. This nurse may visit the school medical centre and hold regular clinics. In schools with a large number of boarders they may find their own nurses to do asthma/sports injury/immunisations courses so that they can manage children with the GP.
If your not getting a good service from the school GP speak to the nurse in charge of the medical centr in the first instance and then if still no joy complain to the GP practice your DS is registered with as you would with your family GP.
Lastly private paediatrics is not easy to find outside of London most NHS paediatricians are too busy and have ethical concerns about private consultations you need to tackle the problem with his GP and get an NHS referral if needed.

As happygardening wrote, they will deal with chronic illnesses like asthma, diabetes and all the immunisation and sexual health matters. When I was at school, our medical centre was under the local GP. She visited once a week but with a nurse available at all times. You could stay in sick bay overnight if you were contagious. Anything major, you would either be taken to hospital or your parents would need to pick you up. The GP could refer you for specialist things e.g. for x-ray or counselling. But all of these referrals and emergencies involved parents. Even though the nurse could escort you to appointments/hospital visits, your parents/guardians were expected to be there and take over at some point.

Dd boards. The school has its own medical centre with a nurse and GP. The GP can make referrals to the local NHS hospital, issue prescriptions, etc.
When Dd is home on exeat / holidays then she would see our GP as she is treated as being temporarily resident in the area.

Children are definitely entitled to NHS care.

Dental treatment at her school is private so we pay for cover as part of the incidental fees.

I thought all boarding schools had an arrangement with a local GP practice ahd schoolmpuios were seen as out of area temporary residents.

So things like minor conditions requiring a prescription can be dealt with locally to the school

This sort of contract can be quite lucrative for a GP practice, so I'm really surprised that this one is being such as arse about it all.

Can you talk to the head of the school's medical centre, explain that owing to poor se vice level, you are unhappy with your DC seeing that practice again, and what can they suggest

(The two acceptable answers are a) rocket to existing GP and all your equests answered by return - because it is normal routine to send a letter to actual parent when hill is brought n by someone in loco parents (be aware that the issue might be with the school stashing these when they should have passed them on) or b) school arranging a different GP practice.

Since when do NHS GPs actually do referrals though? Maybe the GP is just shit as standard rather than specially shit.

You are under no obligation to use the GP practice the school selects, whatever school tell you.

However this doesn’t make the alternative options practical.

A different GP practice local to the school - you might find you need to transport him to appointments.

Your own, local GP As per your OP you would be also need to transport to appts.

I would work with school and the practice manager for the GP surgery to push for the referral you need. Caveat. This assumes that DS is entitled to NHS care.

Thanks Ali, DS is eligible for NHS care, we are actually on a small income.

We have tried to work with the practice, they are not replying to calls or emails. It was October we originally saw the GP at the school.

Since when do NHS GPs do referrals though?

Who else would do a referral? All the referrals we have ever had have come from out NHS GP.

I think I would:
Involve the school, but make a formal complaint to gp practice

If they don’t respond or you’re still not satisfied, go to the next level which I think is contacting nhs England.

Yes if they are registered they should be treated as any other patient on the list - referrals made etc. Who else would make referrals if not the registered GP? (Eg your home one would be reluctant to if dc just see them as a guest patient). Sounds like they are just a bit crap.

We actually saw the school GP with my eldest a month before she started at that school, to facilitate a referral that needed to be done locally to the school. I've been able to meet with GPs at both her boarding schools when it was appropriate to do so, and they have also spoken with me on the phone.

Agree with above, students are registered with a GP local to the school rather than local to their family home, and it is on the same terms as normal registration. Unlike dentistry where it is expected that they will continue to be looked after at a dentist near home as this could normally be done in school holidays.

Is there another GP at the practice you can see 1 man bands are rare these days especially if they’re big enough to provide a GP for a boarding school.
In my extensive experience of large full mainly full boarding schools GPs hold daily surgeries in the school medical centre which may be drop in or by appointment although often school nurses triage out minor illnesses/injuries managing them themselves.
My experience differs from MimiDul in that house matrons will take children to out patient appointments if they are at hospitals local to the school and to A and E/minor injury units in the event of an emergency parents were not expected to be involved or pick children up and “take over” unless they wanted too (and many did) and were free too. Housemasters/mistresses had permission from parents to sign consents in the absence of parents.

This is the equivalent to those at university - I'm a GP and we have lots of 18-21 year olds who register at their uni GP (as they are there most of the year) and see us as temporary patients in the holidays if needed, then if they move back home they re register with us. So the boarding school NHS GP would be the main one and they should do anything needed, referrals etc. your home one would be just for anything urgent and be aware will get no funding at all for seeing your child.

Thank you happygardening the doctor is a senior practice partner, Lead School Medical Officer for two well known boarding schools and sits on the executive board of the Medical Officers of Schools Association (MOSA). I have spoke to the practice manager but I’m told told to talk to the school medical centre, medical centre tell me talk to the GP?

For the sake of time and getting my son some healthcare we are registering him with our local GP this week.

Thanks for the advice everyone, I will make complaint to the practice, medical centre and make sure the school head knows what’s happened. I suspect the GP has done the minimum and so is covered and not technically done anything wrong. Having to move to a family GP 2hrs from the school is not in any students best interest :(

@ohapples are you sure this isn't a misunderstanding? I misunderstood your initial
post (hence my first reply).

I just can't understand truly what the issue is. Is it simply that the school doctor won't refer your child for a certain condition? Is it a normal referral for something standard?

What do the school medical team advise?

I am not sure you can move him though. In
all boarding schools I know of, it's a condition that they are registered locally to the school.

It all sounds very strange to me. I've not had any issue with my teen being referred to things by her GP. They've shown a great three way communication in fact between us, school and them and I've always been copied in on things.

Greybasket thankyou, it’s not a miss understanding unfortunately. I took my son to the GP at the school clinic, we spoke about the effects the condition was having on him, he hasn’t seen anyone for four years. GP had the report from GOSH with diagnosis. He made a referral but to a local general paediatrician and not a specialist. The general paediatrician refused to see my son. No appeal made, no new referrals, my sons just been left to try and cope.

I have called (many times) and emailed the medical centre, I’m told to contact the GP direct. (I was told they had discussed my email with the GP and asked me to contact him direct)

I have called the GP (again many times!) it was suggested I leave it with them, they would do something, in the mean time I could pay for private treatment. The last time the GP spoke to me was early January. I have emailed. No response. When I call the practice I’m referred back to the school medical centre.

I just wondered if other people had experienced this and if I was expecting too much to ask the GP to do the same as our family GP would.

Thanks for everyone’s advice x

Put in a formal complaint to the practice. They are obliged to follow a complaints procedure which must be reasonable, ask for a copy asap. If they don't reply you can escalate in line with the NHS complaints guidance.

Follow this up with contact with the CQC ( online form) and let them know you are happy for them to contact the practice.

Has your child been discharged from GOSH then, or do you have another appointment with them? Was the diagnosis just before your child joined the school, can GOSH recommend someone suitable near the school (a consultant, not another GP)?

Must be very frustrating for you, OP.

the experience you’ve had is the same we experienced at prep school and expected at senior school. I am never copied in on things re-medical centre. DS was sent to hospital (not emergency, they waited until Monday) I have yet to informed. DS doesn’t always have access to his phone, he informed me on the Wednesday. He was shocked and assumed I already knew and couldn’t have taken him. Trust me..if he needs to go hospital or doctor appointment I will be there! If I’m told! ;(