Doctor dumps children to meet cash targets

A FAMILY DOCTOR has removed eight children from his patient list because their parents' refusal to have them immunised against a range of diseases is costing him money.

The parents' refusal, out of concern at possible side-effects, left John Goodall-Copestake, the only GP in the Welsh border town of Presteigne, pounds 2,000 a year out of pocket, because hefailed to meet National Health Service immunisation targets.

Dr Goodall-Copestake threatened to strike the children off his list, unless parents agreed to his demand for immunisation, in a letter written five weeks ago. One parent described it yesterday as "blackmail".

He has now carried out his threat and is unrepentant. He said yesterday: "Being a doctor has changed a lot since my great-uncle was in practice. Whether you like it or not, it is now a business and if you don't make the books balance, the bank manager leans on you, and if you don't pay your tax, you get into trouble. You have to make ends meet."

His action - which, reports indicate, is being imitated in other parts of Britain - last night brought fury from the parents concerned, a warning from the British Medical Association that his behaviour could lead to disciplinary action by the General Medical Council, and outrage from Labour's health spokeswoman, Harriet Harman, who said she would raise it in the Commons tomorrow.

"This is part of the renegotiation of the GPs' contract, which we warned about at the time and were accused of scaremongering," she said. "You don't want financial incentives overtaking everything else. The doctor is clearly wrong in this case. It is holding a gun to the parent's head for the sake of money."

Dr Goodall-Copestake, 53, who has been running the practice for 18 years, argued yesterday: "The problem with immunisation is that since 1990 we have had to meet targets of 90 per cent of the children on the list of the right age.

"In the last quarter, ending in September, I had 29 children needing immunisation, and I did all but three. The three were from families who wished their children not to have immunisation. As a result I dropped under the 90 per cent level by one child, and I did not receive the pounds 500 I would have had.

"I wrote to the Family Health Services Authority, and they confirmed that legally I was within my rights to remove the children, but warned me that, if I did, it would be hot news. Equally, however, I'm sure the bank manager would warn me if I told him I was going to lose pounds 2,000 a year for five years."

Gail Venables, 31, whose 14-month-old son Bryn has been removed from the list, said: "It is very worrying that doctors have the power to pressure you in this way. Whether he wanted to pressure me or not, it is blackmail by the system."

A spokesman for the BMA said it could not defend any doctor who threw patients off a surgery list for financial reasons: "Refusing treatment for financial reasons could be unethical behaviour, which would lead to a case before the General Medical Council."

Last night, child health campaigners who oppose compulsory vaccination claimed that many parents were coming under pressure because their doctors were worried about losing money. Magda Taylor, spokeswoman for the pressure group Informed Parents, produced letters from parents to back up her accusation, and said some parents were being forced to consider private health care.

How the parents were told ...

Edited extracts from Dr Goodall-Copestake's letter:

"I am writing to ask you to reconsider the immunisation for your child, X.

So far no immunisation has been done. This may be because you object to immunisation or because you have not got around to it ... I recommend full immunisation, as a parent of immunised children I realise the concerns involved, but also the benefits gained in protecting my children against some of the world's horrors.

I regret there is a further reason for this letter, which is the health of the Presteigne practice ... for which I have responsibility. Good practice has to make profits to provide accommodation, staff, heating, lighting, cleaning etc and under contract with the Family Health Services Authority we are paid for several aspects of the services, one of which is immunising a set percentage of the children in certain age groups. In the current quarter ... 26 out of a possible 29 children were immunised and as a result the practice was deemed to have failed in the programme, and we lost pounds 500 of income as a result.

The same could happen ... each quarter onward until your child passes out of the target age range. Thus, the problem will mount up, and these days we all know about cash flow problems.

I sympathise with anyone's rights to choose what they believe is the best for their child, and I hope you can sympathise with my rights to choose what is the best for my practice. Unfortunately our rights seem to clash. The next calculating date for children's immunisations is at the end of October, and I would be grateful to immunise X before then. Failing this I would have to remove X's name from the practice register so that the accepted proportion of children are immunised. If this occurs you would be able to register the child elsewhere and I would of course be happy to see any child as an emergency, whether they were registered or not."