Disabled patients are disadvantaged

 I am grateful to Robin Dawson (Letters, July 1) for highlighting the problems with the new regulations governing domiciliary visits. I was beginning to think I was alone, since the AOP and others have been remarkably quiet on this subject.

My experience has been very similar to Mr Dawson's and my attempts to seek clarification or flexibility in interpretation from my local PCT and Derek Busby at the Department of Health have met with stonewall responses which lead me to suspect that these regulations were not thought through prior to implementation and there is a damage limitation and justification exercise now under way.

Specifically, I want to address the questions of what purpose the new rules serve and also to highlight two areas in which they clearly discriminate against people with disabilities in a way that I am sure contravenes current anti-discrimination legislation.

There have been two reasons given to me for prior notification: it offers the option for the PCT to organise an inspection visit for practitioners dealing with this vulnerable sector of the public and it affords the PCT the opportunity to identify any patients who have been tested recently and are thus not entitled to a further test.

Neither of these reasons hold water. If an inspection was required, it appears perfectly reasonable to arrange this in advance with the practitioner (and patient who would have to host the visit). The idea that the PCT might send out a hit squad on an unannounced visit that would require a 'vulnerable' patient to offer them access to their home is preposterous. As for the notion of preventing unnecessary examinations, the PCT has the power to demand justification for an early re-examination after the event and to withhold payment where it isn't satisfied, so prior notification serves no purpose.

However, the areas that give me the greatest concern are those which are clearly discriminatory. As Mr Dawson pointed out in his letter, a patient walking into a practice can have immediate access to the service if a space is free in the appointment book. By virtue solely of their disability, an individual requiring a domiciliary visit cannot have that same access, even if the practitioner has time available.

The second area of discrimination is a financial one. I had a situation recently where I booked a visit in the expectation that it would be private, therefore no prior notification being required. On arrival, I establish that the patient is in fact exempt from charges. If this happened in the practice, that same patient could either sign the GOS form on the spot (or if entitlement was established after the event, claim a refund on an HC5). In the case of the domiciliary, because no prior notification was made, neither option is available and thus the patient has lost out to the tune of a private domiciliary fee.

I would call on all of my colleagues involved in this kind of work to write to Mr Busby and to their local PCT requesting that these regulations be amended as soon as possible so that our disabled patients are no longer disadvantaged and so that we may return to providing the prompt and efficient service that existed before April. Naturally, I would be delighted if the AOP and pressure groups working on behalf of disabled and visually handicapped people were also to make representations on these issues.

John R Tomlinson.
York