Health visitors and community nurses face "teething problems, if not severe toothache", with the launch of London's congestion charge reimbursement schemes.
The Community Practitioners' and Health Visitors' Association is predicting that there could be wide-ranging problems once congestion charges come into force on 17 February and its members try to reclaim the £5-a-day fee.
Health visitors are exempt from the charge as they carry confidential records in their cars, but will have to claim the money back from their employers.
The CPHVA's director, Mark Jones said: 'As an association we would be very unhappy if members had to wait longer than their monthly pay packet to receive the money that they have already shelled out while on NHS business.'
'While we are not against the principle of congestion charging, there are a number of questions that have to be answered if this is to be a smooth operation. From the feedback we have received, we are expecting teething problems, if not severe toothache.'
Health visitors in eight London primary care trusts (PCTs) will be directly affected by the congestion charge every day that they work. PCTs within the charging zone are: Lambeth, Southwark, Kensington and Chelsea, Westminster, Islington, Camden, City and Hackney and Tower Hamlets.
The CPHVA is writing to the PCTs concerned to see whether the systems necessary for reimbursement are in place and if staff have been informed of the claim back procedures.
The CPHVA's London Region, which has 2,500 members, has outlined a number of concerns.
1. Members will be out of pocket by £100 for at least a month as all healthcare staff are paid monthly and reimbursement payments are often paid in arrears. This will cause additional hardship as staff are already subsidising the NHS when they use their cars on a daily basis to visit families.
2. Community nurses and health visitors are already experiencing major upheavals as more controlled parking zones are being introduced by local authorities within primary care trusts adjacent to the congestion charging zone. This will have a ripple effect throughout non-zone boroughs as commuters park as close as possible to tube and train stations.
3. Community nurses, who work after 5pm, such as the twilight district nursing services, will be hampered as they are unlikely to be reimbursed for travelling into the area.
4. There are major problems over cross border visiting - one PCT may have patients in as many as six neighbouring PCTs. Many PCTs were only formed in April 2002 and many boundary issues are still outstanding. Often PCTs outside the congestion charge zone will have patients within the zone.
5. CPHVA members are concerned that the reimbursement will be regarded as a 'perk' and be taxed accordingly, instead of being a legitimate untaxed business expense.
6. There is concern about how the already hard-pressed budgets of PCTs will be able to fund the reimbursements.
7. Some of London's PCTs have introduced cycle allowances to beat the traffic chaos. But this is inappropriate for health visitors and community nurses, as they have to carry bulky equipment, such as weighing scales. If they carry prescription pads on their bikes, district nurses could be targets for muggers.
The CPHVA's London Region vice-chair, Yasmin Malik said: 'The London Region feels that, at present, Ken Livingstone is playing a mirror image of Robin Hood - he is taking from relatively lowly-paid health workers to line his own coffers, without thinking through the impact of his policy on the healthcare of Londoners.'
'There are already 7% vacancy rates for health visitors in London. We could be facing a mass exodus of essential public sector employees and businesses from central London for whom the hassle of congestion charges will be the last straw. Vacancy rates for other nurses have already started to climb.'