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GPs go forth

LMC leaders plan campaign to encourage GPs to 'just say no' to benefit requests

LMC leaders are considering a ‘just say no’ campaign to support practices who refuse to take-on unfunded work, and have already drafted a letter to help them turn down patient requests for support when appealing against their benefits being withdrawn.

The campaign would be designed to back GPs who turn down requests for medical reports from benefit claimants and requests for work from secondary care.

The LMC leaders from Lancashire and Cumbria have already come together to create a template letter for all GP practices to use in the area advising patients against personally asking for help from their GP.

But they are also planning on taking forward a campaign to widen a ‘just say no’ campaign to other areas of unfunded workload at its next meeting, including requests from hospitals and other parts of the NHS and social care.

The campaign comes after GPs complained of spiraling workload from patients requesting supporting information to protect their benefits, and a rising amount of workload from hospitals being dumped on primary care.

Pulse revealed last month that GPs were struggling to cope with 21% rise in requests to provide evidence to verify work capability assessments since January.

The template letter sent to practices advises patients to contact Jobcentre Plus or the appeals service if they need further medical evidence, and allow them to contact their GP if they think more information is needed.

It says: ‘It is not necessary therefore for you to request any extra medical evidence from your GP. Indeed it may slow down or complicate the process.

‘Your GP is very busy seeing patients and unfortunately does not have the time available to complete such reports. Your GP is entitled to charge you for such a report and would not want to burden you with extra costs when they are not necessary.’

This follows a similar letter disseminated to practices by Bro Taf LMC in Wales, which said GPs providing these reports was an ‘abuse of NHS resources’.

Lancashire Coastal LMC chair Dr Stephen Hardwick, who helped write the letter, said: ‘GPs are increasingly pressurised, their daily job is harder. We’re monitored more closely through QOF, our prescribing more closely followed. We’re also having to mop up from other NHS and social care problems.

‘It’s hard for individual GPs to say no, because they want to do what’s best for their patients.  The problem is as that it becomes more frequent, as they bring in the bedroom tax, you don’t have time for anything else.’

‘Lots of GPs do it because they feel it’s their job to support their patients. But there comes a point where it takes such a demand upon your time, it becomes impossible to do the day job. The “just say no” campaign was brought up in response to an increase in requests. It wasn’t welcomed wholeheartedly but we will re-discuss it in the near future.’

He added: ‘So for DSS sickness benefits, we provided an example letter practices could use. It means saying “no-this is not our job”, or “no- that’s not the right request”.

‘I have a ban on providing personal references for accommodation. I’ll do medical reports saying they can’t walk up the stairs, but if they want a report saying “They’re a nice chap”, I say “I don’t live next door to you - we don’t have that kind of relationship”.’

But Dr Jonathan Smith, a member of Cumbria LMC and a GP in the area said he did not agree with the principle of rejecting requests from vulnerable patients.

He said: ‘If patients ask for a report for their appeal then you can claim a fee on the basis of that. My opinion is they should jolly well do it. You get a fee. They’re the most vulnerable. They’re your patients.’

Readers' comments (92)

  • I am outraged, I am a Disability Benefits Legal Advocate, and founder of a pro bono group on Facebook, Fightback4justice, where we aim to help disabled people fight these often, unfair and unjustified decisions by the DWP. Unfortunately it is a common misconception amongst the medical profession, that DWP contact GPs and Consultants direct in order to obtain their opinion. This is not the case during the appeal process, and often DWP do not contact a GP at all during any stage of the application. Therefore the onus is on the claimant to obtain this medical information ie proof they are disabled, themselves. It is also a sad fact that the likelihood of a successful appeal without medical evidence will most likely fail in the Tribunal or during reassessment.

    We understand the burden this is putting on the medical profession, and note the BMA comments recently calling for surgeries to refuse direct medical evidence requests from patients themselves. However this course of action will, most likely have a detrimental effect on the outcome in a tribunal, and subsequently be detrimental to the health of disabled patients if their Employment and Support Allowance payments ceased completely, as a result of a failed appeal due to lack of medical evidence. Worse still is the prospect that disabled patients will be forced to sign on to Job Seekers Allowance and actively show they are seeking work 35 hours a week, in order to financially support themselves.

    We are ourselves as a group, are seeking to redress the flaws in the Work Capability Assessment, through our campaign work, and there are a number of legal challenges currently in the High Court at present. Sadly as the wheels of justice grind slowly, and the government have appealed a recent decision to finding the mental health test in the work capability assessment unlawful, it is likely to be a significant time before any real changes are made to the way the assessments are carried out. The press releases alone, must be ringing some alarm bells with the medical profession, as genuinely disabled people are taking their own life, or dying after being found fit for work and taken off the mere £71 a week they are given to survive. I have worked for CAB and have seen first hand how this is affecting others, and its heartbreaking, I have clients, with amputated legs, told they can walk 200m without discomfort, one who has one arm also, who has been found fit for work, due to the fact he can press a button with his one and only limb! The decisions by the DWP are sublime and most are overturned in court, with medical evidence. Yes that is the governments failings not the medical profession, but surely the surgeries are going to create more work for themselves when these people come in with suicidal thoughts, or severe malnutrition or hyperthermia due to nil income. From October the government has withdrawn the appeal rate to anyone who is found fit for work and appeals, this can be for months, whilst it decides to look again at the case before passing to tribunal. The DWP will not reconsider in a claimants favour without evidence, and the claimant will be left without even the £71 a week pittance to live on, and have to survive on food banks etc. The knock on effect of a failed assessment overspills into other areas, DLA is often then denied, and Housing Benefit, leaving a patient facing eviction to add to the burden. Many of the propaganda paints a bad picture on this country's disabled, but I see different and challenge anyone who thinks these people are scroungers to take a look at fightback, and the forum and see how people are affected, or better still spend a day with me doing probono house visits, where often a customer has no heating or milk to put in a brew to offer.
    All we respectfully ask that you could try and get a full picture of what is going on, its not your patient's fault they have to prove they have a disability, just because the assessment is not fit for purpose, and full of tricks. There is is a large gap in the regulations that is affecting disabled and vulnerable people in an unfair way and this course of action will push many thousands into an early grave or hospital. The medical profession should be pushing the government to change its policies re the assessments and evidence, not blame the vulnerable who already face enough challenges in life!

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  • With all due respect
    1. I'm happy to provide a copy of records
    2. You're not listening - this is not about me getting to my tee-off time promptly, its about me ever getting home (ever) in time to see my children and my own sanity/health. Enough is enough. We are utterly saturated.
    3. I support your view that the system is broken but I cannot fix that with superhuman individual effort. The 'profession' is lobbying for change

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  • great advice. say no and then get saturated with the inevitable complaints. the defence unions will probably say it is all down to communication problems (i.e. doctor's fault). In the end GP suffers yet again. lose- lose situation for the doctor. what a mess!

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  • The rant above from "Fightback 4 justice" is totally irrelevant.

    Providing this information is not in our contract, we are not funded to undertake it and it actually costs us money to undertake (staff and secretarial time etc).

    We are no more liable to provide this for free than Tesco is to provide free groceries.

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  • No but dont you owe a duty of care to your patients, and isnt the BMA recommendations all about maintaining trust and acting with integrity to your patients and never discriminating unfairly against patients? Yes I understand the burden placed on the medical profession and state this in the message, however getting home to your kids and tea is not going to be an option for many of your disabled patients if a strict no medical evidence is in place, as your patients will have no home to go to and no tea on the table, but that is not your concern is it, nor the future wellbeing of your disabled patients affected?
    Its all about the money! £35 paid for every pip form completed, but usually nil for one asked for by a patient with no funds as they have been withdrawn. It infuriates me, when we sent out virtually pre written simple letters that just need minor adjustments and a signature, and fees of up to £100 for doing this are being charged by some GPs. The patients are having to beg steal and borrow money to pay these fees, and whilst I sympathise as the the burden you all face re paperwork its is a fraction of the burden faced by someone faced with crippling disabilities, losing their home, feeding their family, and being called a liar and having to face the courts to prove otherwise.

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  • 'United we stand, divided we fall'
    We should be joining forces with patient advocate groups. the cuts in the NHS seem to be impacting us the most. It seems we are being forced to pick up scraps to eek out a living. But with the success of both previous governments media campaign against the profession it seems apparent that governments think we have a surplus of time and money on our hands.
    Surely time to focus on the real villains, waste within the privatization agenda and the PFI projects

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  • >No but dont you owe a duty of care to your patients

    A 'duty of care' does not extend to providing paperwork and reporting that is outside of our contract - I can see how much you want it to be, but it simply isn't.

    Patients quite correctly have a right to their records under the DPA (which as you know has a statutory limit on fees) but it is improper to expect or be able to force someone (anyone) to undertake extra work that they do not want to or need to undertake.

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  • "It infuriates me, when we sent out virtually pre written simple letters that just need minor adjustments and a signature, and fees of up to £100 for doing this are being charged by some GPs"

    You're not doing yourself any favours. It's never about simply signing a form - it's about the time and training required the be able to sign, the time in checking what is written, the responsibility for signing , the indemnity fees that we pay (sometimes as much as £10,000 per doctor) and the penalties for providing something that is incorrect etc etc

    Every time I spend doing this kind of work is time spent away from my family. If I spent the same time on every one of our 10000 patients I'd never get home.

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  • The vast majority of decisions appealed are correct according to the rules. The problem is that many decisions are unfair or inappropriate because the legislation is so poor.

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  • This isn't about the money at all. We'd much rather not have this work at all. The charging is only there to 1) dissuade all kinds of requests for bits of paper and 2) make sure that if we absolutely must undertake this work this is at least some benefit for it. All of the practices I've worked at have only ever charged a very modest fee (£25-35) which doesn't even cover costs.

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