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GPs go forth

GPs experiencing rising workload after benefit changes, warns LMC

Practices are being asked to assess patients’ eligibility for benefits when this should be the remit of social care services and care agencies, GP leaders in Scotland have told MSPs.

GPs in Scotland say changes to the benefits system have swamped them with extra work as large numbers of patients request information to confirm their care needs or appeal against decisions.

Glasgow LMC have written to the Scottish Parliament’s health and sport committee ahead of its discussion tomorrow on the impact on GPs of healthcare reforms.

The LMC said the extra paperwork came from changes to benefits such as housing benefit and the replacement of the Disability Living Allowance.

The changes have had a particular effect in deprived areas, where there are proportionally more patients within the benefit system, the letter states.

The LMC letter says: ‘Many practices have contacted the LMC as they were seeing increasing numbers of patients making appointments with GPs looking for letters of support for benefit appeals and certificates or notes from doctors to confirm various care needs.

‘This continues to further increase GP workload at a time when demand on GPs services is already extremely high.’

It adds: ‘To compound the issue an unprecedented number of patients being turned down for benefits following their medicals has led to a flurry of appeals, and hence yet more consulting time is being taken up by patients requesting letters and also wishing to have their medical symptoms and conditions updated and documented in their case records as evidence.’

Inclusion Scotland, a consortium of disability organisation, has accused GPs of ‘discrimination against disabled people’ for adopting such as stance.

Its own letter to the health and sport committee says: ‘GPs have a duty of care for all their patients to ensure that their health does not decline where it can be prevented. GPs who refuse evidence to patients requesting it are failing them in that duty of care.’

Dr Alan McDevitt, chair of the Scottish GPC is due to give evidence to the committee tomorrow along with Inclusion Scotland director Tressa Burke.

Readers' comments (8)

  • Of course it is increasing our workload. I've had several patients who were told by our local benefit officer to get DS1600 to "fast tract" their DLA. They are horrified when I tell them it's real criteria and what it means......

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  • better not tell Inclusion Scotland letters in support are not nhs services and chargeable in that case.....

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  • Black Triangle Campaign submission to the Scottish Parliament Health Committee open evidence session on the role of GPs and the DWP-Atos Work Capability Assessment regime

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  • To: Members of the Scottish Parliament Health and Sport Committee


    John McArdle, Campaign Manager, Black Triangle Campaign


    Dr. Stephen M. Carty, MB ChB MRCGP DRCOG, Member and Medical Adviser, Black Triangle Campaign

    Subject: Health and Sport Committee 19th Meeting, Tuesday 11 June 2013 Welfare Reform – Impact on GP Services

    Dear Convenor; Deputy Convenor; Committee Members

    We write with reference to our submission which the Assistant Senior Clerk, Rodger Evans, has informed us is now with all members in advance of tomorrow's session.

    In particular, we would like to ask you to use our submission as the basis of questions to the witness from the BMA, Dr Alan McDevitt, Chairman, Scottish General Practitioners Committee, BMA Scotland.

    We note that is has not been possible for Glasgow Local Medical Committee to send a representative to give evidence at the meeting.

    We would, therefore, request that written questions be addressed to them: specifically how they propose to address the morally, ethically, legally and professionally untenable position (as stated in our submission) of maintaining a blanket instruction to GPs not to provide Further Medical Evidence to patients undergoing the ordeal of the DWP-Atos Work Capability Assessment regime.

    Secondly, we would also like to invite them to hold discussions with us as to how to implement a simple remedy to this situation that will save GPs considerable time and expense whilst also fully fulfilling a doctor's duty to act where there are systems and policies in place that cause avoidable harm to some of the weakest and most vulnerable people in society.

    The present situation is untenable. We propose a solution that will work for doctors and their patients equally pending a satisfactory resolution to outstanding contractual issues.

    The Mental Health Resistance Network's legal team are currently preparing an application for a High Court injunction to stop the reassessment of patients pending a resolution of the issues of the absence of any risk management or reporting mechanism in the WCA testing regime whilst the DWP's lawyers prepare and appeal against the decision in MM & DM v Secretary of State for Work and Pensions [2013] UKUT 0260 (AAC) .

    In the interim, it is now incumbent on the Scottish medical profession to take concrete action to prevent avoidable harm and discrimination to their patients.

    We are clear that this catastrophic situation is by no means the fault of GPs and the blame must be firmly laid at door of the DWP in Westminster and ultimately the Coalition Cabinet.

    We are deeply sympathetic to the enormous strain that our doctors are now under thanks to this unacceptable burden that the UK Government has placed upon them. We seek to assist our doctors in resolving this.

    We have trialed the use of ESA regulations 29 and 35 by doctors in flagging up substantial risk and, as the signatories to the letter to the BMA leadership all attest, this is a solution that has been conclusively show to work.

    We look forward to a successful resolution and outcome to these discussions.

    Yours sincerely,

    John McArdle, Campaign Manager, Black Triangle Campaign and Dr. Stephen M. Carty, MB ChB MRCGP DRCOG, Member and Medical Adviser, Black Triangle Campaign

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  • BMA must condemn work assessments Pulse 6th June 2013

    As frontline doctors, we share the view of many sick and/or disabled people that the BMA
    leadership has failed to give any effect to the unanimous wishes of its members: that the
    work capability assessment be scrapped immediately.

    It is unsafe, causes avoidable harm, lacks meaningful risk assessment and has no formal
    reporting mechanism for adverse events such as suicide.

    According to the GMC’s Good Medical Practice, a doctor must take prompt action if patient
    safety is being compromised.

    Employment support allowance exceptional circumstances regulations 25 and 31 are a way of
    highlighting substantial risk of harm to claimants, yet despite this, most GPs are unaware
    of them.

    We call on the BMA to publicise the lawful application of these regulations in order to prevent further avoidable harm. Failure to do so would in our opinion amount to negligence.

    From Dr Stephen Carty, Edinburgh, and 17 GP co-signatories

    ‘GPs need more guidance on their role in supporting patients as well as their ethical
    responsibilities’ says Dr Graham Kramer

    As a GP, I’m emotionally struggling to witness what some of my patients are experiencing
    with welfare reform.

    This is not specifically a deprivation issue, although GPs working in deprived areas will
    face greater fallout arising from welfare reform.

    The duty of GPs is to promote the health of their patients as a prime concern. It is well-recognised that employment for many people can be therapeutic and so we try to actively
    promote work as a means to achieving health.

    However, for some people – many of whom are struggling to overcome daily disability and
    complex mental and socio-emotional issues – work is a far-away prospect, particularly where adapted flexible employment is unavailable. Forcing people off benefits and into work can seriously destabilise their health.

    Some patients on benefits find they can devote some of their capacity to helping others and try to give to their community through volunteering. But this valuable peer support is being eroded by the reforms and risks undermining networks of support for self-management.

    In my experience there is little meaningful communication between GPs and the Benefits Agency, making it impossible to develop collaborative approaches that best meet the needs
    of patients.

    ATOS assessments seem one-dimensional and assessors’ decisions necessarily involve a conflict of interest with the principle to ‘first do no harm’.

    There is a need to evaluate how these reforms are affecting people’s physical and mental health. There also needs to be an evaluation of how the reforms are affecting GP workload.

    GPs need more guidance on their role in supporting patients as well as their ethical responsibilities.

    Dr Graham Kramer is a GP from Montrose

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  • Doctors and patients must unite in support of each other.

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  • To "Black Triangle" and chums. I am a GP in one of the most deprived areas in Glasgow. This morning alone, out of a surgery of 20 this morning, I had 5 appointments taken up by patients wanting "letters of support for their various benefits" My colleague on call has got a list of over 30 patients to call back today thast couldn't get an appointment- half of these are "disabled patients" who have genuine urgent medical needs which need sorting, but couldn't get an appointment with us bacause we were busy -with benefit requests. Personally , as a GP, I feel I should be sorting out urgent medical needs of " disbled patients"- those which you claim to be campaining for, but cannot get an appt with their GP because you and your group are too busy forcing us into writing "benefit appeals reports all day long! There is only so many hours in the dayk, and so which ones would you truely like us to prioritise? Medical needs as we are GP's or forms? You can't have it both ways however much you want to try to blackmail us! And P.S I am a single parent and spent my entire weekend taking home/ reports for DLA appeals rather than spending time with my young child because , despite what you think about us "evil uncaring GP's"- we do care , but there is only so much time in the day and we CANNOT do everything!

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  • ....and how should we deal with patients who newer worked because of " low mood" or similar ? And another patient needed 20 minutes of my time to give him evidence ...just to declare before leaving my room: "you know, I cannot move, my neck is very stiff ,I hardly walk until my claim is sorted...after that, I'm back to normal ...".. This was a 51 years old man. I do love to help everybody and I'm doing it, however there are too many of similar cases like this...and they are causing frustration. Does anybody know what is the best to do in these situations?

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