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GPs buried under trusts' workload dump

LMCs could face legal action over template letters for GPs to refuse benefit requests from patients

Exclusive LMCs could face legal action over advice to GPs to refuse requests for support from benefit claimants, as campaign groups consult lawyers over communications they claim are ‘staggeringly ignorant’.

Pulse has learnt that two disability activist groups have sought legal advice about taking action against LMCs and they also say there may be grounds for action against individual GPs if they are ‘involved in acts of discrimination’.

But local GP leaders said that the LMCs’ advice was consistent with that provided by the Department of Work and Pensions (DWP) and that the fault lies with the system set up by the Government and not GPs.

The move deepens the row over the support GPs provide for patients who are appealing their benefits being withdrawn.

GPs are facing rising pressure from patients requesting information to protect their benefits, with a 21% rise in requests to verify work capability since January.

As a response, two LMCs have issued template letters for GPs to refuse requests for additional support from benefit claimants, with one considering a ‘just say no’ campaign to support practices who refuse to take on the unfunded work.

But Pulse has learnt that two pressure groups - Black Triangle and Disabled People Against Cuts (DPAC) - are now planning legal action against the LMCs involved.

Dr Stephen Carty, a GP in Edinburgh and the the Black Triangle Campaign’s medical adviser, said they had taken legal advice over the LMC advice and that they felt they had a case.

He added: ‘LMCs are one-trick ponies whose only function is to prevent GPs doing unpaid, or pro bono, work. I think this is a staggeringly ignorant position to take.

‘Any GP working at the coalface will have stacks of examples of patients who have completely fallen to bits over the Work Capability Assessment. There are lots of admirable things LMCs do but this is a disgrace and I have urged doctors to withdraw their LMC subscriptions and stop paying them.’

Dr Carty added that they were also considering action against individual GPs, pending the outcome of the DWP’s appeal against a tribunal ruling from May this year that said the Government’s Work Capability Assessment process discriminates against people with mental health problems.

He added: ‘If the High Court found that the current process was discriminating, then there may be grounds for taking legal action against individual GPs if they were involved in acts of discrimination. If there were legal clarity on this, it would already be happening.’

But LMC leaders said that they had not heard of any legal action yet, and that these requests are outside the normal care provided by GPs.

Wessex LMC chief executive Dr Nigel Watson said: ‘What we have said to patients is that if the appeals people want further clinical information, which only we can give, then we’re more than happy to do that if the appeals people write to us. But what a lot of these people want is not a medical report, just a letter to say that we support the patient.

He added: ‘Some of the disability groups then say that GPs just do things they get paid for and have got quite difficult about it but we’ve just then tried to explain that we provide care for patients, this is what we do, and I think it is not helped sometimes by the fact that there is an inconsistent approach - some practices will do it and others won’t.’

Dr Peter Higgins, chief executive of the LMCs in Lancashire and Cumbria, defended the template letter they drafted to refuse supporting benefit appeals, and stressed the decision on whether to use it or not was still pending.

He told Pulse they had not heard anything yet about legal action, and added: ‘All that we quoted was off the DWP website so I can’t really see where they are going with that.’

The move comes as a group of GPs have supported the Black Triangle Campaign’s work against the DWP and the Work Capability Assessment process by signing an open letter to the BMA.

The letter called on the BMA to endorse an alternative template letter, prepared by Dr Carty, which could reduce the workload of providing supporting information in patients’ benefits appeals. It further said it is GPs’ duty under GMC guidance to take action if they feel that ‘patient safety may be seriously compromised by inadequate policies or systems’.

But a BMA spokesperson said they had already undertaken ‘substantial work’ to point out problems with the WCA.

He said: ‘BMA representatives have met government ministers to put our objections to them directly. We have recently written to the employment minister asking for changes to be made as soon as possible to the way the system is undertaken. We have also met with disability groups including the Disability Benefits Consortium, an umbrella group representing disability charities.’

Readers' comments (82)

  • This is like taking legal action against a plumber who refuses to fix your taps for free...

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  • Perhaps Dr Stephen Carty could move things along by declaring whether he is a paid medical adviser to Black Triangle or whether he does this work pro bono as he is urging the rest of us to do??
    Could we also clarify if Black Triangle's legal advisors are again working pro bono or getting the full solicitor's fee??
    I think these clarifications would remove some of the humbug here!

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  • They would be better off tackling the WCA system itself, rather than the GPs refusal to intervene for free.

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  • If they want us to do the work they should pay us. To say that this is discriminatory smacks of a large chip on the shoulder. There are many examples of work done by GPs for both disabled and non-disabled patients which is not funded by the NHS.

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  • To say that this is discriminatory smacks of a large chip on the shoulder.

    --
    Quite - I'm surprised that any group feels that they should be able to dictate as to what others should do in their spare / family time.

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  • Every time I read an article like this I feel like adding 10% to our charges.

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  • Dr Carty's gratuitous insult to LMCs as "one trick ponies" displays his ignorance of the role of LMCs as statutory bodies that have been in existence for over 100 years.As a GP and Occ Health GPSWI for 30 years, I am well aware of the incontrovertible evidence that being in work is healthy, and conversely that being out of work (independent of cause) carries a significant added morbidity and mortality.As GPs, we should be supporting our patients into whatever employment, paid or voluntary, that meets their capabilities.We can do this within the Equality Act 2010 by recommending commonsense *GP" adjustments on the Fit Note.In this way, we should help and support our patients' needs rather than submitting to their wants.The WCA is far from perfect.Rather than waste time with argy bargy about appeal letters, we should be working to reform the WCA process.In the interim, I strongly support the LMC's attempt to ensure that GPs' time is spent on what we are actually resourced for.

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  • having read all points how can a GP assess the housing needs of the patients without making a visit-this is the remit of the council and the council O/T-money or no money-the letters the GPs give in support are any way weight less-so we need an integrated system where some one from the council should physically go and assess-we are quite happy to give our opinion-actually the law should make it mandatory for the councils to accept our verdict as legal verdicts and then it will work-that's my view

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  • Unfortunately many of the questions regarding mobility, ability to sit at a desk, raise arms, go to the toilet unaided are not the questions that have ever been asked when the patient has been in the surgery and the sick note written. How are GP's supposed to answer this? Bring everyone in and do an assessment? That is what we fear may happen. The letters specifically state" unfortunately we are unable to pay for this."

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  • Yet another reason to quit the NHS or emigrate.

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  • If you look at his own practice website and his private fees charged and "we do not issue letters for housing matters"- he's not quite practicing what he's preaching!!

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  • Many of these responses typify the mercenary mentality of doctors today. They are happy to line their pockets wasting public money doing unevidenced QOF work on a healthy population while ignoring the desperate plight of the most sick, disabled and vulnerable people in society.

    It's moolah before morality. Profit before protecting the sick, disabled and vulnerable.

    Good on those doctors (most of whom are in Scotland) who signed the letter to the BMA.

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  • All of the health professionals reading this site should note that requests for this kind of work (the same kind of work that keeps you from seeing your family and children before they get to bed) sadly too often come from people with the above attitude who think that they have a right to everything for free. Of course, there's no shortage of abuse when they don't get what they want and sadly they drown out the deserving people who genuinely need consideration.

    It's worth considering this before spending time on work we are not contracted to do (and often in no position to undertake).

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  • Anonymous @ 10.49 - well spotted

    Assuming that this is the same Dr Carty, as appears likely - These are fees that far eclipse the charges we make in a similarly deprived area and indeed Dr Carty's Practice seems to charge for many services we provide for free.

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  • This comment has been moderated

  • "They are happy to line their pockets wasting public money doing unevidenced QOF work on a healthy population while ignoring the desperate plight of the most sick, disabled and vulnerable people in society."

    This is such a stupid comment. This is one of the mechanisms by which surgeries get paid, and whilst some of the QOF targets are indeed stupid, most surgeries would not be viable without undertaking this.

    This poster would have us drop the work that keeps the surgery running and replace it with work that we're not meant to be doing that won't pay for staff and business costs. We would, in effect, be paying out of our own pockets to complete reports for other people!

    Genius!

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  • I remember reading the original post which was deluged by the vehement pro-benefit lobby group.That is what happens when you have a freely open discussion forum.Pulse needs to get its act together and tighten up its access policies.Secondly the issue about policing benefits or immigrant access to the NHS should be decided at the national level between our GP representatives and the government.The GPC/RCGP/BMA need to take a tougher stance ensuring the DWP is not shirking its responsibility by passing the buck to us.This is a constant source of friction and stress for jobbing GPs on a daily basis and goes against the doctor patient relationship which is based upon trust and not suspicion

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  • I would suggest that HCPs put their own house in order first. Meaning that many work for Atos Healthcare, the prime contractor to the DWP for the WCA "assessments" that caused this problem of mounting numbers of appeals against decisions to withdraw benefits from seriously ill patients. The problem is further compounded by the insistence of the DWP to send claimants back for another assessment even when they win their appeals in court. Iain Duncan Smith, the Work and Pensions Secretary, has resolutely refused so far to reveal the numbers of claimants that have actually died soon after the cessation of benefit payments. This is the reality of the situation now, people are dying because of benefit cuts and the government won't even admit how many. Is it any wonder that many will seek help from their GPs? For many it will be the last port of call before they depart forever.

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  • I think the NHS should be free. By that I mean rather than paying tax and national insurance to fund the wages of doctors, nurses and staff, and buildings, and equipment, all labour should free of charge and if clinicians want buildings and equipment they should fund it all out of their own pockets. This is supposed to be a caring profession and it seems to me that it's hardly caring to want to be paid to do the job. If you want to get paid, why not consider retraining as a lawyer - I'm sure Dr Carty's lawyer will charge a fee, and rightly so as lawyers don't seem to be a caring profession.

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  • @Ian Sanderman who wrote "people are dying because of benefit cuts"

    Should we take you seriously or are you just trolling?

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  • Does anyone know Dr Carty's website address so we can all have a look?

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  • Anonymous | 03 September 2013 11:49am
    Star Trek fan?
    A utopic world where money has no meaning and life's needs are covered by the genorosity of others. Whilst I care for the sick (or believe themselves to be sick) Ford give me a car or if I'm very lucky Bugatti will provide for me. Waitrose to allow me to shop free as I can't earn any money being in the caring profession. Clakes send me 2 pairs of shoes and Durex a big box of condoms so I do not have children that the state will have to look after. Forget the Durex as I'll be sleeping in the park and practising from a bench because I cannot buy premesis as I can't earn. Not sure the wife wants sex in a laurel.
    I was all for this forum being open so we could see the trolls and idiots as well as the well meaning majority of non-medics feeding in views, after your comment I feel different.

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  • Why does people believe GPs should work for free just because we are in medical profession? Other then the minority who are in charitable trusts, do they know of any profession as a group work for free?

    This isn't discrimination, it's as simple as refusing to do unpaid work. Why don't Dr Carty & Co. give up all their worldly possessions and work for free if that's what he believes.

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  • I already provide good quality typed/ not handwritten/ scribbled reports when asked to provide information for ATOS/ DWP etc.
    I also sit in front of a computer sometimes until 8-8.30 PM completing the rest of my work. So not much blood left in the stone to suck.
    I am also a member of the public who can be sympathetic to those patients who are genuinely in need who sometimes go against my advice by attempting to return to work against medical advice, sometimes losing benefits which they would have been better continuing to claim.
    On the other hand I am less sympathetic when I receive a letter from DWP about a patient who is receiving ESA who I haven't seen for 2 years, who isn't on any medication, who I wasn't even aware was on the sick. Or the patient who claims not to be able to bend/ walk etc. who I then see shopping normally in the same Aldi as me.
    At the end of the day we all do occasional supporting letters, but in general terms I feel it is generally best to answer the questions on these forms using the information contained in the medical records (or my own knowledge of the patient's case) instead of being spoon fed the "right answers" to questions by third parties such as Citizen's Advice when I am really in no position to be able to verify what I am being asked to say.
    I don't think a blanket refusal to provide further information is likely to be appropriate. However also agree with other contributors who correctly point out that these reports aren't a statutory part of our contracted work.
    So at the end of the day I will continue to use my common sense in these matters.

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  • "I remember reading the original post which was deluged by the vehement pro-benefit lobby group.That is what happens when you have a freely open discussion forum.Pulse needs to get its act together and tighten up its access policies."

    _________

    But... the disability campaigners showed themselves to be far better acquainted with the facts than the GPs who were commenting.

    It's telling that you would rather debate the issues with uninformed GPs who confirm your false, right-wing biased understanding of the situation than with people who actually know the facts.

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  • Dr Carty's practice website is Leith Mount surgery in Edinburgh, where he seems to be raking it in quite nicely with his inflated private fees! Maybe thats why he feels everyone else should just be working for free! Our private fees for a similar deprived practice are not even a quarter of that!

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  • Snapshot of my morning surgery
    9am- Abusive call from bloke who's pissed off he can no longer get his branded viagra on NHS, and thinks the generic stuff is s**t, "he pays his taxes you know"- even though he's never worked a day in his life cause he's got a "bad back". Next patient- wanted letter there and then for his appeal for "depression", he's not been to the surgery for the last 5 years, on no meds and failed to attend his counselling we had ref him to 6 years ago. Next patient shouting dogs abuse because he got taken off his ESA at appeal- again not worked for 20+ years due to drug abuse, but not attending drug services for years and not attended GP for years so we had no medical evidence to give him! So for all the disability rights activists out there- do you get the picture!!! We all know those patients that are genuine and I am sure most of us will go out of our way in our own time to help them, but the rest of this stuff is just making our lives miserable! I am fed up being abused every day. I am a caring GP of 20 years experience, but I've had enough, not young enough to retire but I'm out of here and going abroad!

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  • http://www.leithmountsurgery.co.uk/privatefees.pdf

    I cant comment on his charges under competition rules but if I were his patient , I would call Dr.Carty the biggest hypocrite in the world. Given his practice leaflet clearly states they do NOT issues letters for housing matters and then goes on to criticize the LMC and thereby fall afoul on GMC best medical practice and also will have to some bits to fill in the probity section during his appraisal. Of course its possible he may be working for free but he is in a partnership which has these as standard written rules hence should have walked out or amended it before jumping onto the LMC.

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  • Interesting he does not provide letters on housing matters. Could the same arguments not be used for this as well!

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  • But... the disability campaigners showed themselves to be far better acquainted with the facts than the GPs who were commenting.
    ---

    Not really. What the GPs on the other continued to point out was that 1) they are not contractually obliged to provide this information and that 2) undertaking this works takes them away from their families or other NHS work that they are contracted to do.

    Are you disputing either of these facts?

    It's telling that you continue to gloss over these issues and continue your abuse and name calling.

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  • Ildiko Spelt

    I totally agree with Augustus Bennett's comment, I am in the same situation. It is very hard to write a medical certificate to a young person who never worked and hasn't been in the surgery since very long, is not on any medications, but is on benefits. Unfortunately these cases are very frequent. I am happy to support the genuinely ill patients.

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  • Ildiko Spelt

    and also agree with anonymous 12:57 , I get the same situation ....

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  • @11.49 - sorry just wiped the spattered coffee off the computer screen. OK then so if I do the job for nothing then who will feed, house and clothe my kids?
    Or can I claim some sort of benefit for that?

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  • This comment has been deleted by the moderator

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  • 11.49 is joking!
    Don't all lose your sense of humour and reality.

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  • >Don't all lose your sense of humour and reality.

    It's actually hard to tell. Plenty of the posters here are indeed asking that we give up our evenings and work for free (and getting abusive when we decline). Is 11.49 that far away from this?

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  • Obvious troll at 11.49 is obvious.

    Its the interweb kids- learn to spot sarcastic / trolling posts...

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  • Basically the government have done the right thing and tried to reign in our spiraling disability benefit bill and get more people back to work. The problem is the tests have been made very sensitive to pick up the malingerers and so some genuine cases get sucked up into the net. General practice however is not the appropriate place to bring this problem, we are here to sort out medical problems not cash flow! Unfortunately we all see far too many cases (daily in fact) where the claimants chain smoke whilst sitting around drinking from cans of lager watching Sky Sports on huge TVs whilst their unwashed children go neglected and hungry. This is not what the welfare state was designed for - it is a stately net! People who claim benefits should be grateful that in this country you can only fall so far. I've been to countries where poverty means starvation, sleeping rough and true destitution. Given that General practice is overwhelmed with competing priorities, the only fair thing to do is refuse to take on occupational health work or charge more. The simplest thing would be to privatize all GP access and then this problem would melt away as all work would be appropriately paid for.

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  • "This is like taking legal action against a plumber who refuses to fix your taps for free..."

    Almost:
    it's action against the plumber who refused to write a report for free to say the tap cannot work despite Atos seeing water coming out of it!

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  • Anonymous @3.49

    You miss the fact that that same plumber would charge a call out fee to observe that phenomenon.

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  • Anon 11:49 here. My apologies to all those who did not recognise the futility in my tongue in cheek post. Of course it's ridiculous to expect anyone in health to work for free - and that's the point. Dr Carty's lawyer doesn't work for free nor, according to those who've looked up his private fees, does Dr Carty. If LMCs are successfully sued for supporting GPs who do not wish to do unfunded work because it’s for the greater good, where will it stop? And that was the point of my somewhat facetious post.

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  • Of course it's ridiculous to expect anyone in health to work for free
    -----


    The problem is that some of the non-facetious posts are suggesting exactly that!

    :)

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  • @7.43 the problem is that a lot of costs/ work is based at practice level. CQC registration is per practice. A single hander will have to do all the work (or pay for it) whereas a 10 partner practice will be able to share out the work between a group. The cost of inspection will be less, but the work involved in preparing those pointless policies is the same.

    I have no real idea why anyone would go single handed, it would drive me crazy. But in some parts of the country it is needed and they have my sympathy that things are being made harder for them.

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  • @Ian Sanderman who wrote "people are dying because of benefit cuts"

    Should we take you seriously or are you just trolling?

    _____________

    I'm not Ian but there was another avoidable suicide in the news just today where the coroner explicitly implicated financial difficulty due to ESA benefit being stopped for someone struggling with depression......

    http://www.theargus.co.uk/news/10649155.Crawley_man_killed_himself_after_losing_benefits/?ref=twtrec

    Why would the mention of avoidable suicides be "trolling"?

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  • The whole issue is degenerating into an unedifying 'bun fight'.
    It will end badly for all concerned.
    Sick patients need benefits, the DWP's processes require them to justify themselves via medical evidence, it is what it is. This is a burden on GP's, for some it is obviously also beyond what they consider to be their role, nevertheless it is what patients consider their role includes.

    It would be far better if the profession and in particular those LMC's concerned were to work out a mutually acceptable compromise with the so-called 'claimant lobby' to ensure that the issue can be managed.

    If the profession does not do this then the courts will end up deciding....maybe after a long, expensive and bitter battle.

    The government has created a system, like it or not, which requires the need for medical evidence at both the initial assessment and appeal stages. Engage with the system and try to find ways of making it less onerous for all concerned.

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  • The DWP only request an ESA 113 from the claimants GP in 7% of cases.

    The decision maker is then relying solely on the information provided by the patient in the ESA 50.
    Bear in mind the claimant may be illiterate, learning disabled or mentally ill and lacking insight

    So just to restate that - in 93 percent of cases the DWP decision maker has no idea how ill the claimant might be. - no wonder the appeal success rate is so high!

    Yet some LMCs think the best thing to suggest is to deny patient access to supportive medical information for the purposes of appeals.

    There may be a case to answer that this represents unlawful indirect discrimination and breach of equality duties

    My time given to the Black Triangle Campaign is entirely pro bono. The legal counsel sought is also pro bono. The campaign is staffed entirely by volunteers many of whom are disabled.

    My views do not necessarily reflect the views of Leith Mount Surgery Partnership.

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  • Add 10% to what charges? (anon 3rd sept)

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  • Robin knows best!! ........

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  • I will advise all my work-shy lot to go and register with Dr Carty at Leith Mount Surgery.

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  • Stephen Carty 11.05pm

    "My views do not necessarily reflect the views of Leith Mount Surgery Partnership."

    Yet you still benefit financially from their views and conveniently added the modify of 'necessarily' in your sentence.

    No credibility I'm afraid. Its easy to have the courage of your convictions when they cost you nothing.

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  • Anonymous | 04 September 2013 0:27am

    I will advise all my work-shy lot to go and register with Dr Carty at Leith Mount Surgery.

    Perhaps you should either reveal your identity or remove yourself from this discussion. These claimants could only be in receipt of ESA if you or one of your colleagues provided them with a fit note in the first place. The use of language such as "work shy" to describe long term sick and or disabled persons is Daily Mail rhetoric. Perhaps you also think them to be scroungers or unsustainable. - reveal yourself - anonymous posting is for cowards and trolls

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