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Picking up the pieces

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There can hardly be a GP in the land who has not noticed the mess that we are being invited to mop up over the Government’s work capability assessments.

The programme to reassess whether people on benefits are fit for work – as contracted out to the French technology company Atos at a cost of £100m a year1 – is creating distress in patients and additional workload for practices as many people are told to ask their GP for a letter to try and support their claim.

We are asked to fill in cursory forms that give space only for confirmation of the diagnosis; barely any space to describe the impact of illness on a patient. A doctor recently wrote in the BMJ about how difficult she found the process; how much worse is it for patients who are unused to form filling and bureaucracy?2

The fall-out for ordinary people is immense. Many people who have worked all their lives and who feel guilt and shame at being ‘burdens’ on the state find the process of claiming benefits humiliating and degrading.

There are multiple harms created for citizens that are going unmeasured – the ongoing stress of the uncertainty of the process has profound impacts on many people’s health.

The costs of this are not being borne by the company running the scheme; the NHS is bearing the brunt of them.

Earlier this year, the LMCs conference called for the process to be scrapped, saying it should be replaced with ‘a rigorous and safe system that does not cause avoidable harm to some of the weakest and most vulnerable in society’.

It is not a fair system (and there is copious evidence of its unfairness) and its failings will be borne by the most vulnerable. The stress caused by its inadequacies will be pushed on to the NHS.
Of the many people who appeal, some 38% win.1 People who have the help of agencies such as Citizens’ Advice are more likely to be successful at appeal – suggesting that the process does not favour people unfamiliar with the system.3

In October, Margaret Hodge MP, chair of the Public Accounts Committee, described the Government’s contract with Atos as ‘unacceptably loose and (permitting) loopholes that can all too easily be exploited by contractors’.4

Let’s hope the £400m contract Atos won in August to reassess people for the new Personal Independence Payment, which will replace the Disability Living Allowance, is not also full of similar ‘loopholes’.

I believe this will be a recurring problemas large Government contracts with the private sector become more involved in healthcare. Why on earth are we franchising out the care of our most ill to a profit-making system? We need to pull the plug on these contracts.

Dr Margaret McCartney is a GP in Glasgow

References

1 National Audit Office 2012, Contract management of medical services HC627. Published Oct.

2 BMJ 2012, It is too difficult for ill people to claim benefits. Published 30 Oct

3 BMJ 2012, UK Government’s contract with Atos is ‘unacceptably loose’, MPs say. Published 22 Oct

4 Public Service 2012, Hodge: DWP management contract is ‘easily exploited’. Published 22 Oct

Readers' comments (13)

  • I agree entirely about the poor contracts that the government writes.

    But I find the last 2 sentences odd given that is the exact model that has always been used for the provision of primary care services.

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  • Agree 100%....but why should GPs be allowed to charge huge fees to people who require letters to support their claim to this disgraceful agency ie ATOS.R4 revealed today that one surgeon charged £300 for one letter..cashing in on vulnerable people is absolutely revolting..there is no obligation to charge at all..the claimant is over a barrel, they have no choice but to pay up or most likely lose their case, lose their entitlement, until an appeal reverses yet another wrong decision, benefit, lose their self respect even more and ,worsen their health and lose any trust in medical professionalss.

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  • Mark Struthers

    Chris McMurray said,

    "But I find the last 2 sentences odd given that is the exact model that has always been used for the provision of primary care services."

    This is called, 'Margaret's Paradox' ... and I agree, it's very odd!

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  • Mark Struthers

    Margaret said,

    “It is not a fair system (and there is copious evidence of its unfairness) and its failings will be borne by the most vulnerable.”

    Of course, the medical profession does not play fair in its sponsorship of the GMC.

    Professor John Walker-Smith and two colleagues from the Royal Free were subjected to a vicious campaign of terror by the GMC on behalf of powerful government and corporate forces.

    “The GMC's "verdict followed 217 days of deliberation, making it the longest disciplinary case in the GMC's 152-year history."

    http://ind.pn/U8VPl6

    Of course, the failings of this unfair system were borne by the most vulnerable.

    Professor Walker-Smith "paid tribute to his supporters who included the parents of many children with autism and bowel disease seen by him at the Royal Free Hospital in north London up to his retirement in 2001. His supporters say one of the consequences of the GMC's actions is that families are facing serious difficulties in finding NHS treatment for autistic children with bowel disease.

    Anything to be said, Margaret?

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  • Ignoring another disruptive 'MS' rant and getting back on topic, Suzanne Stevens said " ....but why should GPs be allowed to charge huge fees to people who require letters to support their claim ..there is no obligation to charge at all."

    There is no obligation to provide claimants with any supportive letters at all. If the Benefits Agency requires additional information they can (and sometimes do) contact the GP, who as part of the appeals process will have continued to provide Med3 certificates. We occasionally provide such letters and when we do, like every other GP I know, we do not charge anything.
    The ATOS/BA mess is equally the fault of ATOS and the legislation that they are obliged to apply. Many people are found to be indeed inappropriately 'fit' for work but the flawed rules/legislation have been correctly applied. We have a working age long-term nursing home resident (until recently at home) who was found 'fit' for work. This person is most certainly not fit for work but has probably been 'correctly' assessed by ATOS.
    GP, Scotland (anonymous due to minor confidentiality concern)

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  • Mark Struthers

    "Ignoring another disruptive 'MS' rant and getting back on topic" ...

    I believe the topic is fairness or the lack of it in contemporary medical practice. Does the unfairness perpetrated by the medical regulator not matter? Is medical complicity in sponsoring unfairness unimportant?

    "GP, Scotland (anonymous due to minor confidentiality concern)"

    What's that supposed to mean? Is Dr Laurie being economical with the truth of his identity, Scottish or otherwise? Surely not!



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  • Mark Struthers

    Alan Laurie, a GP from somewhere in Scotland, imperiously stated,

    "There is no obligation to provide claimants with any supportive letters at all ... We occasionally provide such letters and when we do, like every other GP I know, we do not charge anything."

    But some GPs do and some GPs don't, and some doctors seem to charge extortionate fees whatever the obligations, as Suzanne Stevens has remarked. Is this playing fair?

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  • Mark Struthers

    Who’s going to pick up the pieces? The process was fair to whom? Who is paying the price for this patently unfair process?

    Apart from his own fees, Brian Deer estimated that the process had cost doctors about £8 million. In 2004, Deer, a freelance journalist hacking for News International, instigated an ATOS style ‘fitness for work’ assessment on John Walker-Smith, one of the world’s leading paediatric gastroenterologists.

    In May 2010, at the final conclusion of the process (a trial after Kafka), Professor Walker-Smith was found unfit for work, a decade after he had retired. At appeal, two years later, the GMC’s decision was overturned, the 73 year old paediatrician was deemed fit and allowed to return to work.

    http://ind.pn/U8VPl6

    Any comment? Or would the Scottish doctors prefer to rant?

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  • Mark Struthers

    Margaret rants about those shameful ATOS processes, but completely ignores the shameless 'fitness for work' assessments carried out by our medical regulator.

    "A feeling of shame" is a phrase taken from 'The Trial' by Franz Kafka. Professor John Walker-Smith quotes it in his updated autobiography* when he says,

    "The charges chiefly concerned my clinical care of 12 children. Yet no parent had made a complaint to the GMC. The correspondence from the GMC revealed that the only person who had made a complaint against me was the original journalist. Over thirty charges were made against me. Some charges were most unpleasant as they included astonishing charges of dishonesty. I knew that at no stage had I been dishonest, but I felt it was deeply shameful to be in the position in which I now found myself."

    Do you get that 'feeling of shame', Margaret? I know I do!

    *Enduring Memories: A Paediatric Gastroenterologist Remembers. A Tale of London and Sydney. John Walker-Smith. The Memoir Club, 2012. ISBN: 978-1-84104-538-2. Chapter 16, The Trial, page 221.
    http://thememoirclub.co.uk/

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  • Mark Struthers

    Dr Jonny Tomlinson is a GP in Hackney, a sometime contributor to Pulse magazine ...and a jolly good sort. He's just written a thoughtful blog post on 'shame',

    http://abetternhs.wordpress.com/2012/11/16/shame/

    On 'professional shame', he's written,

    "Whereas guilt is feeling bad about what we have done, shame is feeling bad about what we are."

    Jolly good food for thought! Eh, Margaret?

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