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Stop exploiting GPs’ goodwill

The benefits row is part of the wider debate about what the NHS can afford to do and what it cannot – a debate politicians must have the courage to lead, writes Pulse editor Steve Nowottny

Our columnist Dr Phil Peverley is no stranger to controversy – but even he was taken aback by the reaction to his column last month.

His piece on sickness certification, in which he admitted to an ‘unfashionable’ degree of sympathy for Atos and criticised the ‘disgruntled unworking well’, drew dozens of comments online, prompting a furious wider debate, articles in The Daily Telegraph and Daily Mail, and even requests for TV interviews.

Such an overwhelming response is perhaps explained by the fact that while many GPs are frustrated by the demands on their time from benefits claimants, few are willing to put their heads above the parapet and actually say so. But that is changing. 

We report this month that LMC leaders are planning a campaign to encourage GPs to ‘just say no’ to benefits requests. A template letter advising patients against asking their GP for medical reports to support benefits claims has already been circulated to practices in Lancashire and Cumbria.

Such advice may be controversial, but for many GPs, it is also entirely reasonable. There is no doubt benefits claims are putting practices under increasing pressure – there has been, for instance, a 21% rise this year in the number of Employment and Support Allowance requests to medical professionals on behalf of the Government.

This kind of unfunded extra work is a prime example of the ‘workload dump’ Dr Michelle Drage rails against in our Big Interview this month, and cannot simply be absorbed by practices. Capacity in general practice is very much a zero sum game; as one exasperated GP on PulseToday put it: ‘Just what part of my job do I stop doing?’

And yet, the uncomfortable truth is that GPs cannot simply abrogate responsibility.

The fabled doctor-patient relationship is a complex and often fragile one. The fact is that many benefits claims are won on appeal, and a GP’s support can be crucial. Charging a fee of up to £130 for Work Capability Assessment appeals may make sense from a gatekeeper perspective, but it sits very badly with those patients who are often least likely to be able to afford it.

It also fits far too neatly into the ‘greedy GPs’ narrative pushed by some of the national media. ‘Just say no’ is an all-too-tempting mantra, but one that could backfire.

It is the Government’s responsibility to run a benefits system that fairly assesses claimants without exploiting the goodwill of GPs. Practices should not have to choose between doing unpaid administrative work or alienating their patients.

The benefits row is part of the wider debate about what the NHS can afford to do and what it cannot – a debate politicians must have the courage to lead.

Whatever you make of the Department of Health’s new guidelines for treating migrants – and many GPs are strongly opposed to charges – they do offer welcome clarity in an area previously mired in confusion.

Ministers must set out similarly clear guidelines around benefits claims. Patients must understand what they can reasonably expect from their GP, and GPs must know how the work they are expected to do will be funded. Until then, practices will be caught in the middle – most unwilling to just say no, but increasingly unable to keep saying yes.

Readers' comments (19)

  • "It is the Government’s responsibility to run a benefits system that fairly assesses claimants without exploiting the goodwill of GPs"

    Perfectly expressed!

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  • The DWP deliberately relies on patients seeking medical evidence for themselves, apolicy which has been successfully challenged via a Judicial Review. There is already a mechanism for the DWP via its proxy, Atos, to approach GPs directly but it is often simply not used. GPs have my sympathy; the Work Capability programme is a steaming pile of...

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  • "It also fits far too neatly into the ‘greedy GPs’ narrative pushed by some of the national media. ‘Just say no’ is an all-too-tempting mantra, but one that could backfire."

    I disagree. Sure, it might generate some more "lazy GPs" stories. But we all know - and so do the public - that these are black propaganda. Fear of such stories is not a good reason to do unnecessary, unpaid work. Unless GPs say no - and do so collectively - they will be expected to do ever more unpaid work, when their workload is already unsustainable.

    It is, of course, important to communicate clearly why GPs are saying no to this work; but to throw in the towel and do it for fear of negative headlines will only accelerate the headlong rush to disaster.

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  • So instead of taking it out in a factually inaccurate and cruel manner on the patients a la Peverley, why aren't Pulse, the RCGP and grassroots GPs launching a campaign against the government?

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  • Our columnist Dr Phil Peverley is no stranger to controversy – but even he was taken aback by the reaction to his column last month.

    His piece on sickness certification, in which he admitted to an ‘unfashionable’ degree of sympathy for Atos and criticised the ‘disgruntled unworking well’, drew dozens of comments online, prompting a furious wider debate, articles in The Daily Telegraph and Daily Mail, and even requests for TV interviews.

    -------

    Peverley's piece attracted a huge amount of public attention because it was factually inaccurate and relied on stereotypes of the sick and those with disabilities.

    Peverley's diabtribe against the most vulnerable in society was nicely demolished on Twitter and also by Greg Wood....

    http://www.pulsetoday.co.uk/views/opinion/peverleys-attack-on-benefit-claimants-was-wrong-headed-and-having-worked-for-atos-i-should-know/20003924.article#.UiXRf2Q5w4o


    Interestingly, Pulse didn't give Greg Wood's blog the same prominence on the website as Peverley's.
    I wonder why?

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  • "Abrogate responsibility"......we are NOT responsible for patients benefits claims, it really is that simple. There is a "mission creep" on what GP responsibility is. It is all about money. This solicitor stuff is nonsense.....GPs always crap themselves when anyone mentions solicitors and back down. We act like victims and wonder why we get treated as such...,!

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  • Vinci Ho

    Steve(editor ),
    I think , for the sake of supporting argument , we need some figures to show , for instance, how many of these support letters an average GP would have to do every day and hence the time lost ( in minutes or even hours) , and therefore the equivalence of how many consultations would be lost every day.
    Of course , this does not exclude the GP exercising common sense to help individual patient...
    Once again , if you have a government which does not care about people's life but only money , it will do anything to lay off responsiblity on matters like this.....

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  • Thankyou for your comment Dr Ho - you make a good point. I'm not immediately aware of any stats like the ones you suggest - it might be something for us to look into and include in a future survey though?

    Steve Nowottny
    Editor, Pulse

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  • Writing these reports is an unbearable burden because we do not cancel appointments but do the reports in our own time. It is us and our families that suffer.

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  • Whilst I sympathise with GP's for the extra workload they have been given by Government policy they also must remember it is not the patients fault either they too are simply following the rules given by Government.

    They after all did not ask for there illnesses and/or disabilities.

    A doctors first duty is to the patient as laid out in the GMC Code of Conduct of which there licences to practice hinges on.

    Getting the best outcome for there patients in all areas whether it be medical, advice or benefits does lead to a healthier patient and less time in the long run at the practice.

    Everything these days seems to be about money and capitalism perhaps GP's should take the lead in compassion and empathy and start seeing the situation more in the patients eyes.

    This shame of the WCA has been ongoing for far to long and making patients more ill than they could be and it needs to end so lets see the GMC, BMA, LMC's and the wider medical profession taking the lead in ending this because it is a fallacy the Government can afford.

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