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Revised benefits letter still ‘misleading’ GPs about issuing fit notes

A benefits letter sent to GPs explaining patients are fit for work is still ‘misleading’ despite having been revised by the Department for Work and Pensions, family doctors have warned.

The DWP has revised the ESA65B letter for a second time after its initial rewording was criticised for failing to explicitly explain to GPs they might still need to issue fit notes for patients appealing a ‘fit to work’ decision.

Charities say although this second revision is ‘a little less confusing’ it is still actively misleading and dissuades GPs from issuing fit notes – previously known as sick notes.

They have warned severely ill and disabled patients have been left unable to claim benefits, even though they are entitled to them pending an appeal – and have warned the new version of the letter will not improve the situation.

GPs agree the changes are ‘little more than rearranging deck chairs on the Titanic’ – but the BMA has said it believes the altered wording is a ‘significant improvement’.

The BMA and RCGP previously criticised the letter and called for it to be amended – but it later emerged they may have seen the revised version before it was authorised for use. However, both denied accusations by the DWP that they had signed off the letter’s altered wording. 

Dr Stephen Carty, a GP in Leith and medical advisor to campaign group Black Triangle, which supports sickness benefits claimants, said although he welcomes attempts to improve the letter, it is ’little more than rearranging deck chairs on the Titanic’.

He said: ’The most common misleading statement is that the claimant is “fit for work” – in contradiction to the claimant’s own GP and their opinion formed over many years.’

Chief executive of advice charity Z2K Raji Hunjan said the letter was a ‘little less confusing’ but added: ‘The revised letters continue to be actively misleading and ultimately leads to people being denied benefits that they are entitled to. 

‘Why do GPs need to know the DWP have declared the person fit for work, and then be told that they can still provide fit notes in some circumstances?’

Dr Rob Hampton, GP and founding member of the Society of Occupational Medicine interest group, has said the revisions to the letter do not solve the problem. 

He said: ‘The BMA and the RCGP were understandably concerned that the previous wording was putting vulnerable patients at risk if we didn’t sign fit notes. I think that concern is not changed by this wording.

‘And the real issue on the table is that whether GPs should even being asked to sign fit notes in any circumstance for people stuck in the benefit system. The surveys I’ve performed reveal we feel very uncomfortable about being in that position.’

But a BMA spokesperson said: ‘While we do not have a role in endorsing DWP communications, we have been consulted on the revised wording of this letter.

‘Insofar as it explains the options open to the clinician, we believe this is a significant improvement on the wording previously being used, and will provide clarity for professionals as they seek to offer appropriate support to claimants.’

A DWP spokesperson said: ‘We updated the letter based on feedback and discussed it with the BMA and RCGP to ensure it is clear and fit for purpose.

‘We want to ensure anyone with a disability or health condition gets the support they need, which is why we carry out assessments to understand exactly how a person’s condition affects them day to day. Assessments are carried out by healthcare professionals based on all the evidence provided, including from their GP or medical specialist.’

The RCGP has been approached for comment. 

A timeline of DWP vs GPs:

In March, it was revealed that the DWP were developing a new IT system which would allow access to patients’ health data as part of welfare support application assessments.

Later that month, the DWP were explicitly telling GPs not to issue fit notes to patients, by removing the section warning GPs they might still have to issue fit notes to patients appealing a decision or it their condition worsens.

Shortly after, MPs called on the Government to scrap the ESA65B letter that was putting off GPs from issuing fit notes.

In April, the BMA and RCGP denied approving the letter the DWP amended, but both organisations admitted they may have seen the letter.