As a GP in one of the most deprived areas in the UK, I really get to know my patients and their stories. With deprivation comes poverty, and a number of our patients are on benefits, while others are in low-paid work and are struggling. Our surgery is situated right opposite a food bank, and our patients increasingly need its support.
I remember visiting Pakistan as a child and seeing terrible poverty. It haunted me but it was considered almost normality for a developing country, however right or wrong that may be. Growing up in one of the most affluent countries in the world, right here in the UK, I never imagined I would see patients struggling with the basic cost of daily living. After all, the principals we champion here are embedded in the NHS and benefits system: society covering the cost for ill health and social needs when people fall on hard times. We should cherish these principals.
Historically, patients would tell me they had a benefits assessment coming up and that they were stressed about it. The thought of someone saying you can no longer receive money you rely on must be daunting. I used to reassure them; it was routine and nothing to worry about. But now my patients consistently tell me that their benefits assessment was really short, not fit for purpose and that the written report does not reflect the actual assessment. This is causing undue financial stress for our patients, but in addition is draining our already scarce resource of GP appointments when patients come to discuss this.
Let me give you some examples. I have a schizophrenic patient who has severe agoraphobia. His parents look after him at home and psychiatry do home visits. He hasn’t left the house in three years. His benefits assessment was sensibly done at home, but the outcome was that he was fit for work and could leave the house. Every time he has an assessment, I have to write a detailed report to support his appeal.
The current system is not working and our patients need help navigating it
Another patient with early onset Parkinson’s disease who is not responding to medication was recently deemed fit for work. He is slow to get up, often freezes mid-motion and due to his tremor relies on his wife for all aspects of care from dressing to feeding. Despite his speech being incomprehensible to strangers, the report stated his speech is normal. He is a proud man who will never ask for help himself so I enquire about his benefits opportunistically.
If the core principals of the NHS and benefits system are that the cost of ill health should not be a burden to the patient, this needs sorting out, urgently. The current system is not working and our patients need help navigating it.
So what are we doing about it at our practice? In an already underfunded and overworked frontline NHS service, we are trying our best to support those patients who need it most. We have provided a free space for the Citizens Advice Bureau (CAB) to consult from our practice once a fortnight. CAB are a free service and we thought that having them on site would improve our patient access to them, particularly for patients who rely on carers, have learning disabilities or are anxious about going to new places.
The workers are consistent so that they can get to know the patients’ circumstances and similarly the patients get to know them too. They help patients fill out forms, navigate the system and advise on what benefits they may be entitled to. For example, my patient with Parkinson’s didn’t know he could also apply for housing benefit, carer’s benefit and personal independence payment. Our receptionists are trained to triage the reason a patient wants to see a GP, and if it is for help with benefits, they can directly refer them to CAB at the practice instead and save our appointments for medical issues. Our GPs and nurses also find this invaluable in being able to direct our patients with long term conditions to a trusted source for benefits advice, on practice premises.
Throughout my training and career, many healthcare professionals would say that the NHS and politics are separate issues. In an ideal world, this would be the reality. However, it is becoming clearer that politics drives the decisions surrounding the NHS and social care.
We know of reports that benefits assessors have been set arbitrary targets for the number of people they assess people as fit for work, and that they are paid commission for fitting in more assessments a day – increasing the chance people are mistakenly deemed fit. It is entirely appropriate for benefits assessments to be taken out of primary care, not least so the doctor-patient relationship isn’t compromised. But we now have to question if the assessment is fit for purpose and if the apparent financial incentives for assessors negatively impact on their decisions.
I will leave that juicy discussion for another day. But I would encourage all of my colleagues in general practice to think about their patient’s wellbeing with regards to finances and to help them by signposting to supportive services like the CAB.
Dr MayJay Ali is a GP partner in the West Midlands. You can follow her on Twitter @DoctorMayJay