If only I had a pound for every time someone in authority said ‘GPs are ideally placed to….’. It’s a phrase that covers everything from sorting out a public health agenda to stopping global warming, and probably includes proving the existence of the tooth fairy.
But helping patients to negotiate the arcane twists and turns of the benefits system is a serious subject. Whether we’re sitting in our surgeries, or going out and about to visit our patients, we come across all manner of social disasters that have befallen those we care for: times have been tough.
Some people, who have always worked and been proud to support their families have, have now fallen on hard times. The previously employed become unemployed sofa-surfers. Sometimes illness strikes and the breadwinner is no longer able to go out to work. Families separate and the main parent or guardian often goes through financial difficulties. We have all been in a situation where an unemployed patient who is fit for work after an illness, begs for a further sick note so they can continue to receive sickness benefits.
Underpinning our society is the UK’s welfare state, which we all rely on it from time to time in various guises. But how many GPs truly understand the web of entitlements to the various benefits?
I used to examine for Mobility and Attendance Allowances (AA) and the Disability Living Allowance (DLA) on behalf of the Department for Health and Social Security (or whatever it was then) so I was more clued up than most on the criteria for entitlement. But ESA and all the new three letter acronyms used now? Search me if I know what they mean.
I was trained in medicine. While it is really important to me that patients have enough to live on, and a civilised environment in which to live, I am not an expert in these matters.
Read the other side of the debate here:
Do GPs have a duty to help needy patients get benefits? Yes
But, in true GP style, I know someone who is. Citizens Advice bureau do a fantastic job, backed up by the local Law Centre, in dealing with people, advising on benefit entitlement and helping people to claim that to which they are entitled.
I cannot form a judgment on whether my patient in front of me fulfills the criteria for ESA and whether the removal or granting of a benefit is fair, correct and legal.
While we should always be our patients’ advocates in negotiating the journey through the health service, we are not best placed to do the same in the social care services and we kid ourselves if we think we are.
We should also be aware that the tribunal service on ESA appeals would not always take much notice of an unsolicited letter from a GP. They do have the means to acquire independent medical evidence when the need arises. Questions have been raised as to whether the system is fair but that is the territory of the MP, not the GP.
What I learned while doing AA and DLA examinations is that it is not the diagnosis that opens the gate to allowances but the effect on function. Two people with similar impairments may have grossly dissimilar disabilities, and we GPs are not trained in disability assessment.
In some practices, a benefits adviser comes in to do a session to help patients – this is great and should be welcomed. But neither my GP colleagues nor myself are trained in this field and we have a duty as GPs to do the right thing for patients, which include referring patients to a specialist when necessary. That is how we offer the best service to our patients.
The doctor-patient relationship is based on trust and honesty. The best service we can offer our patient is to give good advice medically, and not act outside our knowledge in a misguided attempt to help patients maximise benefits – leave that one to the experts. That honesty will bank the maximum goodwill for the future.
Dr Peter Swinyard is a GP in Swindon and chair of the Family Doctor Association.