I have spoken a lot about the severe workload pressures in general practice in recent months and the effects of changes to the welfare benefit system have had a huge impact, not just on the workload of practices but on the relationships between doctors and their patients.
Essentially, by putting patients in a position where they are advised to get additional medical information to support an appeal claim, the Government has placed a requirement on GPs to effectively challenge decisions made by independent medical assessors and determine which of my patients are deserving of their benefit payments.
We need to provide more information
The main area of contention for many appears to come from the requests we get from patients for further medical evidence to support appeals against decisions made by Atos. This is not information that is required under the terms of our contract or for the initial benefits review process, but instead it’s a ‘suggestion’ that could help the individual’s case when subject to appeal, many of which have been successful.
In just one morning in my surgery, for example, these requests accounted for three out of 16 of my appointments. I am in a position where the bureaucratic demands of the welfare system are affecting the time I have to spend on the clinical needs of my patients. I am sure that all GPs are facing a similar dilemma.
It is absolutely true that none of my patients can afford to have less money, yet employment is arguably one of the best determinants of future health. The setting of thresholds for benefits is, quite correctly, a political decision and it should be assessed independently, but we GPs are unashamedly biased in favour of our patients; we are not independent in that sense. Our role in providing evidence should solely be to provide factual information and not to offer an opinion on who should receive benefits, because whoever has that role also says who should not get benefits. I do not want to divide my patients into the deserving and the undeserving sick and disabled.
The current process puts me in an invidious position. If I provide further medical evidence only for some people, I am being partial. I might provide a letter because I am sympathetic to the patient. We could therefore end up in a situation where my decision to provide additional information – which is private because it is not part of the assessment system – is based on whether I have greater sympathy for one patient over another. Should I have to decide who deserves an additional medical report that will help them challenge a decision that they cannot have benefits. For some patients, their doctor may agree with the decision to refuse benefits which could harm the relationship between the doctor and patient.
Therefore if I were to give reports, I would have to give them to everyone. That is just not tenable, given the numbers involved. Surely it is fairer for a system where information is provided in a standardised and fair way and where an independent body decides whether a person is entitled to benefits?
The ethical issues
The role and responsibility of GPs has clearly changed as a result of these welfare reforms, but without any genuine discussion from those responsible for the system, yet somehow we seem to be blamed for it going wrong, which is a strange position to be in.
The system should be fair and just – there needs to be a systematic application of a fair way to get medical information. The process is already there, so change could be easily and immediately achieved – but it is for the politicians and pressure groups to decide how the system works.
As it stands, GPs are expected to prop up a flawed system. Far too many people are being turned down for benefits and having to go through the appeal process. That so many appeals are successful demonstrates the flaws in the system and the urgent need for improvement.
The BMA wants to see improvements where more appropriate and comprehensive information is provided in advance of making a decision on ESA for a patient, because that is the only fair and equitable way for medical evidence to be provided by GPs.
Dr Alan McDevitt is the chair of GPC Scotland and a GP in Clydebank.