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.