Yesterday, BBC Wales reported that GPs in South East Wales have been instructed not to write letters to support their patient's benefit appeals. The Bro Taf local medical committee, representing GPs, says "writing letters stops doctors seeing ill patients" amounting to an "Abuse of resources"
It clearly escaped them that these patients are ill enough to be making a claim for out of work subsistence benefits and therefore likely to be some of the most unwell people attending their surgeries.
However, more importantly, DWP ministers have blamed the staggering 43% ESA (Employment and Support Allowance) appeal rate on claimants not requesting and submitting enough medical evidence. As Mark Hoban claimed,
“What’s happening too often is people are suggesting to claimants ‘oh, just leave the medical evidence until the appeal’ – there’s a shared responsibility here.”
In theory, within the claim process, Atos is expected to request evidence from a claimant’s doctor when the claimant is likely to be placed in the Suport Group. For the year up to October 2012, Atos only requested such evidence (as an ESA113 form) in 27.2% of all ESA referrals; 23.8% of these were not returned by GPs.
Sadly, the House of Commons overturned a recommendation by the House of Lords that supporting evidence be sought in all ESA cases.
Claimants already overwhelming feel that the medical evidence they do submit is ignored by Atos assessors and DWP decision makers and 40% of cases that do go to appeal are overturned.
If GPs withdraw their support in this way, the claimant is entirely at the mercy of a tick-box computer based questionnaire, carried out by someone who does not have to be a doctor and who need have no knowledge at all of their condition or disability. This tick-box system has been shown to be inadequate and unfit for purpose by every major study. Both the BMA (British Medical Association) and the RCGPs (Royal College of GPs) have called for the assessment (WCA) to be withdrawn with immediate effect.
The opinion of a GP who knows the claimant well is often the only lifeline left to many facing this bleak, impersonal "assessment", If they refuse to help, they will be abandoning millions to a broken system.
It simply must not happen.
**Update. This comment was left on The Void and since, Bro Taf have said they will be issuing a statement later today. Hopefully, this measure will not be maintained :
Karin : "I have rung and had a long discussion with someone from the Bro Taf LMC re. this letter. I was angry but polite and she heard me out and understood where I was coming from. ( I have won Appeals recently after going through sheer hell and poverty for 18 months waiting for Tribunals).
She told me the letter is going to be withdrawn. She also accepted that the wording was too strong and a symptom of frustration (more later) and not a reflection of the LMC on patients at all.
She told me the letter is going to be withdrawn. She also accepted that the wording was too strong and a symptom of frustration (more later) and not a reflection of the LMC on patients at all.
The letter is advice only and no GP can be forced to act upon it as practices are independent and can do as they please.
She explained that the letter was generated out of terrible frustration that despite the LMCs telling the DWP time and time again that there needs to be a clear fair system and guidance for people who have to appeal, whereras now there is none, so naturally people go to their GPs. She went on to describe how many GP practices are almost at meltdown point due to inadequate funding and time spent by GPs having to write letter after letter and form after form often doing repeats , because the DWP haven’t told appellants that repetition won’t help.their case. I think I understood from our talk that Gps are funded to fill parts of forms from the DWP and anything else isn’t funded, however many GPs do do these extras
My understanding is that the DWP isn’t listening,to them or to claimants, MPs aren’t listening, pressure is peaking for us desperate claimants and building up in GPs.. Is this so that we fight eachother rather than uniting to effect the change that we desperately need? Of course it is us patients that suffer so terribly and waiting times to see GPs are growing.which certainly does not help."
From Bor Taf "We will be issuing a formal statement later today and this will be sent to you.
Regards
Bro Taf LMC Ltd
Henstaff Court Business Centre
Groesfaen
Cardiff
CF72 8NG
Tel: 02920899381
Email: brotaflmcltd@btconnect.com
Unfortunately (and it is possible I might make myself unpopular with readers here) GPs have been functioning as gatekeepers to deny access to both welfare and medical care to many patients for many years under both Tory and Labour governments since 1979. They have been paid handsomely to do this. Add to this the romanticisation of NHS staff's role, but particularly doctors, and just how much agents of a neoliberal state doctors have become is discomfiting to consider, hence many people fail to understand that this is the situation we are in. The leaders of doctors' organisations may puff and grumble a bit - but there will never be any disobedience by doctors on directives such as this, I predict.
ReplyDeleteI would like to add that, from memory, there is a note at the end of the esa 50 that says, in effect........
ReplyDeleteSend in medical notes with this form if you have them, and don't send in medical notes with this form but send them to the local office dealing with your claim!
I do realise this relates to 2 different notes but I had to read this bit several times to be sure what the heck they meant, and secondly when one hears that some docs will charge for this service, then frankly, sod it! If Atos want it they can pay for it. It's their mess!
I've had some experience of this Sue. I think GPs don't understand the system themselves. I asked my GP, who is fantastic, for a supporting letter and she said not to worry because they would send her the ESA form to fill in. Of course they didn't, so I contacted her and she actually faxed them a letter for me. If she hadn't been allowed to do this, I can't begin to imagine what would have happened. These instructions to GPs in South East Wales not to issue letters for appeals is undoubtedly going to lead to many more sick and disabled people losing their appeals, and if all other GP practices in the UK decide to follow their lead it will be an absolute nightmare. This decision is truly horrific.
ReplyDeleteIt amazes me that a GP who knows me well can have his opinion ignored in favour of someone who has seen me for 15-20 minutes for a WCA.
ReplyDeleteWhen the GP records are asked for, they just get a list of prescriptions asked for and filled and the occasional visit as we just carry on and suffer, having received from the medical profession an air of "Put Up And Shut Up".
Surgical procedures are assumed to be a perfect fix, the doctor at my tribunal could not believe I had trouble with my right knee after a Total Knee Replacement that wasn't total as they left the knee cap.
Now as I have failed in my DLA appeal, my GP is still writing "Sick" notes with the item "I advise you that: you are not fit for work." ticked. This however is not reflected by the DWP assessment of me!
The world is crazy!
In response to MW
ReplyDeleteI had the same issue (having just filled out my ESA50 a couple of months ago).
The exact phrasing is as follows:
"If you have any medical documents that you think would support your claim, send them in with your questionnaire. For example this could be a medical report from your doctor, consultant or support worker.
Please DO NOT* send medical statements with your questionnaire. Send them to the Jobcentre Plus office that deals with your claim"
*in bold
I spent a little while trying to figure out what the heck they meant before spotting the next sentence.
"Medical statements are also known as medical certificates, doctor's statements or sick notes."
I should then add that on the front of the ESA50 form itself it says in bold
"You do not have to see your GP or health care professional to ask for a specially written report. You may be charged if you do."
This seems to be in direct contradiction to Mark Hoban's complaints about claimants leaving medical evidence to appeal time. I would say it is not surprising and in fact claimants have been told to!
Firstly the wording in the accompanying letter is extremely confusing.
Secondly the information on the ESA50 form specifically says NOT to ask for a report.
I sent some information in because I happened to have some (my GP copies me in on any letters from my consultant appointments and I also had copies of discharges from hospital) but most people simply won't have anything to hand.
I totally agree SpoonyDoc - Even with the tonnes of blogs I've written and specific research we've undertaken on this, I STILL had to go back and read it over and over. It really is very unclear.
DeleteAs I said in the post above, Atos are only asking for medical evidence in 27.2% of all cases anyway and a quarter of those are never returned. If we can no longer reply on evidence from our own gPs we would be entirely at the mercy of Atos and LIMA
The GP's perspective: http://www.pulsetoday.co.uk/your-practice/practice-topics/employment/gps-struggle-to-cope-with-21-rise-in-requests-to-verify-work-capability-since-january/20003646.article#.UekNqxzWs_0
ReplyDeleteSounds like they are making reasonable requests; but that DWP doesn't yet know what to do about it!
Nonetheless, for a GP to refuse to assist a patient who will or might deteriorate must breach their ethical code of conduct. The S. Wales stance is outrageous! %///
I seem to recall this is actually a story which is happening elsewhere as well. Wasn't it Scotland or various areas in England which has the same issue?
ReplyDeleteI'm more than a little "meh" about the fact this "frustration" was voiced rather globally, and that it seems that the frustration trickles down to the claimants and not to the government which is the ones responsible for this mess...but that's proving the case in many different ways.
Yep - I've recently come up against the same issue in Glasgow, although the letter isn't worded *quite* so disgustingly harshly... http://farm6.staticflickr.com/5539/9347417152_85227b6f81_b.jpg
DeleteI believe similar advice has been issued to GPs in Birmingham as well: http://www.gponline.com/News/article/1178595/benefit-changes-lead-surge-gp-workload/
Unfortunately it looks like South East Wales are following the herd, rather than leading it, on this one, although the wording of their letter is definitely the most callous I've seen so far.
"The letter is advice only and no GP can be forced to act upon it"
ReplyDeleteI worry that a GP would use this as proof that they don't have to fill in the form. Another thought I do not know if this is common practice but many GP's in Leicester charge for these letters
When I put in my ESA claim I didn't trust that ATOS would ask for the information required. I sent so much medical evidence, pretty much every relevant bit that I had. Luckily I get copies of all letters from specialists and am fairly organised so I had pretty much everything to hand. I know that not everyone is able to. I had supporting statements from my care agency and senior workers from the care agency too, so I had a lot of back up. None of them were contacted. I think I was the opposite of what Mark Hoban said, I probably had enough paperwork for several people!! :O
ReplyDelete3.1 Contractual Obligations
ReplyDelete3.1.1 General Practitioners
There is a contractual obligation for any GP who has issued a Med3 (certificate of
incapacity for work) to provide medical reports in relation to Incapacity Benefit and
Employment and Support Allowance. This should be done free of charge as covered
by the contractual arrangements between GPs and the relevant Primary Care Trust.
(from http://www.dwp.gov.uk/docs/medical-reports-completion.pdf )
My interpretation of this is that, not only are GP contractually obliged to provide a medical report, but they mustn't charge for it as some patients have been asked to do. I don't think the GPs in South Wales CAN refuse to produce a report without breaking their contract with the DWP.
First a of all the DWP are asking you to get the evidence not the doctor if you do not wish to send in evidence that's up to you. The DWP are not asking your GP to do the report so the contract is between you and your GP not the DWP, so doctors can charge you what ever they see fit.
DeleteDoctor can refuse to give you a letter, they can refuse to write letters if they think this letter which is handed to you not sent by the doctor to the DWP would cause stress between the GP and the patient.
Your view would be correct if the DWP asked the GP to write the letter, but they are not, they are just advising you to send in evidence if you wish.
You then ask your GP he can decline.
The contract your talking about was for IB medicals in which the DWP paid the doctors for reports, this is not now happening.
I can't say I understand this stance! Is Bro Taf LMC going to advise GPs not to fill in compensation claims; insurance claims; DVLA reports, HGV reports etc., All these things take up time that "could be spent on ill patients" but of course these reports etc., are paid for - makes a difference doesn't it?
DeleteI now have no confidence in the wca and never did, i feel it really does not matter what evidence you provide because the assessor will interpret that so that they can input to the computer program, they will be nice and smiling and telling you that they sympathise with your condition whilst knowing that they are doing there best to make sure your score is low(always 0), at the appeal things are different as they will look at you and your case and the evidence you have and make an informed decision, in my case it was exemption under article 29 and 42, with a recommendation that atos leave me alone for 18 months.
ReplyDeleteMy doctor had told me she had been told not to write supporting letters by atos/dwp as they would have no effect, at the appeal the opposite was true and the supporting letter helped greatly and i was not charged.
Andy
Hmm, government sinks lower than it's last low shocker! Is there a way to describe something being more unhelpful and arrogant than anything ever before? Yes, look up Conservatives 2013.
ReplyDeletesome doctors will some wont it's pretty simple some DWP staff are great some are out to kill you there again it's pretty simple just the same if you go into hospital some doctors and nurses will be great and some will just leave you to die
ReplyDeleteat the end of the day it's just about luck pure and simple like it's always been
But that isn't right Nick, it really isn't. This is pre-meditated deference of the highest order and stinks of ignorance and malicious hateful neglect.
Deletebut martin that's the real world I'm 58 and that's all I've ever known from the uk and it's governments sure it's worse today because the uk mentality of selfishness and greed is much more pronounced today but it's always been there
ReplyDeleteThe days of kicking around old and out of work or ill and disabled are coming to an end and with the likes of David Cameron lurking about for the next 20 years things will get far worse on a scale never seen before in the whole world
what good doctors are left are all coming up to retirement and the younger breed like David Cameron will be thinking like David Cameron as i said above it's all pretty simple and non negotiable
More sick and disabled people will die in the next 5 years then the previous 20 years such is the magnitude of the destruction of David Cameron mind
You have to remember in his eyes he's helping you and he'll go flat out to help you at whatever cost. his help thou is my death and that's the difference between the two of us
650 mps in favour of the welfare reform bill which leave me on my own and a few here i guess which in a democracy we lose
Reforms were needed without a doubt, but it was needed because more and more people got benefits because of a paper assessment and less and less due to face to face medicals. When I applied for IB I had a medical, when my neigbour applied she got it solely on the forms she sent in, and now she has been told she is able to work and placed straight back onto JSA.
DeleteHer problem was she had a cartilage operation, she had her knee cleaned out and believed that was enough to gain disability benefits.
But whose fault is it that face to face assessments and medical stopped, was this used by Labour to say to many people were getting benefits I believe it was.
DLA use to be the hardest benefits to get again they stated to do more paper only assessments which saw the benefits go through the roof or so we are told.
The real issues here is not that reforms are needed but with both the ESA and PIP's they are actually attacking the most seriously disabled, but if you have a good GP are good at telling fibs and acting your still getting benefits, while those who are severely disabled sick are unable to do this are deemed fit to work.
My GP (in the North East of England) has been very helpful. But the consultant's report I submitted with his endorsement that it was still valid mysteriously vanished in the DWP system and they refused to reconsider my claim because there was "no new evidence". I turned to my consultant for an update on my report. He is also overwhelmed with people wanting his help with appeals. What a waste of valuable GP and consultant time. But it is the system at fault - the WCA is explicitly NOT a medical assessment but it is being treated as one.
ReplyDeleteI submitted a consultants report before the WCA that was two years old but which explicitly said I would not recover from my condition - the assessor had it and I thought it would form an important part of the assessment process - but it obviously didn't. As with other so-called welfare reforms, they save headline amounts of money in one part of the budget only to have to spend probably a lot more clearing up the mess they've caused. When did "joined up government" go out of fashion - if we ever had it!!
Mike
The question of medical evidence is also highly relevant to ib/ESA conversion cases. Currently there is absolutely no statutory requirement upon a claimant on ib undergoing conversion assessment to even contact their doctor before the DWP/ATOS considers the WCA.
ReplyDeleteIt is only once the WCA decision has been made (in an ib conversion case) that the claimant may find themselves having to appeal following a fit for work finding. Perversely it only once an appeal is lodged that the claimant is reminded by the DWP of the need to contact their doctor & provide medical evidence (albeit only a 'fit note') in order to claim ESA in the 'assessment phase' pending their appeal.
In my view, it's yet more flawed legislation. Many long term ib claimants may not have seen their doctor for sometime (as the claimant will have been subject to PCA testing) and are therefore denied an ideal opportunity to have a chat with their doctor before the assessment is conducted. It's a serious failing and means claimants aren't being prompted to discuss accumulating barriers to work so often found in long term ib claims (mental health often becoming more of an issue with declining levels of social interaction associated with long periods of isolation). I was quite happily challenging a wave of these decisions until legal aid became a distant memory - although I continue to try and find ways of furthering the argument. It's a ludicrous system which pays far too much attention to the view of the DWP's contracted HCP rather than the more valid opinion of a more informed GP.
I can't say I blame GP's, they're overloaded with stressed out patients and ultimately I'm sure the majority would like to support their patients. GP's are in part likely to want to lay the blame for errant decisions firmly at the door of the DWP & Atos who should be made to accept responsibility for the dire consequences of the rising number of their inept decisions.
NickD
ilegal.org.uk
We all know something is wrong with the WCA if you help out at a Charity we would now advise people to get as much evidence as they can from anyone and everyone the more evidence you get the better.
DeleteI come from the area of this report and I was told that doctors do not write these report during surgery time, they do them after surgery and this is why many of them make a small charge.
This report has been called into question by doctors who say they would never write letters when patients are waiting, for one thing GPs are told to go back and read through the patients medical records to get an insight of all the issue the patient has.
My GP stated he took my medical record home went through it made notes and then gave it to his secretary to write out, she wrote the letters after surgery and her wages were the cost I paid £100.
He said no doctor in his surgery would write a letters while the patient was waiting since most patient only have 15 minutes and doctors would not lie or make up statements of evidence which were not true and writing a letter while the patient is waiting could cause issues if the patient did not think the letter was in his or her favour..
So I think if doctors are doing this and I know of none that are, then they need to sort out another way.
I think this is another of those reports which somebody has thought patient goes in doctor writes letter on the spot takes an hour while patients are waiting, I know of no doctor who would do that.
So this is another of these things which is taken out of context and made up.
since 1980 I've had around 20 or so medicals covering many aliments with regards my illness.
ReplyDeletemy overall condition since 1980 has as you would expect got worse caused by the DWP keeping me housebound with threats of loss of benefit if i go out under IB/CONTRIBUTION ESA causing me to have many mental breakdowns that have left me looking like a prisoner of war victim at a weight of 100 lbs at 6ft 2inch
Had i of course been political like nelson Mandela or Aung San Suu Kyi then i would be a hero having tea with David Cameron
sadly this is not the case for me and have had to endure years of mistreatment with 8 years still to go till i retire at 66
the dwp are just full of bullxxxx they know exactly everything about you your bank details your ISP YOUR FACEBOOK PAGE IF YOU HAVE ONE YOUR TWITTER ACCOUNT YOUR BLOG IF YOU HAVE ONE AND EVERYTHING MEDICALLY RECORDED AGAINST YOU
HOW DO I KNOW ?
My DWP compliance officer told me when she calls to see me once a year so now you all know
I cant say what the reason is for the DWP to ask for medical evidence is as they already have it other then to cause a way of blaming the public if anything goes wrong like you die or their could be a legal reason that none of us know of
i still get asked for medical evidence and my answers still the same (get lost) and that's the game that I've played for 33 years
so when they say where yours medical evidence just sing them this song say (if you don't know me by now you will never never know me)
http://www.youtube.com/watch?v=zTcu7MCtuTs
PS my DLA does however allow me to go out so provided i keep it short like an hour or so i have got by and the DLA have never caused me a problem as the rules are different
The current IB/ESA SUPPORT rules are very strict as you will all find out over the coming months if you wont your sanity you wont wont to receive this benefit as it can be a nightmare for some people to stay on it only those that are housebound cope well with it anyone trying to get out the front door however needs to think long and hard about this benefit as it'll do your head in and all those around you at best you'll end up with a mental disorder and at worse your'll be dead
In a lot of ways, the government is ignorant and everyone knows it. The more disabled people are oppressed, the more the media cannot lie, the more the people fight back, the more the government loses, the more disabled people win. Why we have to have this cycle of events is purely because of nasty political nonsense and that isn't good enough. Stop oppressing disabled people and the world is a better place. How ignorant is the government if it thinks we don't know this?
DeleteHi Sue, thanks for taking up an issue that affects me deeply. I'm in a dispute with my GP surgery over its refusal to provide medical evidence to claimants. Could I ask where you got this statistic from:
ReplyDelete"For the year up to October 2012, Atos only requested such evidence (as an ESA113 form) in 27.2% of all ESA referrals;"
Thanks
as i say Catherine all this medical evidence is just nonsense as in my case if they need information they call my doctor and in my mind the staff are a bit thick because if you don't know someone's illness after 33 years then you must be thick or playing some sort of game ?
ReplyDeleteGPS turns understanding a lot,, amazing
ReplyDeleteI read your article very carefully. I think you should also write article about antigen test kit suppliers. This will be beneficial for others I guess thank you.
ReplyDelete