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Forum Home  →  Discussion  →  Work capability issues and ESA  →  Thread

psychosis/schizophrenia patients should not be referred for HCP assessment?

Robbie Spence
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I’m doing ESA Appeal for someone who has been on ESA since it was introduced by reason of psychosis/schizophrenia. I’m searching for the rule/reg/guidance that says such claimants should not be referred to HCP assessment without their GP etc first being consulted about whether this is safe.

I can’t find this mentioned in factsheets like https://www.rethink.org/living-with-mental-illness/money-issues-benefits-employment/work-capability-assessment nor in the Forum - closest thing I found was the thread on ESA113 form (DWP questionnaire to patient’s GP) at http://www.rightsnet.org.uk/forums/viewthread/4868/P15

I’ve found the helpful CPAG/GreenwichWR info about ESA and safeguarding at http://www.cpag.org.uk/content/safeguarding-guidance-tool-practitioners but that’s more about home visits and sanctions.

Have I been dreaming that there is a rule/reg/guidance that says such claimants should not be referred to HCP assessment until their GP has first been consulted about whether this is safe? Any pointers or links? Thanks…

Paul_Treloar_AgeUK
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Sorry but I certainly can’‘t recall any such dispensation when it was introduced, nor since, Robbie. If anything, the approach was “everyone” would be able to take advantage of the wonderful world of employment support on offer, as well as the new WCA looking at what barriers you needed to overcome to enter work, as well as assessing your entitlement.

Sadly, it seems the WCA became a simple and brutal tool to make everyone’s lives unhappy.

John Birks
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You would hope the GP would be sent an ESA113 to complete - this depends on the return of the ESA50 and it’s contents apparently - which would lead to a decision without the need for a face to face assessment.

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/251339/esa113-interactive.pdf

There could be no harm actively providing a completed ESA113?

Dan_Manville
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John Birks - 13 January 2017 09:00 AM

There could be no harm actively providing a completed ESA113?

Don’t forget that GPs get a fee for a 113.

There is no provision either in guidance or regulation that a claimant with a psychotic illness should not be referred for a F2F. What there is, in the filework guidance, is instruction that where a claimant states in the ESA50 that they have an appointee, experience either deliberate self harm or suicidal ideation or a couple of other provisions, that CHDA should request further evidence and consider whether a F2F is appropriate. In practice they also request a 113 if a person’s carrying a PV marker.


page 18

 

John Birks
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Dan Manville - 13 January 2017 12:26 PM
John Birks - 13 January 2017 09:00 AM

There could be no harm actively providing a completed ESA113?

Don’t forget that GPs get a fee for a 113.

 

page 18

 

Actually they don’t get a fee - that may be the problem with getting them completed.

(Under current rules) the DWP can’t compel the GP to complete an ESA113 and there’s no financial incentive to spend time completing the form.

see below extract

Medical certificates and medical reports (ESA113’s) are provided under their terms and conditions of service by General Practitioners (GPs) as laid down in the National Health Service (NHS) (General Medical Services) Regulations 1992 (as amended 1998). The GP is remunerated for this service by the NHS.

Hospital health care professionals provide a similar service, free of charge under the standard model NHS contract of employment as long as the report is reasonably incidental to the treatment being given to the Client.

Therefore as GPs are already paid in their GP contract to complete ESA113s, there should be no charge made to an ESA claimant in respect of these.

And separate guidance

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/524047/medical-reports-completion-guidance.pdf

 

Dan_Manville
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John Birks - 13 January 2017 12:52 PM
Dan Manville - 13 January 2017 12:26 PM
John Birks - 13 January 2017 09:00 AM

There could be no harm actively providing a completed ESA113?

Don’t forget that GPs get a fee for a 113.

 

page 18

 

Actually they don’t get a fee - that may be the problem with getting them completed.

(Under current rules) the DWP can’t compel the GP to complete an ESA113 and there’s no financial incentive to spend time completing the form.

 

 

Has that changed? I remember seeing invoices for DWP medical reports in peoples’ medical records. £37 was a the going rate IIRC

Elliot Kent
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I’ve got an ESA113 in front of me now which says (I assume correctly):

Please note:
NHS doctors have a contractual obligation to provide the information requested without charge

I also remember seeing reports of fees in that region. I wonder if they were for DLA/PIP?

John Birks
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The fees can be charged for Disability Benefits as these are outside of the GP contract - Hence DS1500s and PIP/DLA/AA reports attract a fee.

John Birks
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see 123 of link to doc

https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/06/gms-2015-16.pdf


LIST OF PRESCRIBED MEDICAL CERTIFICATES

Description of medical certificate Enactment under or for the purpose of which certificate required

1. To support a claim or to obtain payment either personally or by proxy; to prove inability to work or incapacity for self-support for the purposes of an award by the Secretary of State; or to enable proxy to draw pensions etc.

Naval and Marine Pay and Pensions Act 1865
Air Force (Constitution) Act 1917
Pensions (Navy, Army, Air Force and Mercantile Marine) Act 1939
Personal Injuries (Emergency Provisions) Act 1939
Pensions (Mercantile Marine) Act 1942
Polish Resettlement Act 1947
Social Security Administration Act 1992

stevejohnsontrainer
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Hi Robbie,

Turning back to the matter of the desirability of contacting the GP prior to deciding about an assessment interview etc, I suspect that the safeguarding provisions may offer the best practical support. I know the DWP often seem to fail to activate safeguarding, but in other cases I see the DWP has not been properly notified of the claimant’s background vulnerability.

Had a quick look at the WCA Handbook. The best I could see was as follows…

From section 2.2 of WCA Handbook…

“…The pre-board check is designed to identify those claimants who may meet criteria to be considered to have LCW/LCWRA (Support Group) or those claimants who may meet certain criteria of ‘Treat as LCW’ without having a face-to-face assessment. The case will be accessed through the MSRS application and the outcome generated using LiMA. The HCP will review the information available and may choose to ask for further medical evidence. If the evidence suggests they meet criteria of having both limited capability for work and work related activity, or ‘Treat as LCW’ applies, the HCP will provide this advice to the Decision Maker highlighting the specific LCWRA criteria / ‘Treat as LCW’ category that is appropriate. The filework HCP will justify their advice and provide a prognosis (or re-referral period in UC) for the DM to consider. If the Decision Maker accepts this advice, the claimant will not have to attend for an assessment.”
(my emphasis)

So it is possible to decide matters without a face to face assessment, and further medical evidence should be obtained if necessary. I think pre-board check cases only account for a very small percentage of outcomes, and I have never tried asking for the process to be activated.  I guess you could try to couple the above with the following from para 3.1.3.9…

“…It is important to fully explore psychiatric symptoms in claimants with mental health problems, including suicidal ideation if relevant.”

I think I am trying to make a banquet out of a sandwich, but could not see anything stronger!

Steve