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GP’s not a happy bunch either
I have just had a call from an irate GP who seems to be at the end of his tether in regards to having to write letters of information for clients in regards to the numerous ESA appeals that are arising. I have no doubt that will also have a knock on effect regarding DLA appeals too. Indeed this GP stated quite clearly that he will help with appeals but only wants to put Yes or No answers to specific questions. He did indicate that the DWP and CAB (under the LSC contracts) pay for reports.
Are other representatives experiencing similar problems in their areas and how has it been addressed?
Is anybody aware of the Appeals Service actually addressing the issue by making the Chairs fully aware of the difficulties being faced?
Has anybody actually seen or have a copy of the letter the DWP sends to the GP’s once a client has been found fit for work?
The situation really is getting quite rediculous.
We probably don’t have quite as many appeals as you do but I am pretty sure our local GPs are getting a bit fed up with all the letters as well.
We have tried to reduce the workload by setting out the descriptors we think apply exactly as they are set out in the legislation (I tend to cut and paste them) so that the doctor can either just say yes or no or expand on it if they want to. We also have a ‘notes’ sheet to include that points out we don’t have a budget for medical reports.
In an attempt to be bit proacative I am also trying to give short talk with a handout to the all the CMHTs about medical evidence for ESA in the hope of avoiding appeals altoghether. If you want copies of any of this stuff email me at .(JavaScript must be enabled to view this email address)
I don’t know how much difference any of this will make, its too early to say, but I can see that there may come a point where exasperated GPs simply wont have the time to respond and I think that we need to do everyting we can to prevent that happening.
I recently sent a questionnaire to a GP regarding a client and explained that we do not have funding to pay for medical reports, etc. He wrote back threatening to report me to a local health watchdog for doing this. On the other hand, I find there are some GPs who are quite willing to help their patients for free. I think there needs to be some guidelines to provide a more consistent approach.
We find that some GP practices have a policy of not supplying reports for use in benefit appeals, wheher payment is offered or not. One GP actually told me on the phone that he was “too busy helping his patients” to be bothered with writing reports! Other GPs are quite happy to do the work for free, and often do more than is required. It does however seem to be up to the preferences of individual doctors and practices.
Our local surgeries (or at least, the practice managers) have a policy of always charging for letters, in fact we have been told they have a duty to do so under NHS rules. A surgery has written to us suggesting that in any case we should only be requesting medical support for an appeal in “exceptional circumstances”.
This is where medical records come to the fore. Certainly in these parts Tribunals prefer them, most are digital so only a £10 fee and there’s a statutory duty to provide them so no quibbling practitioners.
IME most clients can stump up a tenner; those that can’t; I ask TS to obtain them instead. So far, and I suspect because we exhaust other channels before asking TS. such requests have been granted.
Twice recently I have asked appellants to request the print outs from their GP and both times the surgeries have siad that they will only do so if a rep writes and asks for them. This might be a way of the appellant not having to pay for them (in which case ‘well done’ to the surgeries concerned!) but I was quite surprised at both the surgeries reluctance to give a patient their own medical records.
This is where medical records come to the fore. Certainly in these parts Tribunals prefer them, most are digital so only a £10 fee and there’s a statutory duty to provide them so no quibbling practitioners.
IME most clients can stump up a tenner; those that can’t; I ask TS to obtain them instead. So far, and I suspect because we exhaust other channels before asking TS. such requests have been granted.
Twice recently I have asked appellants to request the print outs from their GP and both times the surgeries have siad that they will only do so if a rep writes and asks for them. This might be a way of the appellant not having to pay for them .
more likely so that they can charge you £50, rather than the appellant £10. if a patient requests records, they are entitled to them for that £10. doesn’t have to say WHY they want them….
By and large they don’t charge us for them . We have a note included in the letter requesting evidence that says we do not have a budget to pay for reports, for the most part GP are happy to provide them FOC and that if they have a policy of charging for them we may have to go back to the appellant to see if they want to pay. Almost all our local practices have taken this on board and provide evidence free.
In ESA cases it is often the lack of any other medical evidence that allows the ATOS assessment to assume an importance it probably doesn’t deserve and I think it could be argued that a GP is acting in his/her patients best interests by providing evidence for appeals, the strain of being refused ESA and having to appeal is hardly likeley to help an ill person get better !
Like many of you we havea few surgeries that always charge but most will provide a reply and copies of records and reports free of charge.
However we do detect that GPs are getting fed up with having to do this for the same patient on a regular basis. We have many clients who are now on their third WCA appeal and with the most recent being under the new version on the WCA we can’t just ask “has there been any change since your previous letter of X”. With some clients being re-assessed every 6 months we can see payment becoming an increasing issue - before considering aditional migrated IB/IS appeal cases and DLA/PIP!.
If DWP really are going to seek additional evidence (see news item) will they be in a similar format to the existing (next to useless)standard GP questionairre - or will DMs have sufficient understanding of the WCA to ask for information relevant to the individual. How are they going to know what is relevant unless they have a detailed conversation / interview with the client ‘like what WROs do’? I can’t see the resources being made available for that to happen!
Just a few thoughts….
Some of these problems with ESA might be resolved by giving FTTs the power to determine the length of ESA awards, they already do this for DLA and I cant think of a reason why they shouldn’t be given the same jurisdiction for ESA.
I often see phrases like ‘should be able to return to work in six months’ on ESA 85s and that opinion must necessarily be part of the evidence for the DWP decision. If the DWP decision was overturned by Tribunal surely that must call that opinion into question as well. I don’t know how much influence the HCP opinion has on how often a claimant has to be re assessed or if the timing of that reassessment is in any way altered by a sucessful appeal but perhaps it would be better to bring length of ESA award into the arena of appealable decisions rather than the ad hoc way it seems to be done now. Perhaps NAWRA et al should start a campaign.
I agree with Tony about the evidence from others, especially OT’s CPNs and SWs but quite few people don’t seem to have them any more and we often end up with the GP. Although I take the point about GP roles a good many of our local GPs provide copies of letters to CMHTs or similar along with their own opinion.
“....we treat each WCA as a new referral and determine the customer’s capacity for work based on the current medical evidence. we do not consider previous medical evidence or referrals as this may not reflect the customer’s current capability for work. At our next assessment of X, our decision maker will have available to them the evidence from X, the Atos Healthcare Proffessional and (if appropriate) X’s doctor or specialist.”
[Chief Operating Officer on behalf of the Cheif Executive (of Jobcentre Plus) - letter to us dated 7.9.11]
- not clear what “...and (if appropriate) X’s doctor or specialist” will mean in practice.
This was in response to a case of maladministration of which application of the WCA was only a small part (client has a chronic condition which will only deteriorate and has been undertaking the same permitted work / thereaputic work for over a decade - but is was being called for a WCA every 12 months).
We have received the same wording in responses to complaints in other WCA cases recently.
It appears Harrington recommendations has neither reached the Cheif Executive or DMs and suggest it will be ‘a little while’ before we see any real improvement in the WCA!
Just a few thoughts….
Some of these problems with ESA might be resolved by giving FTTs the power to determine the length of ESA awards, they already do this for DLA and I cant think of a reason why they shouldn’t be given the same jurisdiction for ESA.
I often see phrases like ‘should be able to return to work in six months’ on ESA 85s and that opinion must necessarily be part of the evidence for the DWP decision. If the DWP decision was overturned by Tribunal surely that must call that opinion into question as well. I don’t know how much influence the HCP opinion has on how often a claimant has to be re assessed or if the timing of that reassessment is in any way altered by a sucessful appeal but perhaps it would be better to bring length of ESA award into the arena of appealable decisions rather than the ad hoc way it seems to be done now. Perhaps NAWRA et al should start a campaign.
At a Tribunal User Group meeting a member of the ESA department said that all appellants who won their appeals are sent an ESA50 within six months of winning their appeal.
I think that the application of a blanket policy like that is probbaly unfair in a lot of cases and in itself sufficient reason to give the Tribunal the extra jurisdiction.
We get our GP fees paid by NHS. This has been happening since back in the mists of time and nobody seems to know how it started. They were prompted to contact us to discuss this by the fact that the budget for this has doubled since October 2010.
I’m not surprised GPs are not happy, this is taken from a SoS response I got yesterday:
“Miss x has provided medical evidence. A doctor’s statement is merely an expression of opinion by the issuing doctor. It is not conclusive evidence of incapacity for work and although considered along with all the other evidence is poorly equipped to challenge a detailed report of a medical advisor who has been specifically trained in disability analysis. I respectfully submit the role of GP’s and Clinicians is to make a diagnosis and decide treatment. They tend to take what the patient says at face value concentrating on the symptoms and usually ignoring informal observations. They have specific skills in diagnostic techniques and a detailed knowledge of treatments. They are usually the patient’s advocate, acting in their best interest and have the doctor/patient relationship to consider.
The approved health care professional on the other hand has the role of assessing functional limitations and restrictions from an illness, accident or impairment. The diagnosis is taken from the clinician. They ask how the illness affects function and daily living activities. Consistency in the overall picture is looked for. Informal observations are often very important. The examination is objective and inappropriate signs are looked for. Examining health care professionals have specific skills in making an objective assessment of “disability”, justifying the opinion and have knowledge of the legal framework. Examining health care professionals are impartial. They are not acting as Miss x advocate. They give objective advice in accordance with the law based on a detailed functional assessment.”
Whatever you think of the helpfulness of GP evidence, the description of the EHPs takes a lot of swallowing.
I recently sent a questionnaire to a GP regarding a client and explained that we do not have funding to pay for medical reports, etc. He wrote back threatening to report me to a local health watchdog for doing this.
You can’t script this stuff.