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GPs charging for letters - is it an issue?

Daphne
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Inclusion Barnet is hearing reports of people finding GP charges for letters a real barrier at the moment, and is keen to hear if this is a current or substantial issue that people are hearing about in other parts of the UK.  Also interested in hearing from anyone else doing any work on the issue at the moment.

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Paul_Treloar_AgeUK
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Only for as long as I can remember doing benefit appeals…...

bristol_1
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Not an issue for me - I don’t ask GPs for letters.
My advice is that surgeries may charge to write a bespoke letter, which is unlikely to address the DL and Mob criteria of PIP. So therefore why bother getting a GP letter and paying $$$? Patient records (including specialist reports and letters) may be obtained freely via GDPR via the GP surgery. These requests are never refused.
On rare occasions where a specific professional will have direct observations that address the PIP criteria, I might see if they can write something very directly commenting on PIP criteria.

Some commenters on here have made very good arguments in the past as to why DMs and even FTTs have an over- reliance on medical evidence, when the PIP critiera are based on the lived experience of the claimant; PIP tests impact, not diagnosis. I think medical evidence can be helplful where it comments on the impact on the claimants DL and Mob; the majority of evidence available doesn’t. On the other hand, in our area FTT panels will quite often adjourn & issue directions in the absence of med evidence where there are complex health issues and nothing provided with the claim form/appeal.

NB - IAS do a dismal job of obtaining any relevant medical evidence where it would be helpful: e.g. client with limited insight, under the MH team and monthly administered anti-psychotics, twice weekly psych input (plus other phys health stuff) - PIP decision letter says “no evidence of a MH diagnosis or MH treatment”.  Hmmm
If it’s evidentially relevant to have medical or other evidence included for consideration by IAS/PIP, seize the day and provide it yourself/assist your client to do so.

Mike Hughes
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Beat me to the punch bristol_1

I think I’ve requested one GP letter in the last decade to no obvious detriment to my clients. The exact opposite in fact. Relying on anecdotal evidence hones your listening skills; refines the ability to pick holes in claimant evidence but equally let’s you uncover stuff that no medical professional ever could. It also facilitates really accurate prediction of outcomes.

I would say that medical evidence where the claimant lacks insight is almost always useful but otherwise we sit and moan about the medicalisation of such processes and then actively participate in the perpetuation of that. You either believe in the social model of disability and live that or… you don’t.

So, yes, I’m sure it’s an issue for plenty of people but really, if a GP or consultant can talk about your budgeting, reading, toileting and cooking etc. then you’re likely in an inappropriate relationship with them.

Dan Manville
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To the question itself: yes, a lot of GPs around these parts will happily deprive their patients of a fee for a letter that they know makes no material difference to to the matter in hand other than placating a distressed patient.

To the broader debate; I think med ev is useful in rebutting an ESA85 or PA4; if you can get something from their records that contradicts the assessors findings then, more often than not I can get a decision overturned without going to hearing. That, and the fact that a lot of Tribunals will adjourn for records anyway makes such a request a routine part of my appeal prep; whether or not I think they will contribute to the outcome.

Once you’re facing a hearing though I tend to go with Mike and Brizzle above

Mike Hughes
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Yeah I get the medical records aspect of it and of course they are now free. The routine of assuming a claim cannot succeed without supporting GP or consultant letters seems obvious folly to me. In the past I’ve even heard of WROs taking that line. “If you can’t get a supporting letter from your GP then we can’t really get your claim off the ground”. etc.

As DWP are actively contemplating a change in their role in terms of evidence gathering and the medical professions have always had a strong lobby against it seems to me that the direction of travel is obvious.

Peter Turville
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Charging has always been an issue. It became more of an issue with some practices following the ending of Legal Aid funding (we held a LA contract). We know from experience which GP practices always make a charge. We have built up a good working relationship with other practices.

However, even those we have a good relationship with have been reluctant to assist during the pandemic (perhaps understandably) - that includes providing the patient with a print out of their ‘summary’ or dealing with SAR’s.

I know that there are different views on the value of GP letters etc - but we have always found them helpful if the request is made specific to the client and addressed to the relevant benefit criteria and in a format that makes it ‘easy’ for GP to respond to (answer specific question / support what client reports in terms of the criteria). Of course we don’t always get a useful / supportive reply)

[ Edited: 29 Jul 2021 at 10:38 am by Peter Turville ]
Sonia
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Yes, yes, yes! For the most part GP’s state that they will only provide a factual report when requested by the DWP. If gently persuaded to write a letter rather than waiting for a factual report request that may never arrive, they ask for payment and make it clear that the letter will not be provided until they are paid and unfortunately, the letter often falls short of providing what was requested. Requests seem to range from £25 up to £80.

ElaineS
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Was at a telephone appeal hearing with someone only yesterday.  The judge adjourned stating that if we did not adjourn they would remove the entitlement our client already had.  Told her she needs to go and get medical evidence including all letters from other professionals and they don’t jus want a copy of the GP records as this is not good enough.  Unfortunately her mental health condition has meant that she struggles to get to appointments and engage so there is likely to be little evidence.

Mike Hughes
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Medical evidence in MH cases can be excellent as it often involves first hand experience of episodes of poor mental health and can be detailed and quite stark. It often leaves little to the imagination as to how someone might struggle to reliably perform a number of daily living descriptors. Where the persons health is so poor that such evidence doesn’t exist I tend to sit down with the person and get them to detail those incidents from their perspective and then, with their permission, run that past a MH professional for their perspective. Doing that as a written sub can often move the needle positively.

The other side of this of course is that the next tribunal will often require absolutely none of what has been requested and will be sensible enough to see how MH works in real life. It can be immensely frustrating to realise just how poor tribunal members practical experience and knowledge of MH can be.

Daphne
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Caroline from Inclusion Barnet has kindly sent me a copy of her report from the responses she received here and by email - attached - thanks to everyone who contributed :)

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