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Campaign to encourage GP’s to say no
LMC leaders plan campaign to encourage GPs to ‘just say no’ to benefit requests
I can appreciate where they are coming from in terms of it being very time consuming, although I don’t agree. However the following extract, from the letter, is misleading and not really true…
“The Department of Work and Pensions, through your local Job Centre Plus, will already have information available to them on which they have based their decision. It is not necessary therefore for you to request any extra medical evidence from your GP. Indeed it may slow down or complicate the process.”
The info the DWP already have will be provided by ATOS and getting additional medical evidence will only slow down or complicate the process if the claimant wants to stand a chance of being successful at appeal!
“Your GP is very busy seeing patients and unfortunately does not have the time available to complete such reports. Your GP is entitled to charge you for such a report and would not want to burden you with extra costs when they are not necessary.”
But if it’s the difference between winning and losing then claimant may feel it is “necessary” and may be willing to pay for a report?
I only deal with one medical practice that refuses to provide information but they do at least send copies of medical notes which can assist.
I have just trawled through the comments following the article and there is a red-mist feel to lots of the comments, GPs don’t seem to understand the system (why should we, they may argue), many seem to assume that Atos provides reasonable and impartial evidence and/or that DWP will seek further evidence - and that most appeals fail anyway.
The red mist affects some of the non-GP commenters too. Not helpful.
I am worried.
Plainly we need to be working WITH GPs and to argue that the demands created by the benefit regulations (WCA appeals especially) force claimants to seek a fresh sick note or go without money (or claim, usually totally inapproprately, JSA) and that the fault lies here, not with patients or with GPs.
Rightsnet campaign to calm the storm and seek a common approach, anyone?
I have sympathy for the GP’s here. they may be paid a very good salary but like everyone else they only have 24 hours in a day and if they are having to do these letters on top of their workload then I can see the frustration.
the problem is what the solution is? I have worked in areas where the majority of GP’s wont provide evidence but have usually been lucky with mental health services who tend to be supportive. for other clients my other option is to get copies of letters from any specialists they have been to see that have been written back to their own gps’s as they are impartial and usually contain clinical findings.
What I am angry about is the misleading nature of that letter which says that it may complicate the process, we all appreciate GP’s are busy there is no need to tell your patient lies.
I hope the majority of the Tribunal Judges are aware of this.
Recently in a full statement a judge commented that the client had a representative (us) who was very well aware of the importance of medical evidence in appeals but that none had been provided….
This particular clients GP will not reply to us at all and so we no longer try. We know who will and who won’t provide medical evidence and do not see the point in trying to get evidence from a GP who will not even reply let alone send a “no” letter!
I find it surprising that some GP’s seem willing to provide sick notes at the drop of a hat but when it comes to backing up the sick note - which after all is their opinion that their patient is not fit for work - they often don’t want to know.
Yes, I’ve encountered that attitude from some tribunals too. I usually include a stock sentence in my subs now where no other evidence is available to the effect that the only source of evidence is the client’s surgery and the surgery in question refuses to provide letters/reports free of charge (inviting the tribunal to adjourn if they consider evidence from the surgery is required).
On a more general note, there have been a series of threads on evidence and what is, or isn’t, helpful. I’m all for alternative sources of evidence where possible- Blue Badge assessment reports, OT assessments, talking therapy records, support workers, etc, etc- as they are often more relevant than anything the client’s surgery can provide. Having said that, I do realise that in some cases the only source of independent evidence is the client’s surgery (and it does vary substantially from surgery to surgery as to what will be provided and at what cost).
This is certainly a significant problem in our area too (Bootle) and many local GP’s are posting notices with similar wording. As others have suggested I tend to simply ask for specific documentation which should be in the GP files.
Incidentally, even when the DWP do seek evidence from GPs by requesting completion of an ESA 113, invariably the GP records “not known” in relation to questions on functional impairment, even where they should be clearly aware of the client’s difficulties.
If a statement in a recent ESA appeal submission I received recently, the DWP seems to be covertly helping the GP’s campaign by implying that that their advice is irrelevant to an ESA claim.
‘In his appeal Mr L. states that factual supporting reports can be provided by his Consultant Psychiatriust or Community Psychiatric Nurse. It is important to distinguish between the role of the Health Care Professional and that of the GP, Consultant Psychiatrist or Community Psychiatric Nurse. The primary role of the GP, Consultant Psychiatrist or Community Psychiatric Nurse is to diagnose and treat any medical conditions that their patients present to thewm. A GP, Consultant Psychiatrist or Community Psychiatric Nurse, unlike a Health Care Professional, do not routinely consider the functional restrictions appropriate to the activities of the limited capability for work assessment”.
I raised this directly with through the DWP’s Operational Stakeholders Forum and received the following reply:-
‘Claimants are encouraged to provide all evidence that will be relevant to their case, including medical evidence supplied by their GP or other medical professional, at the outset of their claim to both ESA and PIP. This is because the Department recognises the value of the information contained in evidence provided by medical professionals. However the Department does not ask claimants’ GPs or consultants to make a decision about a patient’s capability for work or whether they are entitled to disability benefits such as PIP. This position was endorsed by the British Medical Association in Professor Harrington’s third Independent Review of the Work Capability Assessment: “It is not, however, the GP’s role to provide any opinion on the patient’s capability to work as part of this process. It is vital that these two roles are kept separate and that GPs are not asked to provide opinion on their patient for the purpose of receiving the Employment and Support Allowance (ESA); doing so could damage the doctor-patient relationship.” The Department acknowledges the need for GPs and other medical professionals to maintain a role independent from benefit related decisions. The role of a DWP Decision Maker is to take a decision on entitlement to benefit in accordance with the regulations laid down by legislation, using the information gathered through the claim form, evidence provided by the claimant or health or social care professionals working with them and the assessment. Medical evidence, where it is available, informs the decision making process. However, in using this information the DWP decision maker is looking specifically at impacts on the claimant’s abilities in order to ascertain eligibility to the benefit in question.’
Yeh, right.
Evidence forwarded in support of an ongoing WCA failure appeal includes letter from client’s GP in which GP states:
‘In my opinion (X) has significant difficulty communicating and conveying even simple messages. This coupled with anxiety and memory loss is causing serious strains in his social contacts and interractions. Due to memory loss particularly to recent events or places he is unable to go about without being accompanied by another person. Due to cognitive and intellectual disability he will find it very hard to learn or perform moderately complex household tasks’.
GP goes on to provide examples from client’s medical notes of situations in which these difficulties have been apparant.
DM states (and this is it in its entirety):
‘I have considered this new evidence I have decided there are no grounds to revise the decision under appeal. The new evidence provided does not give rise to a revision as the evidence provided contradicts the evidence already provided at the medical assessment about how X’s health condition affect his day to day living’.
So there you go. GP clearly making it all up.
I once knew of a consultant oncologist who was incandescent when a DM refused to make a DLA special rules award on the back of his DS1500.
Check the recent UT decision on an ATOS physiotherapist assessing a client with mental health issues- its pretty scathing to say the least….
My personal experience of GP’s is that they provide varying reports, and all need chasing to actually get it - yes they are extremely well paid thanks to the last Labour Government that ducked taking them on (despite their commitment to reducing state spending|) and many have gone part time thank you very much on over £100K pa. Also with the ending of legal aid for benefits we can no longer offer to pay them, which would always produce a report in the end, so I don’t bother any more and just ask clients to get a copy of their medical records, which is not perfect but the best under current circumstances. Also no more getting psychiatrist reports on over £100, which were really useful for mental health issues….
‘In his appeal Mr L. states that factual supporting reports can be provided by his Consultant Psychiatriust or Community Psychiatric Nurse. It is important to distinguish between the role of the Health Care Professional and that of the GP, Consultant Psychiatrist or Community Psychiatric Nurse. The primary role of the GP, Consultant Psychiatrist or Community Psychiatric Nurse is to diagnose and treat any medical conditions that their patients present to thewm. A GP, Consultant Psychiatrist or Community Psychiatric Nurse, unlike a Health Care Professional, do not routinely consider the functional restrictions appropriate to the activities of the limited capability for work assessment”. ‘
We have seen this many times. The WCA submission template(s) is clearly written centrally(?) somewhere in DWP. Does anyone know what part of DWP supplies these templates to appeal writers? Does anyone within DWP really think tribunal’s take any notice?
Some years ago on a ‘guided tour’ of our (then) local DBC we were shown the templates then used to prepare DLA submissions - all very enlightening!
Following up on comments made by PCLC, we would be interested to learn how colleagues make use of Patient Summary Medical Records obtained from GPs. This is now our preferred method of obtaining medical information, but have been staggered by the size of some of our client’s files which can exceed 300 printed pages - and that’s just for about 5 years records.
It would appear unreasonable to present a tribunal with the full 300 pages, much of which is not relevant, and in any case they probably won’t want to wade through it all. On the other hand if we provide only the absolutely relevant material we could be accused of being selective with the information supplied.
At a recent tribunal we opted for selective use of material, and stated in the submission that the full record would be available for inspection at the tribunal. The Judge was not impressed and threatened to adjourn the proceedings to allow time to read through the lot - in the end we agreed that it wasn’t necessary for the tribunal to look through the full Record.
We have seen this many times. The WCA submission template(s) is clearly written centrally(?) somewhere in DWP. Does anyone know what part of DWP supplies these templates to appeal writers? Does anyone within DWP really think tribunal’s take any notice?
DMA Leeds has responsibility for producing the templates for appeal writers. The Code of Practice on Appeal also includes some of these in the appendices. You might want to look at Appendix 7:
http://www.dwp.gov.uk/publications/specialist-guides/code-of-appeals-procedure/
I can understand GP’s getting mightily peeved at the extra work they are doing created wholly by the benefit reforms.
Perhaps someone should ask if the DWP savings are costing the NHS more.
I’m certain that the changes ARE costing GPs/health services more.
In our local area (and from what I gather, nationwide) claimants are being asked to provide ‘fit notes’ for weeks after they have won their appeals at tribunal. This means that GPs who were previously out of the ‘fit note’ loop following a successful appeal are having patients who have been found to have LCW/LCWRA coming back to see them on a indefinite basis (usually 2 - 3 months) asking for ‘fit notes’ so that they can continue receiving benefit pending the processing of the tribunal decision.
We’re taking this up via the local MP and have had to go back to him as the DWP aren’t acting in the way we were told they would in a letter from IDS.
Now claimants are having to deal with GPs who are saying ‘this is a waste of my time and the appointments available’ - and they’re right IMO.
Very frustrating…..