There are a number of views about the role of general practice and social prescribing. Some see social prescribing as the key mechanism for connecting primary care to communities while others are more critical seeing it as a diversion from asset based community approaches.
One of the reasons for this debate is to do with the role of general practice. Are GPs just referring patients into ‘community solutions’ at the press of a button or are they playing an active role in responding to the social circumstances that make people unwell?
I recently spoke at the launch of the Torbay FAIR project – and heard Steve Barriball CEO of Citizens Advice Exeter talk (based on their report Appealing for Common Sense ) about the experience of people who had been turned down for Personal Independence Payments and Employment Support Allowance by the DWP contractors the Centre for Health and Disability Assessments (CHDA) who are a subsidiary of Maximus.
Getting access to Personal Independence Payments and Employment and Support Allowance is a three stage process.
- People apply and a decision is made about eligibility
- People who are rejected apply for a mandatory review – a DWP civil servant makes a judgement and usually about 90% are rejected
- People who are turned down can appeal to an independent panel – the success rate (for PIP) of people winning at appeal is currently 68%
GPs are important, at the appeal stage if Citizens Advice are involved they will often ask GPs to provide further medical evidence as part of building a case to demonstrate an individuals poor health.
As Exeter Citizens Advice showed the outcome of the appeal stage is more often than not positive for the claimant. The Exeter report notes that:
“With evidence nationally of around 65% of the denial of ESA and PIP claims overturned at appeal….”
Recently the Local Medical Committee where I live after taking advice from the CHDA “GP Ambassador” produced guidance stating that GPs do not need to respond to requests for ESA Claims & Appeals (Feb18) from local Citizens Advices Services.
GPs are under a great deal of pressure (as are local Citizens Advice services!) and most importantly so are the members of the public who are applying for Personal Independence Payments and Employment Support Allowance.
There is strong evidence that financial insecurity and debt affect health and wellbeing – the GP Five Year Forward View states:
“Voluntary sector organisations can also play an important role in supporting the work of general practice. For example, local models of social prescribing can enable GPs to access practical, community-based support for their patients, including access to advice on employment, housing and debt. Some areas have developed call-off services for specific groups such as carers.”
GP Evidence letters are most important at the Appeal stage and this is usually when Citizens Advice staff get involved – Citizens Advice guidance is here. As the evidence shows this appeal process is (regrettably) a necessary corrective to poor decisions made at earlier stages in the application.
In my view good practice means GPs responding positively to Citizens Advice requests – particularly at the appeal stage. From personal experience I know that there are many excellent GPs who work with disadvantaged communities who would not give a seconds thought to responding positively to such requests if they consider that access to benefits would improve a patients health, even though they are not specifically funded to do this work. In many cases receiving PIP will reduce pressure on the NHS.
This brings me back full circle to social prescribing. GPs (like Citizens Advice) are interface services. They stand on the border between statutory and professional services and individuals and communities – the place that Eileen Conn calls the Space of Possibilities.
There is a real risk that the hard work of dedicated GPs will be pushed out of sight (as is the case for many who experience poverty and health inequalities) unless professional bodies such as the BMA, RCGP and LMCs recognise that if we are to respond to health inequalities good practice is engaging proactively with peoples circumstances rather than just pressing a button.
I am interested to hear whether GP bodies in other parts of England take a similar approach.
What do you think?
Declaration of interest – I am chair of Citizens Advice Sheffield