One of the problems with responding to medical evidence letters is that GPs are not specifically paid for this work.
My last blog looked at the decision taken by the Sheffield Local Medical Committee to advise its members that they did not need to respond to requests by local Citizens Advice for help with medical evidence when people were appealing refusals by DWP to grant Personal Independence Payments or Employment Support Allowance. That blog led to some good conversations on twitter with a number of GPs.
Here are some of the responses:
It’s an important part of the job
“I write Medical Evidence Letters everyday …. they get increasingly irritable in tone.”
Dr Charles Heatley – @drheatley
“Remember, appointments and home visits sky-rocket when people loses benefits. Wipes out Motability car, blue badge, extra money for heat/food and entitlement to carers allowance so they get sicker and can’t self care properly”
Dr Anne Murphy – @DrAnneMurphy
Dr Murphy has published a piece on her blog that sets out in straightforward terms what a GP needs to do with regards to evidence letters .
“It may well be the case that patients who are helped to secure PIPs are more financially secure, have better wellbeing and consult less often and in less of a crisis scenario. My experience is that certainly reduces mental health crisis presentations where we can help with money.”
Dr Tom Ratcliffe – @TomRatcliffe2
“It makes far more of a difference to most patients lives than anything we prescribe.”
“A good letter requires knowledge of the patient as a person, clinical knowledge, understanding fo the benefits system, the ability to interpret data and communicate it. But in the hierarchy of clinical practice it comes below diagnosing earwax”
Dr John Tomlinson – @mellojonny
Yes its important but its not what we are here for
“I agree the system is in a mess and horrible for people to navigate. What work should GPs not do, in order to make time to write these letters? Do the general public mind if I see 3 less patients on the days I do these letters? Or should I charge for the time?”
“…all we are doing is mitigating the action by a third party, a ludicrous inefficiency of public service, and the work we are trained to do, must suffer as a result.”
“…my skill is diagnosing and treating medical problems. Helping people fight the benefits system take me away from what I am good at – don’t get me wrong I do these letters! It saddens me that somehow, a cruel benefit system becomes a problem for doctors as well as for patients.”
Dr Simon Lennane – @SimonLennane
“I didn’t say its not worth doing, but who pays for GPs time? I would rather be at home with my kids than working until 9pm filling out forms.”
Dr Ewen Pearson – @EwenPearson2
As a volunteer at Citizens Advice Sheffield noted:
“I just wish that there was more push-back to private health contractors like Maximus rather than an LMC swallowing their “ambassador’s” PowerPoint whole.”
Simon Landau – @Microcynicon
“For many patients this social administration is the most valuable thing we do, and yet we have no training, no time and no money for it. It isn’t valued in any way except by the people who matter most”
Dr John Tomlinson
It struck me how isolated GPs are – there really was a feeling that they are being left to work this issue out for themselves with little support from bodies with a wider systemic responsibility. This certainly leaves them feeling ignored and in some cases resentful.
I think that there is a failure by the RCGP and by NHS England (and of course DWP) to recognise this is an important issue. Nothing in the GP Five Year Forward View!
I think that local Citizens Advice can make it easier for GPs by offering simple templates that are more likely to succeed at DWP tribunals.
Similarly GPs can help by giving Citizens Advice access to patient data – as Dan Hopewell from Bromley By Bow explained in his comments on my earlier blog when he drew attention to an example from the Glasgow Deep End Group.
We urgently need more collaboration here – we cannot rely on biased advice from Maximus and simply advising GPs who want to help their patients to ignore Citizens Advice requests for evidence letters – does not help GPs or their patients!
What do you think?