What GPs say about DWP Medical Evidence Letters
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 .
She also shared a link to a great BuzzFeed article by Emily Dugan
“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
Thoughts
“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?
Once again I think you have hit the nail on the head Mark! Apart from this being the right thing to do, the business and clinical case is clear: supporting people to self care makes all sort of sense, anything that ‘disables’ people from doing so, like financial meltdown is contraindicated. I look on this service as preventative intervention to support health and well-being.
I take the point GPs make about their workload, the system being dysfunctional etc. but a person centred approach, putting the patients needs first surely means this is a ‘must do’ for GPs even if it’s not in the contract. I’m not sure that GPs and LMCs who say they won’t or can’t do this understand the reputational damage this causes to their profession?
Cheers NB – agree – what we need are sophisticated tactical responses that build alliances across services that are directly affected who see the damage that DWP policies do to people.
These comments remind me of the story of the senior librarian who left her job to become a nun because she felt that often she was spending her time doing ” acts of kindness ” that were not recognised by her manager. I believe it to be true that much of the high regard people have for us as GPs is that for decades we have been doing “” acts of kindness “. . This. aspect of GP practice needs much more consideration by Government and the BMA . Failure to do so will only lead to a further decline in the number of doctors applying to train to be GPs.
Thanks Malcolm – good to hear from you as always – part of the debate here is about what good primary care should look like – particularly with regard to addressing social disadvantage and inequality – as you say the ideas and leadership need to come from the RCGP and BMA in particular – not just DH and NHSE – best Mark
Assessor don’t even look at the evidence! Claimants already pay for medical evidence, ours charge £16 per letter!
Thanks Trudy
Some years ago we had a great conversation with our LMC about this and although it didn’t progress the issue as much as we had hoped it did help enormously with understanding each others problems. With more advice being commissioned to work with / in surgeries collaboration seem to be the answer in increasing understanding and saving precious time for all.
Have you seen the latest Cit A report with RCGP? bit.ly/2K3jEXS
Thanks Nick – agree completely- am after that Cit A / RCGP report so thanks for link – Mark
Thanks for giving the link to the latest Citizens Advice report – I have had a look at it – and am afraid I was a bit disappointed – I have written (another!) blog on it specifically – comparing it to a recent Glasgow Deep End report which I think is much more relevant – https://localdemocracyandhealth.com/2018/06/28/lets-mention-inequality-when-we-talk-about-welfare-rights-and-general-practice/
Best Mark
Morning Mark
Yes . I informed you of the link before i had chance to see it myself. I find it hard to believe there’s no linking with poverty. My thoughts are that the link to poverty and the benefit to health and wellbeing of advice, in particular welfare benefit advice, is so well documented that the conversation needs to be about how that advice is funded and how it’s delivered. For instance Manchester’s hotline approach versus advice based in a surgery and only open to patients on that specific surgeries list.
Regards
Nick