LMC leaders are considering a ‘just say no’ campaign to support practices who refuse to take-on unfunded work, and have already drafted a letter to help them turn down patient requests for support when appealing against their benefits being withdrawn.
The campaign would be designed to back GPs who turn down requests for medical reports from benefit claimants and requests for work from secondary care.
The LMC leaders from Lancashire and Cumbria have already come together to create a template letter for all GP practices to use in the area advising patients against personally asking for help from their GP.
But they are also planning on taking forward a campaign to widen a ‘just say no’ campaign to other areas of unfunded workload at its next meeting, including requests from hospitals and other parts of the NHS and social care.
The campaign comes after GPs complained of spiraling workload from patients requesting supporting information to protect their benefits, and a rising amount of workload from hospitals being dumped on primary care.
Pulse revealed last month that GPs were struggling to cope with 21% rise in requests to provide evidence to verify work capability assessments since January.
The template letter sent to practices advises patients to contact Jobcentre Plus or the appeals service if they need further medical evidence, and allow them to contact their GP if they think more information is needed.
‘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.
‘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.’
This follows a similar letter disseminated to practices by Bro Taf LMC in Wales, which said GPs providing these reports was an ‘abuse of NHS resources’.
Lancashire Coastal LMC chair Dr Stephen Hardwick, who helped write the letter, said: ‘GPs are increasingly pressurised, their daily job is harder. We’re monitored more closely through QOF, our prescribing more closely followed. We’re also having to mop up from other NHS and social care problems.
‘It’s hard for individual GPs to say no, because they want to do what’s best for their patients. The problem is as that it becomes more frequent, as they bring in the bedroom tax, you don’t have time for anything else.’
‘Lots of GPs do it because they feel it’s their job to support their patients. But there comes a point where it takes such a demand upon your time, it becomes impossible to do the day job.
‘The “just say no” campaign was brought up in response to an increase in requests. It wasn’t welcomed wholeheartedly but we will re-discuss it in the near future.’
‘So for DSS sickness benefits, we provided an example letter practices could use. It means saying “no-this is not our job”, or “no- that’s not the right request”.
‘I have a ban on providing personal references for accommodation. I’ll do medical reports saying they can’t walk up the stairs, but if they want a report saying “They’re a nice chap”, I say “I don’t live next door to you – we don’t have that kind of relationship”.’
But Dr Jonathan Smith, a member of Cumbria LMC and a GP in the area said he did not agree with the principle of rejecting requests from vulnerable patients.
‘If patients ask for a report for their appeal then you can claim a fee on the basis of that. My opinion is they should jolly well do it. You get a fee. They’re the most vulnerable. They’re your patients.’
In light of the above Black Triangle and DPAC are now planning legal action against the LMCs
Black Triangle Campaign Anti-Defamation Campaign in Defence of Disability Rights
1. Doctors’ Letter
On 24th June last year at the BMA’s Annual Representative Meeting (ARM) doctors from every discipline voted overwhelmingly to demand that the DWP-Atos Work Capability Assessment end ’with immediate effect’.
Through their Medical Adviser, the patient-led Black Triangle disability rights campaign originated the motion which became BMA national policy. Part (iii) of the ARM motion called upon the BMA to engage with disability groups to change public policy. To date, the only ”official” communication their campaign has received has been a short statement via Facebook.
As doctors on the front line witnessing daily the enormous avoidable suffering of many of our most vulnerable patients caught up in this Kafkaesque system of ‘disability assessment’, we find this failure to meaningfully engage unacceptable. More critically, we fully share in the dismay with which sick and/or disabled people have greeted the failure of the BMA’s leadership to give any meaningful effect to the unanimous wishes of its members: that this dreadful assessment régime should be immediately terminated.
The GMC’s own publication ‘Good Medical Practice’ states that:
‘… a doctor must (overriding duty or principle) take prompt action if he feels that “patient safety is or may be seriously compromised by inadequate… policies or systems.’
ESA Regulations (2013) 29 & 35 deal with flagging up a substantial risk of harm to patients if they were to be found ‘fit for work’ or to have ‘limited capability for work’ and placed in the Work-Related Activity Group (WRAG) where:
‘the claimant suffers from some specific disease or bodily or mental disablement and, by reasons of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if the claimant were found not to have limited capability for work.’
Regrettably, it remains the case that only DWP and ATOS staff are aware of these regulations whilst GPs remain ignorant of their existence and those performing the WCA and DWP Decision Makers continue to make complex risk assessments based on grossly inadequate patient information.
Until the current system is entirely revised, there remains no safety protocol for the assessment of risk and the avoidance of harm to patients.
There are no formal reporting mechanisms for GPs to report significant adverse events such as self-harm and suicides which many of us have witnessed.
Black Triangle have led the way in campaigning for the uptake of Regulations 29 and 35 and their legal Counsel has advised that they should be applied in every case where harm would be more likely than not to occur as a result of erroneous DWP decisions regarding patients’ fitness for work.
We are also fully aware of the fact that numerous conflicts of interest exist between the ethical versus contractual duties placed upon GPs arising out of the DWP-Atos contract. In balancing a doctor’s duty of care to provide supporting information for Tribunal appeals and contractual conflicts with the DWP over the issue of fees and workloads, we submit that the only ethical solution must be the one that causes the least harm to patients.
Black Triangle’s simple campaign for the appropriate application of these regulations utilising one side of A4 has proved highly efficacious in this respect. It has saved General Practitioners a substantial amount of time and expense and has meant that unnecessary, costly and stressful tribunal appeal hearings have been rightly avoided.
We now call upon the BMA leadership to urgently publicise and make known to every GP in the country the existence and lawful application of these regulations without any further delay in order to prevent further avoidable harm to our patients. Any failure to do so would in our opinion amount to negligence.
Dr Stephen M. Carty, GP and Medical Advisor, Black Triangle Campaign.
Dr John Budd, GP Edinburgh Access Practice
Dr Roy Robertson, GP Muirhouse, Honorary Clinical Reader
Dr Ian McKay, GP Rose Garden Medical Practice, Leith
Dr Oliver Aldridge, Edinburgh
Dr Guy Johnson, GP Sighthill Health Centre, Edinburgh
Dr Helga Rhein GP, Sighthill Health Centre, Edinburgh
Dr Elizabeth Morton, GP Challenging Behaviour Practice, Edinburgh
Dr Kate Burton, Public Health Practitioner
Dr Margaret Craig, GP, Allander Surgery, Possilpark, Glasgow
Dr Nick Treadgold, GP, Pollok Health Centre, Glasgow
Dr Christine Grieve, GP Drumchapel Health Centre Glasgow
Dr Chris Johnstone, GP Paisley
Dr Donald MacIntyre Consultant Psychiatrist Edinburgh
Dr Sarah Houston GP
Dr Ros Wight GP
Dr Robert Young, Glasgow
Dr Nora Murray-Cavanagh GP Medical Education Fellow
Dr David Nicholl, Consultant Neurologist, Birmingham
Dr Jonathon Tomlinson, GP The Lawson Practice N1 5HZ
Dr Anita Roy, GP, Yorkshire
Dr George Farrelly, GP, London
Dr Peter English, Consultant, London
Dr Robert Cheeseman, Ophthalmology Registrar, Liverpool
Dr Ray Noble, Medical Ethicist, UCL Institute for Women’s Health
Dr Margaret McCartney, GP , Glasgow
2. Supporting Letter from Trade Unions and Civil Society
As trade unionists, organisations and campaigners from across civil society who collectively represent millions of citizens we write in support of the letter by doctors in the British Medical Association about work capability assessments.
We firmly believe the current assessment régime is unfit for purpose and poses a real risk to the health and lives of disabled people and those with life threatening conditions. This is because the government’s regulations, which ask whether substantial risk or harm would be caused if the claimants are found ‘fit for work’ or with limited capacity for work, are not being applied consistently.
Information obtained through freedom of information requests shows that between January and August 2011, 1,100 claimants died after they were put in the work-related activity group – the equivalent of 30 deaths a week.
We are hopeful for a successful outcome to discussions between disabled people’s organisations and the BMA, following its conference decision last year to call for the current assessment régime to be scrapped.
We send our solidarity to these groups and the BMA and hope you will join us in a united campaign to bring an end to the disgraceful treatment of ill and disabled people.
John McArdle, David Churchley and Dr. Stephen M. Carty Black Triangle Campaign
Linda Burnip Disabled People Against Cuts DPAC
Mark Serwotka General Secretary Public and Commercial Services Union PCS
Len McCluskey General Secretary Unite the Union
Christine Blower, General Secretary National Union of Teachers NUT
Bob Monks, General Secretary of United Road Transport Union URTU
Sally Hunt, General Secretary of University and College Union UCU
Michelle Stanistreet, General Secretary National Union of Journalists
Phil Gray, Chief Executive, Chartered Society of Physiotherapy
Richard Evans, Chief Executive Officer Society of Radiographers
Bill Scott, Manager, Inclusion Scotland
Gordon McFadden, Policy Director, Limbcare
Dr Simon Duffy, The Centre for Welfare Reform
Dan Moreton, Social Work Action Network (SWAN) and SWAN (London)
Mary Olaniyi Coordinator/Family Adviser Lewisham Mencap
John McDonnell MP (Lab, Hayes and Harlington)
Deborah King Co-founder Disability Politics UK
Paul Smith – Founder Atos Victims Group
John Burgess Branch Secretary Barnet UNISON
Gill MacDonald Psychiatric Nurse Lothian NHS
In full: template letter for GPs to ‘just say no’
Letter from Lancashire and Cumbria LMCs
Dr Peverley’s attack on benefit claimants was wrong-headed – and having worked for Atos, I should know Posted on August 20, 2013
Joint Response by DPAC and Black Triangle on Dr Phil Peverley’s Shameful Comments published in Pulse Magazine, The Daily Mail and The Daily Telegraph Posted on August 5, 2013
GPs should provide information for every fitness for work assessment, urges BMA Posted on June 28, 2013
“A Lethal Misreckoning” : Black Triangle Campaign’s Response To Dr Alan McDevitt Chair BMA Scotland’s General Practice Committee’s Pulse Article Posted on August 20, 2013
Disability activists ask for 2nd opinion from reneging GPs Posted on June 27, 2013
‘GPs not ‘supporting’ Atos disabled patients’ : Black Triangle Campaign to enter into talks with Glasgow LMC and Scottish BMA leaders Posted on June 15, 2013
‘GPs unaware they can flag up patients at risk’ ~ The Scotsman and Edinburgh Evening News Posted on May 15, 2013
Doctors’ leaders could face protests over ‘fitness for work’ campaign snub Posted on May 11, 2013
GPs say benefits tests causing ‘enormous suffering’ ~ Edinburgh Evening News Posted on May 8, 2013