Update Friday August 23 2013:
This is an update to the stories a number of us have been running about GPs being told not to provide support information to ESA claimants who are appealing Atos fit for work decisions. You can scroll down the page to see all updates from the last fortnight.
The ante is being upped, here: Pulse is reporting today (Friday 23 August) “that Local Medical Committee leaders are considering a ‘just say no’ campaign to support practices who refuse to take on unfunded work.”
The story says that LMC leaders have:
“already drafted a letter to help them turn down patient requests for support when appealing against their benefits being withdrawn.”
The story goes on to say that:
‘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.’
I also received this statement from the Bro Taf Local Medical Committee today (23 August 2013). Bro Taf was the first LMC to hit the press a month ago with reports that it had instructed its GPs not to supply medical support letters for people who were appealing Atos work capability assessment decisions (the full story is below – you can follow it there).
The new statement says:
BENEFITS APPEALS LETTERS 23 August 2013
From Bro Taf:
‘This advice note clarifies the LMC’s position on benefits appeals letters, following the misunderstandings that were generated by the media’s interpretation of LMC’s original guidance.’
GPs have a contractual obligation under their GMS contract to provide medical information free of charge for certain benefits and where that is the case the information should always be provided promptly when it is requested by Jobcentre Plus.
The DWP has issued its own advice for health professionals on their duty to write reports to support patient appeals after patients have had their incapacity benefit withdrawn.
The DWP advice reflects the position taken by the LMC in its original advice. The DWP advice is quoted here verbatim in bold:
GPs, as certifying medical practitioners, have a statutory obligation to provide statements of incapacity to patients on their list and certain information to a healthcare professional working for ATOS Healthcare on behalf of DWP when requested.
However, under their NHS contract there is no requirement for GPs to provide reports or offer an opinion on incapacity for work to anyone unless requested to do so by Jobcentre Plus.
Claimants should contact Jobcentre Plus or the Appeals Service if they think that further medical evidence is necessary to support their claim or appeal.
They should state clearly their reasons for believing that further evidence is necessary.
If Jobcentre Plus or the Appeals Service consider that further medical evidence is necessary, they will seek it. They will be responsible for paying any fee to the doctor providing the report.
So NHS GPs are under no obligation to provide such evidence to their patients nor to provide it free of charge.
The link to this advice for health care professionals on the DWP website is: http://www.dwp.gov.uk/healthcare-professional/frequently-asked-questions/
GPs should always use their own discretion and judgement based on the circumstances of each case.
Bro Taf LMC
This is the first statement sent (on 9 August – it has since been replaced by the statement above) by the Bro Taf Local Medical Committee in response to concerns about this BBC news report which said that the LMC had instructed its doctors not to provide medical support information for employment support allowance appeals.
I’ve put it here as we link to it in our NS story this week on Atos, work capability and the problems that people are having getting medical support information for ESA claims and appeals.
Bro Taf told me they were going to issue another statement this week.
You’ll see that they are instructing doctors not to supply medical support information for people appealing Atos decisions.
LMC advice given to GPs in May about their involvement in benefits decisions received wide coverage in the media on Thursday 17 July.
We are issuing this statement to explain our reasons for issuing the advice and to correct any misunderstandings that have resulted from the press coverage.
We are sorry if our advice letter has caused upset or distress and we want to assure GPs and patients that there is no intention to discriminate against any groups and at no time did we intend to threaten the GP-patient relationship.
GPs are under stress and pressure with respect to workload, but we recognise that benefit applicants are also stressed and we can see how the interpretation of our letter by the media may have exacerbated their anxiety.
In considering this matter everyone must understand the distinction we are making between the provision of medical reports to the Department for Works and Pensions (DWP) to support benefit applications and the provision of evidence to support appeals (after an application has been refused).
GPs want to help their patients and willingly provide reports for the former, but the situation with appeals is different.
The information that appellants are given suggests that they can get a letter of support from their GP and it is this part of the system that is causing major problems for GPs following the recent changes to the benefits system.
The increasing number of appeals has resulted in more GP appointments being taken up to deal with such requests, when they should be used to see patients who are ill or believe themselves to be ill.
In the vast majority of cases (all but 3% according to figures we have been given) a GP report at the appeal stage will not add any value and GPs have been advised not to send the Tribunals Service (which handles appeals) letters which state “the patient says”.
Most GPs do not have the expertise to make decisions about patient’s eligibility for the Employment and Support Allowance and most are not trained in disability assessment medicine or occupational health medicine.
We support the GPC and the BMA lobbying against the benefits system changes that have produced so many unfair results for disadvantaged patients and which is forcing them to request assistance from GPs, but GPs do not have any central funding for this work and in times if austerity have to prioritise their time for the sick.
Added 17 August 2013: From the Oak Tree Surgery site:
Please see below a letter we have received from the Cornwall & Isles of Scilly Local Medical Committee regarding letters from GP’s for benefits.
Benefits Reform – GP letters
Cornwall & IoS Local Medical Committee (LMC) is the representative body for all GPs in Cornwall & Isles of Scilly. This letter has been produced by the LMC for use by GP practices.
The Benefits System is undergoing major changes and this is impacting on many people across the country in the amount of money they receive and also the benefits they may be eligible for.
GP’s provide General Medical Services to their patients and we are not in a position to administer nor to police the Benefits System.
The LMC considers that it is not appropriate for the GP to be asked for letters of support or a letter to confirm care needs.
GPs are not resourced to provide this service.
Time taken up with paperwork is time taken away from direct patient care.
There are contractual and agreed methods for GPs to provide medical information to the Department for Work and Pensions.
These are sent to the GP practice and GP’s respond directly to the departments requesting information.
Therefore we cannot respond to your request for a letter.
Please show this document to the service who has asked for the GP letter.
The service can contact Cornwall& LoS LMC, Sedgemoor Centre, Priory Road, St Austell, PL25 5AS for more information.
BMA GPs Local Medical Committees leaders plan campaign to encourage GPs to ‘just say no’ to benefit requests Posted on August 23, 2013
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 25 and 31 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