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drafted a letter to help them turn down patient requests for support when appealing against their benefits being withdrawn.”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.”

So.

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on their duty to write reports to support patient appeals after patients have had their incapacity benefit withdrawn.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
August 2013

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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.

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Added 17 August 2013: From the Oak Tree Surgery site:

Benefit Letters
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.