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cost of GP letter

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  • david235
    david235 Community member Posts: 170 Pioneering
    The assessment provider is deliberately independent of the claimant so that they have an objective viewpoint rather than the healthcare professional potentially being placed in conflict by their loyalty to the claimant. It was for the same reason that they moved away from Blue Badges being issued primarily on the recommendation of the patient's GP; an independent mobility assessment report is now used instead.

    The NHS as a whole would be in a conflict of interest if it provided benefit assessments for DWP. The NHS is there to provide healthcare, not to issue benefit reports that might be adverse to the patient.


    It is up to individual health professionals whether they want to be involved in benefit assessments or not. Similarly, it is up to doctors how they use their time; if they want to be appointed to PIP tribunals and work part-time for the NHS, that is their right.
  • worried33
    worried33 Community member Posts: 492 Pioneering
    edited September 2019
    See that is part of the cultural problem of the DWP I have referred to in some posts.  The DWP been distrustful of GPs and claimants.

    You do contradict yourself there tho david, on what part of your post you think its wrong for NHS staff to be doing assessments and healthcare but then you say its fine for doctors to do healthcare and tribunals (which are also assessments to a degree).  Either both are wrong or both are ok,

    GPs providing wrong information because they feel loyalty to a claimant I believe has only ever been speculated and not factual.  Also to clarify on my suggestion of NHS doing actual assessments, that wouldnt be the patients own GP.
  • pollyanna1052
    pollyanna1052 Community member Posts: 2,032 Disability Gamechanger
    Thank you for sharing this with us @pollyanna1052 and we wish you the best of luck with your f2f on Thursday!
    Oh Chloe, I`m so stressed. I got a call last night from the assessor, who was supposed to visit me tomorrow. She rang first to confirm her visit, then 3 minutes later, she rang again! She cancelled!!!! She was apologetic and advised me to ring the DWP today...which i did. I rang and rang, held on and had to  press this, that and the other button...only to be told to ring a different number.....finally got a real person, who offered me 24th sept between 9 and 11. I said my carer doesnt come till after 9 and I could be in bed......they said that`s ok...but I dont want to be in bed! They offered another date. I said I cant do with it being changed again and began to cry. The manager came on the phone. I explained gain...he changed the time to 10am....so I have 3 weeks to wait now. Arrgghh!
  • Adrian_Scope
    Adrian_Scope Posts: 10,821 Scope online community team
    Hi @pollyanna1052, I'm so sorry they've cancelled and changed things about on you! I'm glad they've managed to change the time to 10am instead of 9 so you can be more prepared and your carer be around, but it's such a shame you have another 3 week wait. How annoying! :(
    Community Manager
    Scope
  • pollyanna1052
    pollyanna1052 Community member Posts: 2,032 Disability Gamechanger
    Hi @pollyanna1052, I'm so sorry they've cancelled and changed things about on you! I'm glad they've managed to change the time to 10am instead of 9 so you can be more prepared and your carer be around, but it's such a shame you have another 3 week wait. How annoying! :(
    yes, all the lead up stress to go through again! Thankyou x
  • Joanne_Alumni
    Joanne_Alumni Scope alumni Posts: 188 Pioneering
    Hi @pollyanna1052, that sounds really stressful! I am really sorry that you are having to wait so long.
    Joanne 
    Scope
  • pollyanna1052
    pollyanna1052 Community member Posts: 2,032 Disability Gamechanger
  • cristobal
    cristobal Community member Posts: 984 Disability Gamechanger
    edited September 2019
    worried33 said:
    See that is part of the cultural problem of the DWP I have referred to in some posts.  The DWP been distrustful of GPs and claimants.


    @worried33 -

    Earlier when I asked what would happen if your GP provided a letter which was contradictory you said, 

    "Yep if its not supporting then you dont supply it"

    DWP aren't stupid - they'll realise what's happening.

  • david235
    david235 Community member Posts: 170 Pioneering
    There is no contradiction in what I said. As things stand, nobody has to carry out benefits work as part of their employment with the NHS, and the NHS has no role in benefits work. If DWP contact a claimant's GP for a GP Factual Report then they pay privately for it. Individual healthcare professionals are free to choose who they work for, which means some work part-time for the NHS and part-time for an assessment provider, or for HMCTS as a medical member of DLA and PIP tribunals. All registered healthcare professionals are bound by the code of ethics imposed by their professional regulator in all the work they do, including work for the benefits system.

    I believe there might be one exception to this, in that I believe GPs are compelled to issue "fit notes" as part of their NHS work. There is a difference between expressing a relatively short term view on capacity for work than a longer term view on the specifics of ill-health and disability.


    If you are proposing that an independent NHS professional carried out DWP assessments, it is hard to see how this would differ in practice from the current system. All assessors have to be regulated healthcare professionals (for PIP a doctor, nurse, physiotherapist, occupational therapist or paramedic). The healthcare provider is going to be bound by DWP's contractual requirements and their professional obligations as a registered healthcare professional no matter who they work for when carrying out benefits work.


    The conflict of interest scenario if a patient's own healthcare professionals are involved in external assessments is real, at least in the view of those GPs who have expressed an opinion to me. I have been a patient participant in the practical training of medical students on placement with my GP practice on many occasions. A common theme of these sessions is "the role of primary care professionals in chronic illness". It was usually stated that part of the role of being a GP is being an advocate for a chronically ill patient when he or she is dealing with other services - though there are severe limits on the time and energy that a busy GP can devote to this work.

    I have heard several GPs express the view that it is difficult to refuse a request from a patient because of the consequential damage in the doctor / patient relationship. One senior GP, whose views I trust, went further when it came to benefits, saying that he was happy to provide factual information but much of the time the request was for opinions he was badly placed to provide. He felt he could give six good reasons why my walking ability is almost zero, but he could not provide justification for a particular PIP descriptor, as he would have been asked to do if DWP requested a GP Factual Report, as he had no training whatsoever in occupational medicine and certainly not in making objective assessments. He felt strongly that an independent physiotherapist or occupational therapist could do a much better job than he could in my case.

    Some GP surgeries manage requests in relation to benefits by a blanket policy of not providing bespoke letters, merely copies of records and responses to GP Factual Report requests.


    The current Assessment Provider system is far from perfect. It is all done down to a cost, with often inadequate time allowed to assimilate the claimant's submission and supporting evidence properly, conduct a full assessment and write a fully detailed report. I can't help thinking that paying more for more assessment provider time per report (when needed) would perhaps save money overall by improving the quality of initial decisions, meaning there were fewer reconsiderations and tribunals.

    Ultimately no system can be perfect.
  • worried33
    worried33 Community member Posts: 492 Pioneering
    edited September 2019
    I do actually agree there is an issue with GPs in terms of not wanting to upset their patients, I think in that dilemma if the GP believed they didnt meet the descriptors they would do the honest thing and present that to the DWP, the problem resulting from that of course is a relationship breakdown between patient and GP, I believe that would be the problem rather than GP presenting false reports to the DWP.

    I just came up with the idea as a possible workaround to the NHS budgeting problem and GPs been overstretched.  As I think the ideas proposed where people never ever ask their GPs for evidence is with things how they are are fantasy land.  Its not just benefits but also things like housing where people need to present evidence to be given points for disability needs, and GPs asked for reports for all sorts of things outside of benefits as well.  So I agree there is a problem with paperwork taking their time up, benefit letters are only a small part of that problem.

    I think there seems to be a clear push in the NHS to try and get patients not get too close to a GP, every surgery I am aware off from friends and family seem to be trying to push for themselves to choose the GP on appointments rather than the patient.  MY own surgery has gone even more radical where they working with two other surgerys and your appointment can be assigned to a different surgery never mind different doctor.  The NHS have even grander plans then that where they want surgeries done away with altogether and people ring a triage service, where GP consultations need to be approved and if approved people go to health centres or a hospital to see one.

    The NHS reasoning are likely financial related e.g. seeing a GP for the first time I think will be less inclined to do a referral (saves money) and of course making people see health care assistants, pharmacists etc. first also saves money.
  • Chloe_Scope
    Chloe_Scope Posts: 10,586 Disability Gamechanger
    Thank you for sharing this with us @pollyanna1052 and we wish you the best of luck with your f2f on Thursday!
    Oh Chloe, I`m so stressed. I got a call last night from the assessor, who was supposed to visit me tomorrow. She rang first to confirm her visit, then 3 minutes later, she rang again! She cancelled!!!! She was apologetic and advised me to ring the DWP today...which i did. I rang and rang, held on and had to  press this, that and the other button...only to be told to ring a different number.....finally got a real person, who offered me 24th sept between 9 and 11. I said my carer doesnt come till after 9 and I could be in bed......they said that`s ok...but I dont want to be in bed! They offered another date. I said I cant do with it being changed again and began to cry. The manager came on the phone. I explained gain...he changed the time to 10am....so I have 3 weeks to wait now. Arrgghh!
    Hi @pollyanna1052, I'm so sorry this is the case. I know how stressed the whole process has made you and this cannot have helped. I'm really glad they were able to see you when your carer was there, I know that's what I would prefer! If you need any support from the community then please do let us know.
    Scope

  • worried33
    worried33 Community member Posts: 492 Pioneering
    Thank you for sharing this with us @pollyanna1052 and we wish you the best of luck with your f2f on Thursday!
    Oh Chloe, I`m so stressed. I got a call last night from the assessor, who was supposed to visit me tomorrow. She rang first to confirm her visit, then 3 minutes later, she rang again! She cancelled!!!! She was apologetic and advised me to ring the DWP today...which i did. I rang and rang, held on and had to  press this, that and the other button...only to be told to ring a different number.....finally got a real person, who offered me 24th sept between 9 and 11. I said my carer doesnt come till after 9 and I could be in bed......they said that`s ok...but I dont want to be in bed! They offered another date. I said I cant do with it being changed again and began to cry. The manager came on the phone. I explained gain...he changed the time to 10am....so I have 3 weeks to wait now. Arrgghh!
    yeah you probably had to ring a new number as the assessor telling you to ring the DWP was wrong, the DWP dont book appointments.

    You probably eventually ended up ringing the AP to get the new appointment, hopefully they dont cancel on you again.
  • cristobal
    cristobal Community member Posts: 984 Disability Gamechanger
    @worried33 - I don't believe that you understand the extent of the problem that a lack of GPs is causing the NHS - and it's getting worse due to retirement.

    There is a significant risk that my local surgery will close - and I will have to travel ten miles to see a GP. Some people less fortunate than me will need to take two buses.

    If there are GP's who have the free time to deal with benefit claims, and housing now according to your latest post, then my preference is that they were sent here to do what they were trained to do.

    I'm sorry if this sounds a bit selfish!
  • worried33
    worried33 Community member Posts: 492 Pioneering
    edited September 2019
    I understand it, but you cant choose to just stop doing things because of the problems.  That just creates new problems.

    Put things into perspective, a fraction of the population claims sickness/disability benefit, they maybe ask for evidence once every 1-2 years on average (and thats only a portion of those people).  The overall impact that would have on things like your GP closing probably wouldnt be a factor, if the GP chooses to write those letters during consultation hours it might tie up a couple of appointment slots per month, but it wouldnt close a surgery.

    GPs probably spend far more time on common sick notes than benefit letters.
  • cristobal
    cristobal Community member Posts: 984 Disability Gamechanger
    @worried33

    Fortunately we don't need to 'stop doing' anything as benefit work isn't part of a GPs job description...and it's not likely to change anytime soon!!!
  • worried33
    worried33 Community member Posts: 492 Pioneering
    edited September 2019
    Thats what you proposing.

    What is your suggestion to someone who needs evidence for something (as its that departments policy to ask for evidence to mitigate fraud), and there only source is a GP, are you simply proposing these people simply have a "tough luck" situation.

    Many people do things not in their job description.

    I sympathise over your GP surgery but I dont think this would make any difference and I also expect most letters get written outside of consultation hours as well hence the fee's for them.

    I will agree to disagree with you on this one.  You obviously have a very strong opinion on this, I suggest contacting your councillors and MP about getting the surgery reopened. 

    My only last comment is, I would consider much more if you proposed a solution, you just proposing for things to change, without an alternative. 
  • david235
    david235 Community member Posts: 170 Pioneering
    worried33 said:
    What is your suggestion to someone who needs evidence for something (as its that departments policy to ask for evidence to mitigate fraud), and there only source is a GP, are you simply proposing these people simply have a "tough luck" situation.
    If a situation genuinely arises where evidence from a patient's GP is needed, DWP will usually request a GP Factual Report accompanied by an offer to pay a flat fee for the work to be done privately. Most GPs will fill these reports in if asked, even those who will not otherwise provide reports for benefits purposes.

    If all else fails, you have the right to access your medical records and can have copies made for a relatively small sum. Increasingly summary medical records will be available online, including via the NHS app. The time may come where you simply give consent for DWP to receive your summary medical record.


    You have no right to insist that a GP or any other health professional writes a letter on your behalf at your request. Some will do so and not charge, some will do so but only if you pay privately and some will refuse. Health professionals are perhaps more likely to respond to requests directly from organisations requiring information with the patient's consent.


    NHS staff burn-out is real and very worrying. I know two doctors, both of whom have developed severe mental health problems from pressure of work in the past four years. One has quit not only her job but the medical register as a direct consequence; she never intends to work in medicine again. The other has had one nervous breakdown and I think is heading for another - he wants to quit medicine but cannot find another job on enough money to support his family if he does. Both are in their early forties.

    It would be wrong for me to share more about the specifics of each case. I am clear in my own mind that medicine is often a difficult and demanding job - but it wasn't doing the job that pushed either of these people over the edge. It is the staff shortages, the constant financial pressures and the way that staff have to cover for the failings of the system.
  • worried33
    worried33 Community member Posts: 492 Pioneering
    That is very believable able also a likely reason many doctors retire early as well.
  • chiarieds
    chiarieds Community member Posts: 16,007 Disability Gamechanger
    edited September 2019
    Thank you @david235 for sharing both your objective & personal experiences. I suppose the best that any of us can do is share our own personal experience as many in this thread have done. When I mentioned to my GP that I would have to migrate from DLA to PIP he said, 'Don't worry, I will support you.' & offered to write a letter supporting my claim.  

    If I may digress, may I say that altho' I have only known this GP for 4 years, I do always ask to see him. The founder of the support group for the relatively rare disorder I have used to see him, & when she moved away from the area, was willing to supply me with his name. So, he does have more understanding about my disorder than others. I am also a qualified physio & my GP has been willing, perhaps because of this, to look at further information I provided him with as to neurological problems that have also occurred in our family & give credence to them. So, I am fortunate in this GP, who could reliably mainly describe my mobility problems, but also, when this was pointed out to him, describe my poor grip, shoulder weakness, etc. as I knew the terminology to explain this. He had previously just concentrated on my main issue, pain, in prior appointments.

    I have always been a bit of a rebel, even in my student days, when I refused to treat a woman with terminal cancer & also bone cancer. She believed that altho' it hurt, mobilsation of her arms would help her. I stood up to her consultant but still asked that I could see her; we just talked. I often found with patients that they said I explained in a few minutes what Drs didn't do as they didn't have the time.

    I will not forget a 9 year old boy who had had a stroke & also an ileostomy due to ulcerative colitis. We talked, as well as me giving physio. His grandad had given him catalogues about seeds they would buy next year....I hadn't a clue then about gardening, but this gave him hope, which I tried to help. Seeing him walking around the ward a few weeks later, drip stand in tow, giving drinks out to bedbound children was just amazing.

    Nor will I forget Mark, a 2 year old who as a baby was battered by his father. This resulted in him being epileptic, blind. profoundly deaf, unable to walk, feed himself, etc. The staff on the ward did not go near him except to spoon feed him at mealtimes as he was so aggressive & sensitive to being touched. My initial 'physio' consisted of giving him hugs.....I went home often with a badly scratched neck. End result, he was often smiling, got him walking with an aid after surgery I recommended, & got a speech therapist involved who also felt she could help him. He was then able to also feed himself.

    Again, I will not forget one Christmas when as a student I went up to the geriatric ward; everyone seemed to have a relative there apart from one old lady. I held her hand & we sang carols together. Despite my training, I feel that often just being there most often helped.

    I could give even more examples of patients I will never forget; it can, for whatever reason, however cause you to lose hope that you can ever make a difference, which is one of the reasons why I left the NHS. I always seemed to be battling with the 2 elderly consultants views where I was hoping to bring in new techniques to help children with CP or developmental delay. Problems existed even in the late 1970's.

    However, to get back to the thoughts here on the merits of asking for a letter from your GP supporting a benefit's claim....it all depends. IMHO if you have established a good rapport with your GP they may be willing to help, but, as David says, they are in no way obliged to do so.



  • pollyanna1052
    pollyanna1052 Community member Posts: 2,032 Disability Gamechanger
    chiarieds said:
    Thank you @david235 for sharing both your objective & personal experiences. I suppose the best that any of us can do is share our own personal experience as many in this thread have done. When I mentioned to my GP that I would have to migrate from DLA to PIP he said, 'Don't worry, I will support you.' & offered to write a letter supporting my claim.  

    If I may digress, may I say that altho' I have only known this GP for 4 years, I do always ask to see him. The founder of the support group for the relatively rare disorder I have used to see him, & when she moved away from the area, was willing to supply me with his name. So, he does have more understanding about my disorder than others. I am also a qualified physio & my GP has been willing, perhaps because of this, to look at further information I provided him with as to neurological problems that have also occurred in our family & give credence to them. So, I am fortunate in this GP, who could reliably mainly describe my mobility problems, but also, when this was pointed out to him, describe my poor grip, shoulder weakness, etc. as I knew the terminology to explain this. He had previously just concentrated on my main issue, pain, in prior appointments.

    I have always been a bit of a rebel, even in my student days, when I refused to treat a woman with terminal cancer & also bone cancer. She believed that altho' it hurt, mobilsation of her arms would help her. I stood up to her consultant but still asked that I could see her; we just talked. I often found with patients that they said I explained in a few minutes what Drs didn't do as they didn't have the time.

    I will not forget a 9 year old boy who had had a stroke & also an ileostomy due to ulcerative colitis. We talked, as well as me giving physio. His grandad had given him catalogues about seeds they would buy next year....I hadn't a clue then about gardening, but this gave him hope, which I tried to help. Seeing him walking around the ward a few weeks later, drip stand in tow, giving drinks out to bedbound children was just amazing.

    Nor will I forget Mark, a 2 year old who as a baby was battered by his father. This resulted in him being epileptic, blind. profoundly deaf, unable to walk, feed himself, etc. The staff on the ward did not go near him except to spoon feed him at mealtimes as he was so aggressive & sensitive to being touched. My initial 'physio' consisted of giving him hugs.....I went home often with a badly scratched neck. End result, he was often smiling, got him walking with an aid after surgery I recommended, & got a speech therapist involved who also felt she could help him. He was then able to also feed himself.

    Again, I will not forget one Christmas when as a student I went up to the geriatric ward; everyone seemed to have a relative there apart from one old lady. I held her hand & we sang carols together. Despite my training, I feel that often just being there most often helped.

    I could give even more examples of patients I will never forget; it can, for whatever reason, however cause you to lose hope that you can ever make a difference, which is one of the reasons why I left the NHS. I always seemed to be battling with the 2 elderly consultants views where I was hoping to bring in new techniques to help children with CP or developmental delay. Problems existed even in the late 1970's.

    However, to get back to the thoughts here on the merits of asking for a letter from your GP supporting a benefit's claim....it all depends. IMHO if you have established a good rapport with your GP they may be willing to help, but, as David says, they are in no way obliged to do so.



    Oh your comments have really moved me to tears...the little 2 year old chap, who was so badly treated...how utterly utterly cruel, that a tiny defenceless person ends up in such a state. And the lonely old lady you sang carols with....you are lovely to be so compassionate...bless you xxxxx

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