FORMAL ESCALATION TO HEALTHWATCH ENGLAND Topic Paper: GPs charging patients for letters October 21, 2013 Healthwatch Cornwall CIC Author of report: Jayne Zito Acting CEO Healthwatch Cornwall has been made aware of GPs charging patients for letters in support of the patient’s claim to the Department for Work and Pensions for benefit about their condition or disability. It is the responsibility of the claimant to provide a medical letter in support of their claim, which has been written by a health professional, and GPs are charging up to £70 for this service, which if the patient is not yet in receipt of the benefit is not affordable for them. The Local Medical Committee (LMC) is advising doctors not to provide medical evidence to DWP and ATOS. Healthwatch Cornwall raised a formal letter to NHS England on July 3, 2013, requesting a formal response from NHS England around any action which may be taken to alleviate the financial pressure on the patient to provide this information to the Department for Work and Pensions. NHS England’s letter of July 17, 2013, responded to the formal letter by stating its commitment to scheduling a meeting with ATOS to “make the whole process more consistent and clearer to patients and GPs”. The Devon, Cornwall and Isles of Scilly NHS Area Team have advised, Oct 16, 2013, that they been in touch with the National Support Centre about these issues and are taking action to meet up with the Medical Director of the DWP to discuss how we can work together to refine the process and make it more sensitive to the issues of mental illness. RECOMMENDATION Despite this action Healthwatch Cornwall recommends that Healthwatch England use their national status to investigate if Cornwall is the only region with this concern Healthwatch England request a formal meeting with the DWP to highlight this specific issue affecting patients ____________________________________________________________________________________________ Comment from a patient: “I was told a letter describing my medical history of which I must provide in order to receive ESA would be a £70 charge. I was currently receiving just £71 week in benefits so I was unable to afford this. I, with the help of Bufferzone, contacted my local MP who wrote to the surgery questioning their charging policy. The letter was written by my GP and the practice reduced the charge to £35 which my MP paid. I then was asked for further evidence from ESA from my doctor as the first letter wasnt detailed enough. I was told by the receptionist a further letter from my GP would be another £70. On seeing my doctor personally at this point because I was in severe distress not only from a financial point of view I was also being driven to a mental breakdown my personal doctor wrote the second letter and I was never billed for it.” Comment from Tony Lea, Bufferzone: “I was contacted by a client today, in great distress. She had been to see her doctor, a Dr surgery Truro asking for a letter of support regarding DWP Tribunal. They informed her, if she needed a letter, there would be a charge, which was undisclosed. This has made my client conditions exacerbate, due to stress and unsympathetic behaviour from professionally trained medical practitioners. As you are aware, this is now becoming an endemic issue regarding many vulnerable, that since May 2013, we personally have had to deal with 13 attempted suicides and an array of doctors surgery, who believe that their behaviour and refusal to support their patients, due to unfounded opinions that their letters do not help at ATOS medicals or Tribunals. Their letters are vital to help their patient’s physical, mental and financial well beings to an equilibrium they are able to manage.” The Department for Work and Pensions gave this information in an email: Having sought guidance on what can and is expected of GPs with regard to DWP processes, the following apply: Claimants are encouraged to provide all evidence that will be relevant to their case, including medical evidence supplied by their GP or other medical professional, at the outset of the claim. Atos healthcare professionals are expected to seek further medical evidence in situations where that would help them provide advice without calling a claimant in for a face-to-face assessment. GPs are required to provide a fit-note as part of their patient’s claim to benefit, and are also subsequently required to complete an ESA113 / FRR2 on behalf of that patient at the request of Atos (on behalf of the Department) to support a claim to benefit. Any other information requested by a claimant in support of a claim / appeal may be subject to a charge not met by the Department. However, claimants are advised that they can submit medical evidence in support of their claim if they wish though this is not a DWP requirement. It is not for DWP to tell the Medical Council if it is correct in its guidance to GPs with regard to requests for medical information relating to individual patients, be they claimants of DWP or otherwise. Regards I District Business Support Manager I Department for Work and Pensions I Redruth Response from NHS England about the issue: Thank you for recent enquiry regarding the difficulties experienced with your clients obtaining written reports/letters from their GPs to help them through the welfare reform. I am sorry your clients feel that the service received has not met their needs or expectations. Supplying copies of medical reports and/or written communications to help support patients with various claims and assessments is a service offered on private basis by GPs who can charge for this. I hope you find this information satisfactory. Yours sincerely, Customer Contact Centre Case Officer A subsequent email from the same person at NHS England: Thank you for forwarding the information regarding Cornwall and Isles of Scilly Local Medical Committee’s (LMC) stance on providing information in support of the Benefits System. As I mentioned in my previous email, this is a service offered on a private basis by GPs who can apply a charge. As detailed in the LMC statement, GPs are not resourced to provide this service. There are already agreed steps for GPs to provide medical information to the Department for Work and Pensions (DWP). As per the LMC statement; ‘These are sent to the GP practice and GPs respond directly to the departments requesting information’. You ask in your email dated 23rd May why GPs ‘are ignoring DWP, their patients or ATOS requests for this evidence?’ GPs are not ignoring these requests but are in fact following the contractual and agreed methods for providing this information. I understand you are working towards the best outcome for your clients’ needs and would like to assure you that appropriate procedures are in place, through the correct channels, to ensure the relevant information is provided. If you require further clarification regarding this, please do not hesitate to contact me on the details below. Please quote reference 75140 in any communication. Yours sincerely, Debra Coulson, Customer Contact Centre Case Officer Email to Mr Tony Lea, Bufferzone, from Jane Moore Customer Contact Centre Case Manager: NHS England. Oct 16, 2013. Dear Mr Lea Thank you for your recent emails. I am very sorry to learn of the difficulties your clients are encountering. The issues around writing reports for patients seeking to appeal a decision by the Department of Works and Pensions (DWP) or seeking support in the form of an additional letter from their GP in the initial application is a complex and difficult area. Currently, the DWP contract out to ATOS who assess the patient’s form that details the nature of their illness and why it is that they are unable to work. These forms assess the ability of a patient to function and to carry out activities of daily living. GPs are often asked to give a factual account of the illnesses a patient suffers - and this is undertaken without charge. However, patients are often asking for a more descriptive account from their GPs detailing the impact an illness has on their ability to work. This is necessarily more subjective and there is no contractual requirement on GPs to write an additional letter for patients to better describe the impact of the illness on their quality of life. Should this become contractual in the future, a duty could be imposed on GPs and the implications of this would be given due consideration prior to the implementation of any changes. We do take the issues you have raised very seriously and recognise that there may be shortcomings in the current process. The Devon, Cornwall and Isles of Scilly NHS Area Team have been in touch with the National Support Centre about these issues and are already taking action to meet up with the Medical Director of the DWP to discuss how we can work together to refine the process and make it more sensitive to the issues of mental illness. Graham Lockerbie is the local Medical Director and has confirmed both he and Carol Williams, Director of Nursing, will be happy to update you on the progress and outcome of the meeting in due course. I hope that this will of assistance to you but if you have any queries, please contact me using the details below quoting the relevant reference number. Yours sincerely, Jane Moore Customer Contact Centre Case Manager NHS England
Posted on: Mon, 28 Oct 2013 14:13:06 +0000
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