gp wont write a supporting letter

[willitblend]

hi there

 

i recently attended a wca

i'm currently awaiting the "0 points" letter (an optimist i am not)

so i'm currently thinking one step ahead to the "mandatory reconsideration" where another decision-maker looks at my case

or a "mandatory rediscrimination" as the case may be

 

i heard you can send supporting information/evidence for said reconsideration

the problem is my g.p has said "as a matter of policy" they do not write supporting letters as the demand would be too high

 

i understand that in most succesful appeals, evidence is paramount

 

i have failed my last rotation (wca-appeal-tribunal) due to what i believe to be lack of evidence

i would have attempted to attain some at the time but not once was i informed that this was needed and important

a convenient lack of transparency on the part of the dwp i think

 

anyway, does anyone have any help/ideas/tips in getting medical evidence when your local clinic is unhelpful?

any help would be greatly appreciated.

 

:violin::violin:

for the record, my claim is mainly on the basis that i cant walk 30 feet without experiencing pain in my lower back, knees and ankles.

i needed a walking stick just to get from a car to the atos center, nothing was asked or looked at in the wca regarding this

despite me going into detail about it in the esa50 and yet im confident of a "the customer can walk 100 meters unaided" diagnosis.........its a miracle........hallelujah

 

thanks again for listening to my ramblings

[honeybee13]

Hello and welcome to CAG.

 

I'll move your thread to the main benefits forum, which has more traffic so more people will see your questions. Your question is more to do with DWP processes now. Atos have done their 'bit' and are out of the picture for the time being.

 

My best, HB

[BRIGADIER2JCS]

Hi You have a " right" to see your medical records and copy any data you require, the usual process is to make a request to view to the " practice manager" or senior partner of the practice.

[rebel11]

Hi willit

 

To be honest it doesn't matter what your GP says is policy. You need to inform him/her that he owes you a duty of care on two fronts, firstly the 'Hippocratic Oath' and secondly under the NHS constitution, if the information you need is sought to protect you from coming to any harm, then regardless of any policy they have in place or regardless of the 'high' demand he needs to act in your best interests. Tell him you want the requested info within 7 days or you will take further action.

 

You need to point out that 99% of GP's provide this information on request without hassle.

 

http://www.adviceguide.org.uk/england/healthcare_e/healthcare_nhs_healthcare_e/nhs_patients_rights.htm

[Guest]

I totally agree with Brigadier and Rebel on this.......I understand the GP's may well get inundated, its their problem to deal with the workload not yours as a patient. The duty of care includes the GP opinion if your fit or not for work, I had to wait 2 weeks for my letter but it was done. You do right to ask in advance, and yes the practice manager is the way to go with this. A polite reminder of duty of care etc will hopefully sort it out. Your medical notes/records will have evidence also but I think there is a charge for getting these, but likely well worth it. Also, any evidence you gather now, always keep copies for the future if you need them, I say this as all my evidence provided in 2011, including a tribunal decision in my favour, helped me get ESA support group without any face to face assessment. I would also ask dwp for esa85a, which is the report made on the findings of atos assessment, whether you fail or pass, its all helpful in one way or another.......above all don't give up and stand up for your rights. Some good people and advice on this website. Good Luck.

[**Margaret**]

:willitblend:

 

At the moment support for benefit issues, from general practitioners, hospital consultants, mental health services, etcetera, is a contentious issue. Most of them refuse requests from patients on the grounds of workload, and that if supportive evidence is needed it'll be requested by Atos/Jobcentreplus under the terms of National Health Service contracts.

 

The next best alternatives are;

 

A subject access request for your medical records. A tenner gets you everything that's on the computer and your doctor doesn't get a choice about whether to hand over the info, unless it may be harmful. Copies of clerical records can cost up to £50, but you can make an appointment to view them first. I'd suggest you do this as soon as possible cos the doctor's got forty days to supply the info, but you'll only have a month to request mandatory reconsideration.

 

http://www.nhs.uk/chq//Pages/1309.aspx?CategoryID=68&SubCategory=160

 

Statement from a carer/friend/partner about the help they give you with getting to the doctor/pharmacy, shopping, etcetera, cos you can't repeatedly walk 50 metres within a reasonable time.

 

Also, the descriptor talks about mobilising. If you didn't explain why a manual wheelchair isn't appropriate on the ESA50, be sure to include it as part of any request for mandatory reconsideration of an adverse decision. And I'd suggest a written request cos Jobcentreplus often lose phone calls.

 

Best wishes, Margaret.

 

As you had a face to face assessment, you need to ask Jobcentreplus for the ESA85 report. Should be available on request, for the cost of a phone call to the number on the last letter you had from them.

[think about it]

I'd better start this by explaining that I'm a Practice Manager in a rural practice.

 

There's a number of things at play here as to why your GP might be unwilling to write a speculative supporting letter.

 

I say speculative as there's no result from the WCA either way as yet.

 

GP's do indeed have almost insurmountable workloads and so in the absence of a decision from the DWP I can see why they might be reluctant at the moment. Equally without specific questions the GP is left to guess at what the aim of the letter is, hence the reason why they prefer to respond to questions relating to you condition and not just make a guess at the desired outcome.

 

Someone earlier had mentioned getting a copy of your medical record, this will carry just as much weight as a letter.

 

I can't speak for all surgeries across the UK but, certainly in our area we have an arrangement with the local Citizens Advice Bureau in that we will waive the fees for producing a copy medical record should the request come from them on the patient's behalf.

 

So, my initial advice to you is to await the decision. If it's not in your favour, involve your local CAB and ask them to get a copy of your records and in their letter, ask the practice manager to waive the charges ( I certainly would and most of my colleagues in surrounding practices do also). Speak to your practice manager too, explain the situation and the information you need. We're often well 'protected' by our reception teams as we have countless calls from sales people trying in desperation to get hold of us but, explain that you're a patient and that you'd like to speak with us about a concern - that normally gets us out of our office

 

Something to bear in mind is that lots of PM's work part-time, so we might not be immediately available.

 

In the meantime, if you have not fully discussed the severity of your conditions with your GP, make an appointment and do so. That way the details will be recorded on your medical record and will show when the copy is produced.

 

Equally, there is likely to be a provision to have the GP write a private letter (we often do this for insurance reports etc on a 'to whom it may concern' basis) and although there is a charge involved it's normally no more than £15.00 if you feel that a copy of your records won't meet your needs.

 

Lastly, this time of year particularly is exceptionally busy in 'GP Land' as we approach the end of one contract year and the start of another and before anyone else says it, no it shouldn't impact on the patient but the priority is most certainly on those patients who require attention with active concerns, so the lack of a decision from the DWP may factor in this. However, once the 2nd of April passes there's normally a lot more 'time' to do things and you may find your request is met more favourably.

 

Good luck.

TAI

[rebel11]

Medical Records could be quite substantial and meaningless to a DWP decision maker as well as the time it would take for the decision maker to go through them, the same as a SAR request in these circumstances. A concise letter from your Doctor summarizing your conditions with the medicines you are taking is exactly what's needed. You need to put your case to the DWP, that means meaningful information, concise information. I'm not sure why CAB need to get involved at all in getting your Doctor to writing a supporting letter for your claim.

[think about it]

Why involve CAB? Because they're a free experienced and trained resource with the sole purpose of getting the best possible outcome for you. I'm talking holistically when I say get them involved in the whole appeals process and make use of their expertise. This may depend on the clinical system used in your practice but ours (called EMIS ) produces a summary of all of the patient's health concerns and medications in the first few pages before it shows individual consultations, test results, letters and so on. So it's very easy indeed to gather an excellent overview of the patient's conditions without trawling through what can, quite rightly, be hundreds of pages.

[rebel11]

CAB do have a part to play, but not in every claim, they have limited resources due to government cutbacks, lack of staff and waiting times for appointments, this might be worse in the inner cities where needs on their services are greater.

 

Why involve CAB? Because they're a free experienced and trained resource with the sole purpose of getting the best possible outcome for you. I'm talking holistically when I say get them involved in the whole appeals process and make use of their expertise. This may depend on the clinical system used in your practice but ours (called EMIS ) produces a summary of all of the patient's health concerns and medications in the first few pages before it shows individual consultations, test results, letters and so on. So it's very easy indeed to gather an excellent overview of the patient's conditions without trawling through what can, quite rightly, be hundreds of pages.

[**Margaret**]

:think about it:

 

Thanx for your alternative perspective from the other side of the fence on this increasingly contentious issue. I've no doubt that the scenario you describe works for the patients in your practice, and many contributors to this site testify to excellent support from their doctors with benefit entitlement.

 

But, and it's a very big but;

 

http://www.pulsetoday.co.uk/home/finance-and-practice-life-news/benefit-request-refusal-letters-are-proving-valuable-for-local-gps-says-lmc/20004687.article#.Uys4kXlF1jo

 

Four weeks to return an ESA50 questionnaire!

Four weeks (usually nearer three cos Work n Pensions increasingly use second class post) to request mandatory reconsideration!!

Six weeks minimum wait (where I live) for an appointment with Citizens Advice!!!

Then Work n Pensions Ministers bleat that evidence isn't produced until a tribunal hearing.

 

I accept your point that as yet we don't know the outcome of this particular work capability assessment. But given Government reluctance to change a decidedly flawed system, that rarely asks specific questions, I can understand the original enquirer's pre emptive approach to the doctor.

 

Margaret.

[think about it]

Margaret,

 

Thanks for the link to the article in Pulse, it’s a really useful resource and one we use a lot.

 

There’s always been a bit of a ‘gap’ when it comes to Doctors’ opinion on work related matters. In fact the introduction of the fit-note was similar as GP’s were not equipped to make decisions on what aspects of someone’s role were / were not likely to worsen their condition and so in all of the notes we produce I don’t think I’ve seen more than a handful that say that ‘You may be fit for work taking into account the following advice:’

 

GP’s are, oddly enough, just GP’s they’re not qualified to make workplace assessments (mind you, I’m not sure ATOS are either) and so their sole focus is your treatment and wellbeing.

 

What renders someone fit/unfit for work depends on so many factors that I personally wouldn’t want to make the call.

 

I’ve had the pleasure of working with people with a massive range of conditions that haven’t stopped them from working, including someone with duchenne muscular dystrophy who worked with me as another manager many years ago. I’ve also met others who, in the absence of any specific diagnosis, I felt were totally out of their comfort zone.

 

Anyway, that’s a huge digression, apologies…

 

There’s an article linked to the one you posted which show just how little notice is taken of the GP’s input in deciding the outcome of an appeal.

 

http://www.pulsetoday.co.uk/your-practice/practice-topics/employment/courts-carry-out-review-after-study-reveals-gp-evidence-was-factor-in-only-29-of-disability-benefits-appeals/20005144.article#.UywXYqh_uqg

 

You’re right, the present system is unfit for purpose, the assessments already have the input from the claimant’s GP from the outset and so, the evidence is already there (in-fact, a records request would include a scanned copy of the report sent to the DWP/ATOS) so a copy of the GP’s opinion is already included for the appellant to re-submit if they felt it hadn’t been acted on.

 

I fully understand the difficulty in getting the CAB involved. I worked for them for five years on the operational management team and lost my job due to funding cuts. What I do know though is that it’s worth the wait, especially in the face of the fact that the OP has already been through one unsuccessful appeal.

 

We’re certainly not ‘on the other side of the fence’ and the reason that we go to work is to care for the thousands of people that are registered with us. We do though have an incredible task ahead of us, in the face of increasing scrutiny we do what we can to ensure accessibility for our patients, we too are registered with GP’s in other practices and have to wait for appointments, pay for prescriptions and sit in the same queue for hospital referrals (30 weeks so far to see an ENT consultant as I progressively lose my hearing). We do however have to protect our time to deal with the constant flow of patients and sometimes that does mean saying no to requests. No one wants to do this and we certainly feel the impact on welfare reform here in ‘GP land’. Fingers crossed a change in assessment methodology comes soon but until it does we’re lumbered with a system. A system that only considers GP’s input in 2.9% of appeals and seems to disregard evidence submitted – reason if ever there was one to ensure that you have someone fighting your corner with you.

 

One last plea, support your local CAB. Yes, it’s frustrating to wait but that’s only due to a lack of resource. Our biggest challenge was finding willing volunteers that we could train to offer the very support that people so desperately need.

[**Margaret**]

:think about it:

 

Again, thanx for your contribution to this debate. I understand that you personally and the doctors at your practice are trying to do the best for your patients against a background of cuts to mental health services, NICE, and waiting lists. But on my side of the fence disallowed claimants, often for lack of medical evidence, wait even longer for help from their doctors with conditions aggravated by malnutrition, poor housing and acute mental health crises.

 

Now I don't blame any doctor for not writing a letter to accompany a claimant's ESA50. Waste of time cos Atos seem to lose more than they read. But supportive letters for claimants to send directly to Jobcentreplus decision makers can avert tribunal hearings.

 

'...... assessments already have the input from the claimant's GP from the outset', what input:???: What '...... report sent to the DWP/Atos' And at what point is it added to the assessment:???: (Don't think a Med 3 constitutes a report.)

 

Yes, Atos/Jobcentreplus ask for ESA113s 'if ...... the patient may have a severe health condition or disability'. About 20% of cases. Usually when Atos are trying to avoid a face to face to clear their backlog. And what about the other 80%?

 

And I've yet to meet an Atos assessor who knows what a FRR2 form is! They're not much better with FRR4s. (Notes of phone contact with a claimant's doctor.)

 

Once past the nil points farce; '...... judges cited GPs' supporting evidence as the principal factor in only 2.9% of successful appeals ......' Cos Work n Pensions put the responsibility for evidence onto the claimant/appellant but doctors are discouraged from providing it. After all, the angst of a tribunal hearing (at £300.00+ each cost to The Treasury) makes far more sense than doctors writing supportive letters/reports to facilitate their patients welfare.

 

(Work n Pensions have lost a case on this issue in the Court of Appeal, but so far they've declined to implement the judgement. )

 

As for the original enquirer, s/he doesn't have time to wait for Citizens Advice to source a letter that's already been refused as a 'matter of policy'.

 

Sadly, neither of us have access to one of the specially designed and patented by Atos 'cure all' magic wands. But in my opinion, highly salaried doctors have far more clout and resources, than beleaguered and disabled claimants, to put an end to the current travesty of justice.

 

Margaret.

[**Margaret**]

:References for #13:

 

https://www.gov.uk/government/publications/dwp-factual-medical-reports-guidance-for-healthcare-professionals

 

https://www.gov.uk/government/publications/esa113-interactive-for-use-by-healthcare-practitioners

 

http://www.mind.org.uk/news-campaigns/news/victory-for-welfare-campaigners-as-government-loses-appeal-against-benefits-ruling/

 

Margaret.

[Guest]

Neither atos nor the dwp contacted my GP at any stage, they contacted nobody, all the evidence I had was gathered by either myself or my daughter and had to be requested.

 

As the dwp told me, the "the burden of proof" is on me to prove how my illness limits me, quite how I could have done this without the GP having his opinion and being prepared to put it in writing, and the referral to specialists in the given fields, I have no idea.

 

Thankfully my GP would seem to be one in a million, he always offers any support, including records or letters to help. I have obviously taken this for granted, assuming everyone with an illness or condition that limits them has the same support. In my case my GP has been the same for some 10 yrs maybe, and my adult children and I see the same GP each time, continuity and knowledge of the whole picture is an advantage. Again this seems another rarity these days.

[**Margaret**]

:Asleep in Wonder:

 

Has helpfully drawn our attention to another useful booklet that explains when Work n Pensions may contact a claimant's doctor;

 

https://www.gov.uk/government/publications/a-short-guide-to-the-benefit-system-for-general-practitioners

 

'DWP may ask you to complete an ESA113 form ...... You will only be asked for this form if it could result in approval of your patient's benefit without them needing to attend an assessment.'

 

Of course, some doctors agree to claimant requests for letters/reports to evidence benefit claims. But for most claims to employment n support allowance there's no supportive evidence from a claimant's doctor/hospital specialist. Claimant requests are refused, and Work n Pensions don't bother to ask.

 

Margaret.

[richardscanlon]

Hi willit

 

To be honest it doesn't matter what your GP says is policy. You need to inform him/her that he owes you a duty of care on two fronts, firstly the 'Hippocratic Oath' and secondly under the NHS constitution, if the information you need is sought to protect you from coming to any harm, then regardless of any policy they have in place or regardless of the 'high' demand he needs to act in your best interests. Tell him you want the requested info within 7 days or you will take further action.

 

You need to point out that 99% of GP's provide this information on request without hassle.

 

http://www.adviceguide.org.uk/england/healthcare_e/healthcare_nhs_healthcare_e/nhs_patients_rights.htm

 

Hi, just one point; our doctors charge £60 for a letter if we ask for it but it is free if asked for by the DWP/ATOS. Most people can't afford to pay these prices which is what I think the DWP/ATOS depend on.