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GPs have a duty to help needy patients get benefits – the contrary view.

by Dr Peter Swinyard The Phoenix Surgery Swindon Wiltshie

GPs have a duty to help needy patients get benefits – the contrary view.

If only I had a pound for every time someone in authority said “GPs are ideally placed to….” – the phrase can cover anything from sorting out a public health agenda to stopping global warming and probably includes proving the existence of the tooth fairy.

But this is a serious subject – helping patients to negotiate the arcane twists and turns of the benefits system. Sitting in our surgeries and out and about visiting our patients, we come across all manner of social disasters which have befallen those we care for. Times have been tough and those who have always worked and been proud to support their families have fallen on hard times. Illness strikes and the breadwinner is no longer able to win the bread. Families separate and the custodian of the children often goes through major financial difficulties. The previously employed become unemployed sofa-surfers.

Underpinning society is the welfare state. We all rely on it from time to time in various guises. But how many of us truly understand the web of entitlements to the various benefits.

I used to examine on behalf of the DHSS, or whatever it was then, for Mobility and Attendance Allowances and the Disability Living Allowance so was more clued up than most on the criteria for entitlement. But ESA and all the new three letter acronyms? Search me!

I was trained in medicine. While it is really important that patients have enough to live on and a civilised environment in which to live, I am not the expert in these matters. But, in true GP style, I know someone who is. The Citizens Advice bureaux do a fantastic job, backed up by the local Law Centres, in dealing with people, advising on benefit entitlement and helping people to claim that to which they are entitled.

I cannot form a judgement on whether my patient in front of me fulfils the criteria for ESA and whether the removal or granting of a benefit is fair, correct and legal.

While we should always be our patients’ advocates in negotiating the journey through the health service, we are not best placed to do the same in the social care services. We are kidding ourselves if we think we are. We should also be aware that the tribunal service on ESA appeals will not always take much notice of an unsolicited letter from a GP. They do have the means to acquire independent medical evidence when the need arises. Questions have been raised as to whether the system is fair but that is the territory of the MP, not the GP.

What I did learn while doing AA/DLA examinations is that it is not the diagnosis which opens the gate to allowances but the effect on function. Two people with similar impairments may have grossly dissimilar disabilities and we are not trained in disability assessment.

In some practices, there is a benefits adviser who comes in to do a session to help patients – this is great and should be welcomed. But I am not trained in this field and we have a duty as GPs to do the right thing for patients – including referring patients to a specialist when necessary.

That is how we offer the best service to our patients – not by trying to maximise a patient’s income – the extension of that argument would be that we should help our employed patients negotiate a pay rise. We have all met the situation where the patient, who is entirely fit for work after an illness, begs for a further sick note as they are unemployed and receive more if they are on the sick. A real ethical minefield.

The doctor-patient mutual investment company is based on trust and absolute honesty. The best service we can offer our patient is to give good advice medically and not act outside our knowledge in a misguided attempt to help patients maximise benefits – leave that one to the experts. That honesty will bank the maximum goodwill for the future.

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