Jobs on Prescription
The Government’s latest proposal to turn GP surgeries into Jobcentre Plus must be treated with extreme caution. The Islington GP surgeries that have agreed to pilot this scheme have, perhaps unwittingly, crossed another boundary which plays into the wider agenda of blurring functions and roles of public servants. Hidden behind the deception of “joined up” services lies a de-professionalisation and lowering of standards the public can expect. Merging of functions and budgets will also provide richer pickings for corporate takeover which is the intended endpoint. Meanwhile respected public employees like GPs will be used to set the precedent.
My experience of patients who have had benefits stopped has not been encouraging. Most have gone on to appeal the decision and won. Many were clearly not fit for work and their accounts of the assessment often beggared belief. One patient sticks in the mind. A 62 years old man with severe Parkinson’s disease who despite medication was struggling to function requiring help to dress and wash himself, walking with the classic shuffling gait and experincing disabling tremors in his arms. He was summoned for a work capability assessment. To my shock he was deemed fit to work. Others have been driven to relapse of chronic mental health disorders and the desperation of relying on food banks. The DWP and its outsourcing partners are interested in one thing alone and that is to reduce the spend on benefits. The impact on those refused benefits that then go on to suffer extreme financial hardship, psychical and mental harm as a result of ludicrous decisions are the collateral damage the government is quite happy to inflict.
As a general practioner I am well aware of the financial and bureaucratic burdens deliberately places on practices struggling to provide safe high quality care with diminishing budgets and staffing vacancies. It can seem tempting when government offers alternative financial opportunities for cash strapped practices to grab them only later to realise how temporary and damaging the deals have been and for what purpose they were offered up. Much of what I am tasked to do with my patients neither serves their best interest nor clinical priority. Limited time and resource is constantly being diverted to activity which has no significant health benefit for patients but has income attached.
The Jobs on Prescription schemes will damage the doctor patient relationship particularly for people with mental distress and physical disabilities. The GP will be seen as an agent for the DWP with a potential conflict of interest in advising patients into job focused interviews. No doubt in time the role will be given to less qualified staff with perhaps less ethical objection. Bonus payments for getting people off benefits could speed up the achievement of the government goal to reduce the benefits bill. The constant focus on benefits and work add further psychological burden to people eroding self-worth and esteem. The threat of “conditionality” implying you either engage or face sanction hanging heavily over claimants. The subliminal message is that the patient is to blame by choosing not to comply so whatever happens they bought it on themselves.
Doctors need to remember their duty to do no harm. Patients pressured into employment schemes or put off seeking medical care from doctors they no longer trust may come to harm. This is against our ethical duty and should be rejected for what it is a draconian attempt to deny basic financial safety net for sick and disabled people.
Dr Bob Gill