Feb 222016

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

General Practioner

Welling Kent



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 Posted by at 12:00

  12 Responses to “A letter from a GP about “Jobs on Prescription” #DoNoHarm”

  1. To everyone who posted, Especially to Catherine and Andrew. Good you fought the terrible system and won. Andrew please do not take your own life, you have a wife and family. They need you. More and more disabled people are fighting back. Please be one of them? I have felt like you over the past few years. I was put in the WRAG group of ESA. When I went to sign on at the local Job centre, the woman who interviewed me could not believe I was there to sign on. She was told I only had a back problem. I am totally blind with other major disabilities. Six month’s later the benefit’s agency called me and apologised numerous times and reinstated my benefit and put me in the ESA group, unable to ever work again.I am dreading the changeover from DLA to PIP. I mean dreading it. I suffer from Clinical depression and the stress in unbelievable. I panic just thinking about it. Bob, don’t worry about your Dr not writing you a letter for the DWP. They will send to your Dr for a full medical report. He has to tell them what your health problems are. He cannot state you are not suffering from the condition’s you are being treated for. This new approach is extremely dangerous for the government. Human right’s are being infringed here. Plus there is a double standard which could be positivly exploited by disabled people and organisations. The DWP in effect reject Doctor’s report’s regarding the claiment. These Dloctor’s report’s are then used by the claiment to lodge an appeal. Over 60% win there appeal. Those on the Appeal tribueneral accept the Doctor’s reports as legal. The twist is that the government are abusing not only the claiment’s human right’s but the Doctor’s human rights in forcing the GP to force the disabled person into work. If they don’t then they won’t get paid. A parralel is drawn by the health board in England threatening the local NHS trusts with cut’s to specific services. A Doctor has a duty to his or her patient. Neglect of that duty can find the Doctor brought up in front of a Complaint’s committee. Disabled patient’s can also change their GP. A Doctor has no right in law to force a disabled person who is their patient into work.. This is clearly against all human rights. Another arguement is why reject the Doctor’s word regarding his or her patient’s abilities with regard to a Medical assessment, disregard those report’s and at the same time accept the GP’s word that his patient is fit to work. I hope my thought’s are clear enough. Using GP’s for this purpose is illegal and should be appealed against and if there is no means of appeal. Then contacting our MP’ with the complaint.

  2. I recently asked my doctor if he would write a letter for me towards helping me at a PIP Tribunal, he said he would do anything he can. When he finally wrote a letter, it was two sentences explaining that as a GP he could not advise me on social security matters. Without his ‘medical evidence’ I may have to drop the tribunal and try and survive on the money I have.

    • Recommend that you still proceed with the tribunal – take as much evidence on paper as you can, and also testimonies of friends/family if you can get them explaining how your impairments affect you day to day – also can you get to a Citizens Advice or local citizens advocacy service on your side.

    • My GP printed off a correspondence between my specialist and himself, which just had basic details of tests, results and probable diagnosis. The DWP ask GPs not to give their “opinion” and only state what’s on record anyway. That’s your medical details, you then have to explain how that impacts on your day to day life. I used the docs printoff, plus 4 or 5 pages of my own account, descriptions and updates, and I won. As Bob says, if you can get friends and family to provide an account, that’s great too. My son came with me.

  3. Bullying Tory Scum

  4. Hi Andrew. .please don’t have those dark thoughts, another life lost is what they want and @ 64 myself who fought the fraud team for 2 years, went to court and won that and a tribunal hearing won that,l know what pressures are. I was fighting on my own with no family for support. My money was stopped my car stopped and they were going for an overpayment of £80.000 probable having to sell my home and all because my ex husband decided to report me after he left me for another woman after 34 years of marriage for revenge. What l am trying to say Andrew is we all have to keep up the pressure of a fight and take it to them. It’s never easy but life isn’t for the disabled in this world, but don’t give into them because if we do we all lose…take care and find the right support it is out there..

  5. What Iain Duncan smith has done to the mentally ill , disabled and unemployed is totally disgusting . Why people are not rioting over this is beyond me . I am not however condoning violence of any type . It’s a cleansing of the weak , vulnerable and poor of this country . I have severe mental health problems and have had dealings with the DWP , ATOS and the WCA , which left me suicidal . maybe if some GPS wrote to IDS explaining how his welfare reforms have affected so many people with devastating results . Maybe he’s ice cold heart may thaw a little . I don’t think many more people will survive another 4 years of Tory rule and their barbaric welfare reforms .

    • Hi Sam – they thought they could bully us – but they can’t – if we stick together and keep opposing them – we WILL win in the end. Together – and I mean everyone who campaigns, protests, signs petitions, tweets, facebooks, talks to people, and comments on blogs, Put all that together and we are a very serious political force. I really think the tide is turning – a year or so ago public opinion was on the side of welfare reforms but over the last year – public opinion is changing dramatically as people are becoming aware of the effects of what is being done to us. Just one example of that here http://www.independent.co.uk/news/uk/politics/disabled-cuts-esa-wrag-vote-house-of-lords-poll-iain-duncan-smith-dwp-a6837426.html – there are many more.

      So my message to everyone is, yes it is tough, but hang in there and keep going – we are starting to turn things around. Keep going.

  6. Good to read this, but how many other GPs think likewise, I wonder. At my GPs practice, one of them seems to be prepared to do anything for money eg not interested in ME/CFS becasue there’s no ‘payment’ to GPs for treating CFS/ME. I thoroughly accept all that Dr Bob Gill writes, and can see that it won’t be long before the Toxic Tories nebulise duties even more! Yet, 11.3 million people voted for the Tories at the last General Election and, even then, it was obvious what direction the Tories were going in NHS-wise and, rather than veering off course, they seem to be more in the ‘steam ahead’ mode as is borne out by their inposition of the contract on Junior Doctors

  7. Dr bob, I have severe mental health problems caused by physical and mental abuse when I was a child in care! Maggie thatcher was in power. The system left me homeless at 15, I am 45 now the Last3-4 years have set me back years. They tried to say I was fit for work and left me my wife and 6children with no money, stopped my rent. 2 years of fighting the ungovnerble force. It took a judge a mental health charity and 2years of being told lies to sort out. I am a broken man who feels hated for being ill, if you contact the dwp they hardly ever answer and when they do they lie and talk to me as if I am dogs mess. If they carry on I will publicly commit suicide near downing Street, I can’t take no more. My family would never have gone through what they have had to handle, Dr bob please keep up the good work people like you are so important, my doctors don’t have time for me. Andy (my life is not fun Mr Duncan Smith you muderer and liar) To the people, Hope you don’t get sick because there is no help out there from the dwp just mistrust and a vile hatred for the poor and sick.

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