Apr 262018

Following this article about DWP interference in the way that GPs treat patients who have been refused ESA, DPAC have initiated a letter to the Royal College of GPs and the BMA GP Section, asking those organisations to get involved in this issue.

The letter to the Royal College of GPs is copied below and the one to the BMA is identical. We will publish on this blog the responses we get from them.

To: Professor Mayur Lakhani, President of the Royal College of General Practice


Editor Pulse Today

Editor Disability News Service

Second copy to : Chair of the General Practitioners Committee UK Dr Richard Vautrey

Dear Mayur

We write as a group of concerned health professionals and disability campaigners regarding a recent change by the Department of Work and Pensions which we feel will gravely impact on the doctor / patient relationship between GPs and disabled people claiming benefits.

The DWP has issued a new ESA65B, the form used to inform a patient’s GP of their WCA outcome. This form which requests GPs not to send any further fit notes for ESA purposes after a claimant has been found fit for work, unless they appeal had already been at the centre of a controversy.

A claimant, James Harrison died 10 months after being found fit for work and after the jobcentre asked his GP not to issue further fit notes for ESA purposes. James Harrison wanted a fit note because he was too ill to attend the jobcentre appointments, but his GP refused to issue them (Metro), this being just one bleak example of the distress and hardship enacted on people through the current callous benefit regime.

The new ESA65B form which is headed ‘Help us support your patient to return to or start work’ has an added paragraph

In the course of any further consultations with [Title] [First name] [Surname] we hope you will also encourage [select] in [select] efforts to return to, or start, work. (extract from the DWP’s letter to GPs)

It is all in keeping with DWP’s insistence that not only work is good for health, but also should be a ‘health outcome’. This recurring mantra from the DWP is based on the thinnest veneer of evidence, a single study, which was commissioned by the DWP itself in 2006, which does not even fully support the generalised conclusion that “work is good for you”.

The DWP has also not taken into account other, more in-depth research that concludes that unemployment is less harmful for mental health than a poor quality and insecure job..

There are many reasons, from a clinical point of view, why this action of co-opting doctors by the DWP is wrong and Dr Jay Watts, Consultant Clinical Psychologist, lists some of them:

Health professionals across the country will be horrified at this latest interference from the DWP – a move that undermines clinical expertise and threatens the safety of patients. There are a number of problems. First the letter places the expertise of DWP-funded ESA assessors above that of GPs. This is despite the fact GPs are more qualified to assess mental health, and can do so with the benefits of having known the patient for years, often decades (as opposed to in a one-off assessment).

The DWP letter makes clear that they wish claimants to return to work at any cost, even if that means leaving a current occupation – an attack on the core identity of patients likely to have a damaging effect on mental health.

Second, the letter states that “we know most people are better off in work”. This ignores a considerable literature showing that work can be damaging for mental health, with poor work environments a frequent trigger to mental breakdown. Economic evidence shows that rushing people back into work increases the likelihood of long-term illness.

How then can it be right to encourage GPs to coerce patients back to work, a pressure likely to increase the feelings of shame, despair and anxiety at not working that have been exacerbated by the governments relentless and damaging campaign to associate worklessness with worthlessness?

Third, the pressure the DWP is exerting on GPs to ‘encourage’ patients back to work, and desist from providing fit notes, is an attack on clinical expertise and the sanctity of the clinical space and clinical decision-making.

Without a firm denouncement of this letter from Royal College of General Practitioners, we risk a situation where claimants will feel unwilling to make appointments with their GPs, given the level of fear the DWP and the work agenda elicits, with damaging and potentially life-threatening effects on the physical and mental health of claimants.

It is vital that health professionals speak up for claimants rights, and insist that fit notes and therapeutic conversations are dictated by the needs of patients not the DWP.

We the undersigned, both medical professionals and disability campaigners ask that the Royal College of General Practitioners inform its members of the risks to patients from this measure, ask doctors and allied health professionals to use caution and discretion when following DWP instructions.

We will be publishing this letter to you on the Disabled People Against Cuts website, and look forward to publishing your response


Dr Jay Watts

Consultant Clinical Psychologist

Anita Bellows

Disabled People Against Cuts

Dr Philippa Whitford


Bob Ellard

Disabled People Against Cuts

Dr Louise Irvine

GP, Lewisham, BMA Council Member

Roger Lewis

Disabled People Against Cuts

Dr Stephen Carty

GP Leith Mount Surgery Edinburgh Medical Adviser Black Triangle Campaign

Denise McKenna

Mental Health Resistance Network and Disabled People Against Cuts

Dr Coral Jones

GP in Hackney

Paula Peters

Mental Health Resistance Network and Disabled People Against Cuts

Anna Livingstone FRCGP

Tower Hamlets GP

Linda Burnip

Disabled People Against Cuts

Ben Newton

Community Worker in Glasgow

Ellen Clifford

Disabled People Against Cuts and Inclusion London

Beatrice Millar

on behalf of Psychotherapists & Counsellors for Social Responsibility

Andy Greene

Disabled People Against Cuts

Julia Evans

Lacanian Psychoanalyst

Miriam Binder

Disabled People Against Cuts

Dr Laura Winter

Counselling Psychologist

John Kelly

Disabled People Against Cuts

Emily Shah

Trainee Clinical Psychologist, Camden and Islington NHS Trust

John McArdle

Black Triangle Campaign

Gavin Robinson


Brian Hilton

Greater Manchester Coalition of Disabled People

Dr Kara Bagnall

Clinical Psychologist

Recovery in the Bin

Lauren Canvin,

Trainee Clinical Psychologist, University of Hertfordshire

Jennifer Jones

DPAC Sheffield

Dr Richard House,

Chartered Psychologist (BPS), Educational Consultant Alliance for Counselling & Psychotherapy

David Cracker

DPAC Sheffield

Andrew Samuels

Professor of Analytical Psychology, University of Essex: Former Chair, UK Council for Psychotherapy

Kevin Deegan

DPAC NORTH Staffordshire East Cheshire

Robert Jenkins

NHS Primary Care Counsellor (Retired)

Henry Foulds

Momentum Sheffield Disability officer

Debbie Porteous

Counsellor MBACP

Jill Goble

Brighton DPAC

Dr David Porteous

GP Fishponds Family Practice, Bristol

Merry Cross

Berkshire DPAC

Denis Postle


Rick Burgess

Manchester DPAC

Paul Atkinson


Dr Johann McGavin

GP Brighton Health and Wellbeing Centre

Dr Danielle Gaynor

Chartered Clinical Psychologist, NHS.

Clare Slaney MA

BACP Accredited

Linda Gask

Emerita Professor of Primary Care Psychiatry University of Manchester and Honorary FRCGP

Stuart Morgan-Ayrs

Clinical psychotherapist

Dr Gillian Proctor

Clinical psychologist and lecturer.

Dr Rich Moth

Registered social worker/SWAN Psychotherapy & Counselling Union

Dr Donna Oxley

Clinical Psychologist, NHS

Frances Taylor,

Therapeutic Counsellor and Supervisor, Diversity Worker, Substance Misuse Counsellor Practitioner

Dr Jade Weston

Clinical Psychologist

Mandy Coghill

Sensorimotor Psychotherapist

Nicola Saunders

Psychoanalytic Psychotherapist UKCP

Ian Parker

Psychoanalyst, Manchester

Sarah Wolfe

Clinical Psychologist in Children’s Social Care

Richard Bagnall-Oakeley

Integrative Adult & Child Psychotherapist (UKCP Reg. MBACP)

Valeska Matziol

Equalities Research Coordinator

Juliet Lyons

Integrative Child Psychotherapist

Annie Mitchell

Clinical and Community Psychologist; Associate Professor, Plymouth University.

Dr Sohrab Panday

GP and Clinical Lead, Mental Health Commissioning Team Hardwick CCG

Mark Burton

Former Head of Disability Service

Richard Byng

GP and academic, Community and Primary Care Research Group and PenCLAHRC, Plymouth University.

Kim Jackson-Blott

Trainee Clinical Psychologist

Anna Rose

MEd MA  (Psychotherapist)

Dr Lealah Hewitt

Clinical Psychologist, NHS

Dr Safi Afghan

Consultant Psychiatrist & Primary Care Lead RCPsych

Liam Farrell

Former NHS GP

Jen Daffin

Clinical psychologist in training / psychologists for social change

Dr Sheila Cheeroth, FRCGP

Tower Hamlets CCG, London.

Libby Kerr

Psychotherapist UKCP

Dr Jackie Applebee GP

Chair of Tower Hamlets Local Medical Committee.

Dr Stephen Weatherhead

Senior Academic and Clinical Tutor HCPC registered Consultant Clinical Psychologist

Dr Kambiz Boomla,

Senior Lecturer General Practice.

Dr Rachel Barcroft

Clinical Psychologist Royal Preston Hospital

Rosalind Davy,

Psychoanalytic Psychotherapist

Dr Grant Ingrams

GP, Oakmeadow Surgery, Leicester

James Randall-James,

Clinical Psychologist

Pauline Miller

GP St Lawrence road surgery

Dr Danny Taggart,

University of Essex

Dr Chris Manning

MRCGP Mental health activist and retired GP with lived experience of major depression(s).

Jeyda Hammad,


Fay Maxted OBE

CEO, The Survivors Trust

Guy Gladstone

Psychotherapist The Open Centre London

Emily Connolly

Trainee Clinical Psychologist

Dr Katherine Macey,

Clinical psychologist working in physical health.

Ron Singer

retired GP and vice president doctors in Unite.

Dr Colm Gallagher,

Clinical Psychologist, Greater Manchester Mental Health NHS Foundation Trust.

Dr David Shiers

former Gp (Leek, North Staffordshire) and Carer of a family member with a severe mental disorder.

Dr Simon Stuart,

Clinical Psychologist in Adult Mental Health

Dr Carolyn Chew-Graham

GP Principal, The Chorlton Family Practice, Manchester and Professor of General Practice Research, Keele University.

Anne Wagner

Clinical Psychologist Locality Lead Psychologist

Dr Lloyd Baron

GPST2 Health Education West Midlands

Dr Alice Jones

(FY1 Psychiatry)


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 Posted by at 11:51

  2 Responses to “Letter to the Royal College of GPs and BMA about DWP interference in GP Practice”

  1. Sounds like “Arbeit Macht Frei”. Outrageous.

  2. The DWP has also not taken into account other, more in-depth research that concludes that unemployment is less harmful for mental health than a poor quality and insecure job.

    Perhaps it hasn’t but I wouldn’t be surprised if the DWP has now made unemployment as harmful or more harmful than a poor quality and insecure job.

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