Healthwatch England
Skipton House
80 London Road
SE1 6LH
Re: GP charges for patient benefit appeals letters
During 2014 Healthwatch Dorset received feedback from local people raising concerns about GP responses to patients’ requests for additional supporting medical evidence for benefit appeals, especially in regards to charges and consistency. To ascertain if these issues were widespread across the county we requested (under the Freedom Of Information Act) the following information from all GP practices across Dorset, Poole and Bournemouth:
“…We would like to know how your practice is responding to requests from patients for additional supporting medical evidence where they are appealing their benefits allocation with the Department of Work & Pensions (please note – we are interested in your approach to patients’ requests rather than to formal DWP requests).
We are receiving more comments from people across Dorset about issues surrounding benefits assessment processes and appeals and your response to our request will help inform our research.
1. Does your practice supply letters of support for patients who wish to appeal removal or adjustment of benefits (such as Employment Support Allowance) or to confirm care needs?
2. Has your practice in regard to these requests changed in the last 3 years? If so, in what way?
3. If your practice does respond to such requests, do you make a charge? If so, what is it?
4. Does every GP in your practice treat such requests in the same way?
Any further comments you wish to make on how this issue affects your Practice would also be gratefully received”.
We received 89 responses (an 88% return) and the results were used to inform the national Citizens Advice Social Policy Campaign “Fit for Work”.
We also met, together with colleagues from Citizens Advice in Dorset, with local representatives of the DWP and, separately, with our Local Medical Committee.
Our understanding is that the provision of such letters by GPs does not fall within the requirements of the GMS contract and is down to local determination. Our findings show that not only does this result in a lack of consistency among GP practices in Dorset but even among different doctors in the same practice.
We remain concerned that some people who are already suffering because of sickness or disability are being put under even greater strain by being asked for money to help lodge an appeal (money which they may not have), and that there is a wide variation in the scale of such charges.
Whilst we have investigated and highlighted this problem locally, our conclusion is that it is a systemic problem and can only be solved on a system-wide basis. That is why we are sharing our concerns with Healthwatch England, in the hope that we may be adding to intelligence and evidence already gathered by other local Healthwatch and that thereby Healthwatch England may be able to influence appropriate change. We have included the results from our own work below, which we hope will help to inform any further work that you may carry out on this issue.
With kind regards.
Martyn Webster
Manager
FOI Results:
1. Does your practice supply letters of support for patients who wish to appeal removal or adjustment of benefits (such as Employment Support Allowance) or to confirm care needs?
Yes / 65No / 22
Sometimes / 2
Locations of practices that DO NOT provide information:
Location / Number of PracticesPoole / 6
Bournemouth / 3
Wimborne / 3
Christchurch / 2
West Moors / 1
Verwood / 1
Sherborne / 1
Weymouth / 1
Ferndown / 1
Dorchester / 1
Blandford / 1
Lyme Regis / 1
2. Has your practice in regard to these requests changed in the last 3 years? If so, in what way?
Only 5 practices said “Yes” their procedure had changed – reasons:
3 practices had started to charge because of the increase in requests
1 practice had stopped providing the information after receiving the LMC guidance
1 practice now provides letters on patient request rather than waiting for requests from the DWP. GPs have even phoned ATOS whilst the patient is in the surgery.
3. If your practice does respond to such requests, do you make a charge? If so, what is it?
Yes, a charge is made / 30Maybe (depending on amount of work required) / 7
Charges ranged from £8 to £40 – many practices advised the charge is dependent on the amount of work required.
Locations of practices that DO make a charge:
Location / Number of PracticesBournemouth / 13
Poole / 6
Christchurch / 3
Shaftesbury / 1
Bridport / 1
Weymouth / 1
Portesham / 1
Maiden Newton / 1
Wareham / 1
Dorchester / 1
Blandford / 1
4. Does every GP in your practice treat such requests in the same way?
Only 5 practices advised that GPs DO NOT follow a consistent policy. All 5 stated the same reason “GPs are under no obligation to provide this information so the decision to charge, and the amount of the charge, is at individual GP discretion and based on a case by case basis”.
Additional comments received:
“Charge depends on the nature of the request. We try to be compassionate but we have limited resources” (Bournemouth area)
“Patients would suffer if we didn't provide the information.” (Christchurch area)
“We feel the DWP should contact us for more information not the patient. These requests put pressure on GP time.” (West Dorset area)
“We don't get many requests so this is not an issue for us”. (Mid Dorset area)
“We have a CAB advisor attends the practice once a week for consultations with patients. We find CAB input very useful (with patient consent) when responding to these requests”. (Dorchester area)
“Charges are discretionary but none of our GPs can remember an occasion where they have charged” (Blandford area)
“We feel patients would suffer if we did not provide support”. (Christchurch area)
“Usually these patients are the ones under the most financial pressure and we do not feel comfortable charging them”. (Bournemouth area)
“We don’t usually charge but it is possible we may do so if the request was deemed to be extraordinary in some way”. (Poole area)
“LMC advice is the patient should contact DWP and DWP should request the information. We have seen an increase in requests which are often "excessive or unnecessary" thus putting pressure on the practice”. (Blandford area)
“GPs are already overloaded with extra work and don’t have time for more reports. We request agencies to write to us directly and they are charged not the patient who is already struggling. We look at every case individually but usually follow LMC guidance”. (Poole area)
“For a simple letter we do not charge. For a report we charge a fee, assessed on case by case basis. We charge where we feel there is justification”. (Bournemouth area)
“No charge for 2 letters in line with our policy to waive fees in some exceptional circumstances”. (West Dorset area)
“We do a letter on patient request rather than wait for a DWP request. GPs have even phoned ATOS whilst with patient where necessary”. (Dorchester area)
“The LMC provided us with a letter for GPs to give to patients stating requests are unnecessary and inappropriate. If we did letters we would charge and the charge would depend on content. We have a uniform approach but there may be special exceptions”. (Bournemouth area)
“We are getting more requests. We make a charge if the request is deemed unreasonable”. (Dorchester area)
“We make no charge for short letters. If DWP requests more information we ask them to request formally and we charge accordingly”. (Weymouth area)
“GPs can choose to charge as this work is not in their contract. No charge is made as long as the patient goes through official lines and completes the appropriate forms”. (Bournemouth area)
“If a patient informs us verbally that they are appealing any decision and if the DWP needs further information we ask the patient to go back to the DWP and ask them to send us a formal request for further information. It would not be appropriate for us to make decisions on what the DWP may or may not require as further evidence”. (Mid Dorset area)
Freepost RTJR-RHUJ-XBLH, Healthwatch Dorset, 896 Christchurch Road, Bournemouth BH7 6DL