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GPs: for us or against us?

Pulse, the magazine for GPs, has written that, "GPs warn the system for assessing whether people are too sick to work is becoming increasingly stringent, leaving severely unwell patients without benefits."

In their article they quote from a number of GPs who say variously that, "GPs are not benefits assessors and must never be used as barriers for patients to receive benefits when they are entitled to them, as ultimately, this can have a detrimental impact on their health"; "I've noticed the [Government’s] assessments don’t seem as fair as they used to be. A lot of my patients whom I would expect to be eligible for benefits are told they’re fit for work"; "I usually tell patients the whole set-up is geared to be superficial, to make them fail. But I say, if you persevere, you will most likely win"; and "We need to bring back the benefits system which aimed to help patients while they're sick and we need to use that as the foundation for the assessment."

It is deeply concerning that GPs are having to spend so much time that ought to be being spent treating patients instead addressing the social and financial problems that the governments of the last nine years have caused.

But what really concerns me are the comments underneath the article. It is as though there are two different types of GPs in our country: those who support benefit claimants, and those who think we're predominantly fakers.

These commenters believe that a few genuinely sick people get failed by the system, but that these are massively outweighed by the many who are fakers or exaggerating their incapacity for work.

If this were true, then the Tory approach to welfare would work. Reducing how many people get sickness benefit and reducing the amount of money paid would trigger a mass return-to-work as these allegedly mostly healthy people would go out and obtain at the least part-time work. We've had over ten years of increasingly tough policy based on this premise which is more than enough time to see whether or not it works.

The answer is clear: these people are not well enough to work. A perso's health is the key factor in predicting who does and doesn't move into work. Again and again, studies who follow people who claim sickness benefits show that those who return to work are the ones whose health improves to a good/fairly good level, regardless of whether these people are officially found fit for work or instead leave the benefit of their own accord. In contrast, those who don't see an improvement in health don't move into work, even if they have been told that they are fit for work. Instead such people can experience worsening health as they struggle to comply with the benefits system and insufficient money, or they drop out of the system altogether - off benefits, and completely cut off from any support to live or return to work. This is not a positive outcome for anyone.

Leaving aside for now the psychological distress of being repeatedly rejected for work, if people were well enough to work then 35 hours a week at a computer or visiting businesses to hand out CVs might be boring, mundane, repetitive and inefficacious, but it wouldn't make people sick.

The most thorough and definitive assessment of capacity for work that we have is when people face a panel of three people made up of a judge, a doctor and a disabled person. Their combined legal, medical and lived expertise turns them collectively into a highly qualified, experienced and skilled assessor. If these three can't make reasonably accurate assessments under our current system, it's hard to think who can. Certainly not the very GPs who simultaneously say "I’m not an expert on work place adaptation and different types of work and their physical and mental demand" and "most sick note requests are very questionable" - apparently unaware of the contradiction of claiming to be unable to judge fitness for work, yet simultaneously judging the majority as fit for work.

Anecdotally, I know several people whom I could easily imagine being judged as fit or faking by GPs. These would largely be working class people who don't take condescension quietly and will call out and challenge any dubious or patronising behaviour they are presented with. They expect respect GPs to deserve respect if they are to show it, and a GP who gets on the wrong side would quickly find himself facing a feisty, outspoken person who will not take prejudice lying down.

Having said that, it's not only working class who get condemned by GPs as fakers. I have a middle class upbringing, and presenting as depressed does not get much traction with a GP who thinks you've had a cushy life. Which, bar some bullying including sexual harassment at school, and an underlying and undiagnosed genetic condition that caused fatigue that in turn caused reactive depression, was true. My illness is much worse now because I didn't know that my body wasn't physically capable of the amount of activity most people engage in, let alone the amount I pushed myself to perform.

These anecdotes have indirect support from the data. The other common trope aimed at benefit recipients is that there are generations of worklessness, with doctors and social workers and other professionals professing to know such cases. But when Tracy Shildrick and other researchers went out on behalf of the Joseph Rowntree Foundation to deliberately seek such families, they couldn't find any. The most they could find was a parental generation that was currently work-less due to ill-health, but had worked in the past, combined with a young adult generation who had only recently left education and some of whom had also previously had work. This was despite only looking for ten such families in each of two very deprived areas.

If professionals insist that generational worklessness exists, when research proves it doesn't, how much can we trust doctors who claim that a large body of fake sickness benefit claimants exists, again when research as far as we have it says it doesn't?

In a country where both unemployment and low skilled work are damaging to health, we desperately need our doctors to be for us and for our health.

If you are interested in the claims made in this article, Second Class Citizens discusses these issues in more detail and provides references.

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