COMMONS

Committee publishes doctors’ views on “Fit Notes” and ESA appeals

29 April 2019

Following a series of distressing media reports about people dying as they await the result of the PIP and ESA assessments, the Committee is publishing the Royal College of GPs’ and the British Medical Association’s views on DWP’s advice to doctors on “Fit Notes” for people awaiting the outcome of an ESA appeal.

The Committee asked both (PDF PDF 163 KB) organisations (PDF PDF 163 KB) for their input, following DWP’s repeated claims that they had approved the advice, given in a letter (a form, ESA65B) to the GPs of people who have been denied ESA after assessment: PIP and ESA Assessments.

The Committee has described the assessment processes for disability/incapacity benefits as “gruelling” and “error-ridden”, potentially forcing claimants into DWP’s “arduous, protracted” reconsideration and appeals process. People who have been denied ESA at the assessment stage, but who are awaiting the results of their appeal are entitled to an “assessment rate” of ESA, in recognition of the hardship they may endure during the potentially lengthy wait for their appeal. However, in recent months the Committee has been investigating concerns (PDF PDF 1.41 MB) that the advice DWP is giving to doctors about the system and process is causing confusion, leading directly to claimants being left without essential income they are entitled to.

Comments from RCGP and BMA

The Department has asserted in response to the Committee (PDF PDF 219 KB)that Agreement on the final wording of the revised ESA65B was obtained via the regular meetings DWP holds” with both the British Medical Association and Royal College of GPs”, (PDF PDF 84 KB) and that the wording is the outcome of “close and extensive working between DWP, BMA and RCGP.” (PDF PDF 165 KB)

Both medical professionals’ associations’ have now written to the Committee - and in the case of the RCGP, directly to the Secretary of State (PDF PDF 199 KB) – expressing their concerns about both DWP’s advice to GPs and its characterisation of their approval or endorsement. The RCGPs said:

"Without a fit note from their GP, claimants who are awaiting the outcome of their appeal will not be able to receive ESA. They would therefore have to seek Universal Credit or Jobseekers Allowance, and subsequently try and meet the work-seeking requirements of those benefits, potentially endangering their health in the process. As such the College is deeply concerned about the potential impact of this on doctors and their relationships with potentially vulnerable patients."

As the BMA describes in its response to the Committee (PDF PDF 164 KB):  

“By way of background the BMA attends meetings with the RCGP and the DWP where information is shared with the aim of improving working practices between the DWP and clinicians. While the BMA may act in an advisory capacity it does not have the authority to clear, approve or otherwise sign off any DWP correspondence or policies and would see this as being clearly outside of our remit...At a meeting with the DWP and RCGP a BMA representative was given sight of the ESA65B amended letter. The BMA considers that sight of this letter was for the purposes of information sharing and did not agree or otherwise sign off the content of the letter.”

The Royal College of GPs put the same point to the Committee (PDF PDF 197 KB):

“We are aware that the Department claims that ‘The British Medical Association and the Royal College of General Practitioners agreed to the revised wording of the ESA65B on 4 August 2016’. However, there is some ambiguity about what was said in the referenced meeting with the DWP. Since the DWP did not keep any written records of what was said at this meeting [as DWP admits in its latest letter to the Committee (PDF PDF 165 KB)], we are unable to provide further clarity.”

The RCGP continues:

“Since these changes were made, significant evidence has come to light about the negative impact that these changes have had in relation to patient care, leading to some patients being denied fit notes by their doctors. We are concerned that the current wording of ESA65B does not sufficiently clearly indicate that there are circumstances in which GPs may need to continue to issue fit notes for their patients. It is essential that communication with GPs is as clear as possible, to uphold the high levels of trust that exist between GPs and their patients. As a minimum we would want to see the wording of the ESA65B letter urgently changed to its previous wording.”  

Further information

Image: PA

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