Disability assessment for benefit claims and UK GPs’ conflict of interest By DR BASHIR QURESHI FRCGP, FRCPCH, FFSRH-RCOG, AFOM-RCP POLITICS, ECONOMICS AND LAW are as important in patient care as medicine. It is my experience that some academics believe that health professionals should not consider the above three disciplines. Some may recognise law but might consider that politics, economics and religion are taboos. In fact, politics is a science dealing objectively with realities. Disability assessment, management and financial support need input from all four disciplines – politics, economics, law and medicine.
What is the issue in disability assessment? It has been recognised by the British Government that the financial cost of care for disabled people and social welfare benefits is very high. It needs to be trimmed down fairly and gently. There are genuinely disabled people, fake disabled people and many grades in between. Similarly, there are legal and illegal immigrants. Some industrial employers employ independent occupational physicians, who examine the employees for fitness for appropriate work. These occupational physicians may not have any conflict of interest as they are employed as doctors. As their fees and salaries are high, they may not be employed by Social Security and Disability Assessment Authorities. In good faith, they take a cheaper and easier option. They ask the patients to go to their own GPs for assessment of disability, sickness, driving, housing, child abuse and a host of other physical, psychological and social conditions. Does every GP who examines to assess his/her patients for disability have a conflict of interest? This is a fundamental question which requires evaluation.
Why every GP has a conflict of Interest? Principal GPs, who run General Medical Services (GMS), are self employed doctors. For this reason their contracts of service are cheaper for the NHS than if they were employed directly by them. Salaried or Locum GPs are employed by these GP Principals or by the Primary Care Trusts. Every Principal GP’s income depends upon how many patients there are on his or her list. Some GPs earn more, some would earn less. In my opinion, every Principal GP is likely to face a dilemma of conflict of interest because: • Every GP is required by law to be efficient, factual, truthful and impartial in writing a report or a certificate – as if he/she were a Loco Magistrate. • Every GP is advised by the General Medical Council and Royal College of General Practitioners to provide the highest quality of care and support to each patient in every way. Indeed, GPs in the UK try their best to do just that. • Every GP’s fee is paid by the patient or the requesting authority or the NHS. • A GP is usually obliged to give or disclose the report to the patient. Computer records make access to a disability assessment report easy. Only in exceptional cases, such as crime, would the report be hidden from the patient. • If the report is in favour of the patient, he or she would stay on that GP’s list. However, if the report is against the patient, who would lose benefits, the patient would be angry with the doctor. He or she may leave the GP’s practice. In Asian, black and catholic communities the family bond is strong and the whole family may leave that GP’s practice. Such a GP has no one to turn to in order to compensate for a big financial loss. There is no government resource or insurance available. Just imagine the financial loss and shock.
How every medical expert also has a conflict of interest? As an expert witness in medical issues such as disability a medical expert also has not only a financial and moral conflict but also a legal conflict of interest. Every practising doctor, GP or non GP, has been taught by their educational and regulatory bodies that their duty is only to their patient. However, Civil Procedure Rule Part 35.3 requires that every expert’s overriding duty is to the Court. It clearly states that it is the duty of an expert to help the court on the matters within his or her expertise. This duty overrides any obligation to the person from whom he has received instructions or by whom he is paid. These conflicts of interest are complex and need to be understood and resolved.
How can there be a fair play? Politics is a science dealing with realities. Indeed, both patients and doctors are important in medicine and politics. The concept of a ‘Fair Society’ can only be successful if politicians and parliament protect all disabled persons and provide for their care, welfare and financial needs. We can only solve problems if we can talk about them calmly. Therefore, I propose we talk about this issue and reach a fair deal. Parliament could consider ways of removing the conflicts of interest of GPs who may have to assess their patients with disabilities. These measures may include: • GPs being asked for a medical records summary related to the disability and being appropriately paid for it with no loss of income to them. • Disability assessments should possibly be carried out by newly created Salaried Disability Physicians, similar to Occupational Physicians, who assess fitness for occupations. Disabled people may or may not have occupations. Moreover, there should be some mechanism for appeals as fair play is essential. • These independent Salaried Disability Physicians may be based in local Polyclinics, Day Centres or Health Centres which have recently been established in many localities. • In the meantime, if a GP loses a family from his/her list because of an accurate assessment there should be some payment to compensate for the financial loss. Everything changes with time. The National Health Service, national or local finances and politics are changing. Parliament has passed a new bill about benefits for eligible people and litigation about benefits is likely to increase. These days, it is appropriate to revisit the disability assessment issues in House of Commons committees and in Local Council Working Parties. q • Dr Qureshi is an expert witness in cultural, religious and ethnic issues in litigation and also in GP clinical negligence. He is also the author of ‘Transcultural Medicine’ and can be contacted via email at drbashirqureshi@hotmail.com. www.yourexpertwitness.co.uk
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