FUNDAMENTOS DEL DE FLUJO

Views on the pilot arrangements sometimes changed during the research interviews. During their interview some people gained apparently new information about the purpose of the pilot and the way that medical evidence was dealt with in determining benefit claims, and some misunderstandings were cleared up. Such new information influenced the reflections of the GPs and administrative staff on their experience of the pilot arrangements. One GP discovered during the research interview that, contrary to his initial expectations and preferences, actual records were leaving the practice. Overall views on the new arrangements also depended on what people felt about the usual process of completion of the IB113 form. This section thus starts with a summary of GPs’ views on dealing with IB113 forms.

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2.3.1

GPs’ views on the IB113 form

The IB113 asks the GP to provide factual information to the DWP medical officer (approved doctor) on the named incapacity benefit claimant. Payment for this work is included in GPs’ overall NHS remuneration.

The general view among participating and non-participating GPs was that currently there were problems in seeking medical evidence to determine IB claims using the IB113. Filling in the form could be time-consuming. Generally, GPs said the forms took about 15 minutes; those who said they liked to do this work ‘properly’ said it could take 30 minutes to look at the records, decide what to write and fill in the form. Keeping abreast of the IB113 work sometimes meant taking the forms home to deal with in private time. One way of saving time was for nursing or administrative staff to fill in parts of the IB113 from patients’ records. No GP interviewed said that they sometimes did not return the IB113 forms, but some with strong negative views about this work said they spent as little time on it as possible, and this could be just a few minutes for each form.

A view often expressed was that some of the questions asked on the IB113 were hard to answer, such as ‘effects of the medical conditions on daily living’. GPs were irritated to be asked for information which they did not know. Some were concerned, however, that patients might be penalised by their answering ‘don’t know’ or leaving blank spaces. Care was needed in providing answers on the IB113 in case the patient went to appeal and challenged what the GP had written. One way of dealing with this was to discuss with the patient how to fill in the form, but this was unusual and created even more work.

On the other hand, GPs who did know something about the patient’s daily activities felt they were not always objective, because they tended naturally to act as ‘advocates’ for their patients. It could be hard both to be fair to their patient and meet their responsibilities to the state. Some said that personal views inevitably crept in, such that an IB113 completed for a patient thought to be a ‘genuine case’ was likely to contain information phrased in ways that might support the claim. On the other hand, when a patient was thought better able to do some work, the IB113 form was likely to contain only essential factual information set out succinctly. Some GPs saw the opportunity to influence the benefit decision as a result of what they wrote on the IB113 form as an advantage.

Some GPs felt their involvement in benefit decisions, by providing medical evidence on forms such as IB113, affected relationships with some patients who were angry when their claim for benefit was disallowed.

Different views among GPs on a number of the above issues contributed to a wide range of attitudes towards their provision of medical information on the IB113 forms. At one end of the spectrum were GPs who saw their work on benefit forms as part of their commitment to their patients and tried to be fair and accurate, sometimes despite insufficient time or irritation with the questions. At the other end were GPs who felt that they were not the appropriate people to ask for the information required, said they did not prioritise this work and sometimes did not take it very seriously.

2.3.2

Advantages and disadvantages of using GP records

Drawing on both their own experience and the discussion during the research interviews, GPs and practice staff who had taken part in the pilot weighed up the advantages and disadvantages. The GP records were generally felt to provide fuller, more comprehensive information. This was likely to serve patients’ interests better and lead to fairer decisions about benefits. In turn, the GP saved some time to spend on work which some felt more appropriate. A further advantage was that the new arrangements increased the distance between the GP and decisions made about entitlement, and thus reduced some potential for problems developing in the relationships with patients.

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Disadvantages perceived by some practices sending photocopied material were that this created considerable additional administrative work, with insufficient remuneration under current arrangements.

There remained some concerns about releasing to third parties some kinds of sensitive information which was recorded in some patients’ notes, for example information about social or marital problems, and convictions. This was linked to continuing concern about the level of patient understanding about material in full GP records and whether patients really understood what they were agreeing to. There was also continuing concern among both participant and non-participant GPs about the low quality of some GP case notes and records, especially from locums. Some hand written consultation notes were believed to be generally illegible.

As we might expect, non-participating GPs tended to continue to emphasise their concerns and the disadvantages they perceived. By the end of the research interview there was sometimes a reduction in concerns initially reported about issues to do with collection and return, as a result of greater understanding of options for transferring information. A request for records for the last two years might have led one non-participant GP to consider taking part more favourably, because recent records and notes were computerised. Other GPs, however, both participant and non-participant, felt a two-year period for assessment would be insufficient. They said that some conditions had long histories and this had a bearing on capacity for work.

When GPs, maintaining strong negative views about the pilot arrangements, were asked whether anything might change their mind, suggestions made included:

• evidence of better benefit decisions, at realistic cost for the Exchequer; • evidence that patients wanted the new arrangements;

• specific written consent from patients (comparable to those prepared by solicitors);

• reduction of length of the period for which records were required to two years (thus enabling wholly electronic transfer procedure).