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Sunday, 30 October 2011

WCA - an alternative, very obvious approach.

I am not a social scientist, but the current “model” is designed along adversarial lines based on an assumption of dishonesty and mistrust which not surprisingly generates conflict – it talks about evidence, appeals etc.  Play around with semantics as much as you like, but a WCA is essentially a health assessment so where better to undertake it than within the NHS, whose role in society is given away by the “H”.  On average, a GP surgery would have to cope with no more than a few a week, less once in steady-state.
Think of the benefits.  I am in familiar and safe surroundings with good disabled access.  I am seeing people I know and who know me and my history.  I know they have my welfare at heart and I trust their judgement to be in my best interests even though I might not always like what they say.  They have my records on hand for reference if needed, so I don’t have to mess around getting copies of notes, letters, prescriptions, X-rays etc. to “prove” what I’m doing.  There are other experts around who could be called in for a second opinion if needed.  I know they are all suitably qualified and do this day in day out, so they know what they are talking about.  At least when I walk out of here, I will know exactly where I stand and what will happen next because I’ve agreed to it – I won’t have to wait a month to find out.  If something changes, I can always drop in for a chat and an update.  I am using resources already in place and with pretty much a fixed cost, so I’m not costing anyone a lot even if I have to come back a couple of times.
This is much better than the old rigmarole . . . . . . . . . . people I don’t know, don’t trust, have doubtful motives and conflicting interests; appeals, tribunals, months of waiting, indecision, uncertainty, stress . . . . . . .
And as far as I can see, the only barriers are:
·         A belief (partly justified) that GPs are too soft.  So re-train and re-educate them.  If you can trust them with £bn of NHS budgets, why not with this?  Also, for people working, we are quite happy for a GP to provide “fit-notes” for an employer to manage absence, so we presumably trust their integrity and professionalism, so why not in this area.
·         If we need a different breed of GP in the future to cope with all these changes, adapt the degree courses etc. now.  If you never start, you will never finish.
·         The lobbying power of the BMA, who will probably resist based on a spurious argument about breach of trust – for heaven’s sake, they are not priests!  GPs are very well paid and the occasional small upset in their daily routine will not do any harm.
·         DWP protectionism – deciding on benefits is our job.  You have created the non-job of decision maker because you have outsourced the assessment, but surely you can trust your NHS colleagues.
·         The inherent (spurious) attraction of outsourcing – someone else to blame.  You can outsource a service, but you cannot outsource accountability and the PM continually needs to remind his direct reports of this simple fact.
·         In the short term, the contract with Atos and the exit costs, whether early or on natural expiry.
·         Political dogma.

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