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Tuesday, 17 July 2012

GPs performing WCAs - why not?

As far as I can make out, whilst DWP criticises GPs for being too soft (or inappropriately focussed etc. as they would put it), it has not stated categorically that they cannot perform a WCA – they have just not provided them with the wherewithal to follow the “process”.  I do not believe Atos has been granted absolute exclusivity.
Many GPs undertake occupational health assignments in the private sector without any additional training and the BMA actively promotes its members’ expertise in the area.  There can therefore be no question that GPs are adequately qualified.
So, as long as he follows the DWP format and produces an ESA85, why can’t my GP perform my WCA in the somewhat more relaxing environment at his own surgery?  One (minor) issue is that he does not have ready access to the LiMA computer system, but nor does an Atos HCP undertaking a home assessment, so there must be an easy answer to this problem if a system link is not possible.
I'll post the answer when I get it.

3 comments:

Anonymous said...

Doesn’t your question presuppose that the WCA is a valid test and that the main problem with it is the way it is being carried out by Atos HCPs?

I suspect that many GPs wouldn’t want to perform WCAs as they don’t believe the descriptors represent a fair and accurate assessment of work capability. My own GP is certainly bright enough to realise that just because someone doesn’t fit into DWP’s ridiculous boxes, it doesn’t mean that they are fit for work.

By the way, even Atos HCPs admit that some severely ill or disabled claimants (who are clearly not fit for work) fail to meet the ESA threshold because they don’t fit into the descriptors. (See DWP Research Report 719, pages 26-28.
http://research.dwp.gov.uk/asd/asd5/rports2009-2010/rrep719.pdf)

Polio Baby said...

While agreeing that GP's might not wish to actually do the WCA's, the BMA & GMC recognise that it is seriously flawed.
If they were both included in the LIMA system they could improve it.
It is obvious that the previous Government wanted it implemented and that this Government are loathed to admit it's not working, it could be improved. It is after all a computer programme, these by design can be added to and improved, more 'drop down menu's ' is just one example which could better 'encompass' some of the complexeties disabled people encounter every day. This is by no means a solution.
Looks like the plan is to roll this system out for DLA/PIP/UC

Tia Junior said...

Anon, it is not meant to – just being pragmatic, by looking for ways of making the best of a bad job in the short term, wrestle the initiative away from DWP and improve the accuracy of assessments.

They have constructed the process from the top down, not the bottom up as they would have us believe – it is all designed to achieve the desired end result driven by political dogma. As it lacks compassion & humanity, this result could not be achieved though the obvious, traditional route as it requires a fundamental change in attitude to risk that that contravenes the Hippocratic Oath.

Judging work capability will never be an exact science. GP’s rightly would not gamble with a patient’s health and would therefore err on the safe side. DWP however has no such qualms and indeed is prepared to risk the odd “mishap” – the end justifies the means and some collateral damage along the way is the price you have to pay – “tough love” is the latest cliché bandied around. They even insist that even having countermanded my GP’s opinion, they do not assume any of his responsibilities! They have very cleverly constructed and implemented a framework and process that appear to have solid scientific foundations but do not and can be deconstructed piece by piece – this would be part of that process.

Gaining an acceptance that there is no truly legitimate reason why a GP cannot perform a WCA to the standards required by DWP would be a step in the right direction.

This is not to say that in parallel we should not be doing the same with the content of the WCA. I feel it would be very hard for DWP to reject a properly constructed assessment performed by a GP that concludes that their patient is not FFW.

There is nothing wrong in principle with an assessment orientated specifically to work capability, but the current WCA misses the mark in several respects.

Firstly, what employers need from the workforce more than anything else is reliability – turning up at the same time every day and getting through a predictable amount of work and these are just the commitments many sick/disabled people find hardest to make and where the current WCA falls most woefully short.

Secondly, it is logically impossible to perform a test effectively for something that is not defined – what the hell is “some form of work” – if it is so obvious what it means and we all agree what it means, why can’t DWP explain it better, if only in terms of “minimum” characteristics? This is a complete cop out on their part and allows them to move the bar to wherever they like whenever they like depending on the proportions falling either side of it.

Thirdly, ‘occupational health’ has been over-hyped as a radically new branch of medicine, when it is no more than a slightly different emphasis on traditional considerations. This is all part of the overall strategy to de-skill the assessment and privatise the activity, which would be far harder if it revolved around better qualified medical professionals. DWP insists that clinical and diagnostic expertise is unnecessary, which is wrong but necessary to underpin what they have done.

As a slight aside, I don’t think there is anything wrong per se with Lima. There needs to be a computerised logging system for all sorts of good reasons - it is the emphasis placed on the diagnostic algorithm that is the problem. Again, less qualified HCPs will rely more heavily on it, so it all snugly fits together . . . .