Liz Curran and Emma Bates ask whether GP medical letters are a hindrance or a pathway out of inequality.
Doctors are a caring profession; therefore, there is no way they can realise the impact of charging the poorest for GP reports.
The charge of between £60 and £175 for a critical report can be 15% to 43.75% of a person’s monthly universal credit payment. For people experiencing deprivation, poverty and with complex health needs or disabilities, these GP reports are critical for enabling assessments against a backdrop of authorities which are incentivised to save money.
These authorities are limiting access to benefits, housing decisions, social care assessments and aids and adaptations, for example, special educational needs for children and a ramp for people to leave their home.
Healthcare Today is rightly committed to spotting clinical risks before they escalate, safeguarding patients and advancing care. All too often, patients are unable to afford these critical GP reports and as a result are pushed into poorer health, stress and isolation. We witness first-hand at Central England Law Centre (CELC) patients stuck in unsuitable accommodation faced with choices like not putting the heating on, buying cheaper and poor nutritional food, while experiencing increasing levels of stress and anxiety contributing to even poorer health outcomes. But when justice and health work side by side and share their expertise, they can improve social determinants of health outcomes.
Think twice
Recently, a CELC client had been newly diagnosed with dementia, with deteriorating eyesight. CELC successfully supported the client to claim a personal independence payment; however, the client did not qualify for the mobility element. He was advised he would need a disabled person’s bus pass. As part of the support process, Transport for West Midlands wanted evidence of his medical condition from a qualified medical expert. The client’s GP required the client to pay £60 for the letter, and without this letter, the client would have been isolated from family and support networks.
We urge all doctors to think twice before charging the poorest of patients. This practice drives inequality and is counterproductive. Research is so clear about the morbidity outcomes for the poor and people with disabilities, the elderly and those with mental health issues. The solution here is for GPs to decide not to charge those with limited incomes for such a report, as is the case with domestic abuse cases, given the significant impost on the poor.
Particularly pertinent is evidence for those wanting to access improved housing. As well as not charging the poorest for such reports, the following advice might assist GPs in ensuring their reports are fir for purpose for the authorities: The letter’s information must be specific and exact. Only include the relevant diagnosis or condition; how the housing/disability/ poor health situation is affecting the patient (for example, damp worsening asthma, stairs affecting mobility, overcrowding, impacting mental health).
Next, state any risks if the housing situation remains unchanged. Clearly detail specific needs, for example, a clear explanation of what type of housing or adaptation will assist the patient (for example, ground-floor property, step-free access, extra bedroom for their carer, proximity to medical facilities).
Finally, summarise with a professional medical opinion as the patient’s GP, that housing or any other specified change is necessary for the patient’s health and wellbeing. This will make time spent on the letter worthwhile, as this advice incorporates the criteria that a decision-maker must consider.
Improving outcomes
As a law centre with six health justice partnerships, CELC sees how, with justice interventions, people’s life outcomes can be improved. Justice is a health intervention. If health and justice can work together, each bringing their disciplinary expertise and perspective, we can only improve patient outcomes.
An example of this has been the honing of housing regulations by health and justice coming together to improve living conditions caused by asthma in social housing. This has reduced multiple hospitalisations of babies and family members in accident and emergency wards in Australia, Canada and the US and makes sense in early intervention and downstream saving at the acute end.
There is so much power in combined efforts that we, as justice and health partners, can make. These sorts of collaborations can bring about reductions in inequality and improve conditions for a good life.
Liz Curran is associate professor at Nottingham Law School. She has recently been appointed as academic health justice partnership advisor (pro bono) for Central England Law Centre. Emma Bates is the director of positive action on poverty and partnerships at Central England Law Centre (CELC).
