Welfare reforms increasing GP workload, harming patients, finds investigation

Two thirds believe patients' health is being harmed by benefit cuts, while many feel their professional opinion is regularly disregarded by those assessing people's ability to work.

The investigation also reveals how employment advisers and welfare rights officers are an increasingly vital part of general practice during the austerity period.

Since 2010 the UK government has introduced a raft of reforms to the welfare system in a bid to reduce the deficit. But what have these meant for GPs' workload and patients' health and wellbeing?

A total of 1,056 GPs across the UK completed the survey out of 28,602 who were contacted. The findings suggest that people receiving welfare support due to illness or disability are struggling to cope with cuts to their benefits and are turning to their GP practices for help.

Most doctors say they are seeing an increase in patients with non-medical problems, such as debt, unemployment and housing issues, and many believe this is affecting patients' health, particularly those with mental health problems.

They are also being asked more frequently to provide medical information for their patients' Work Capacity Assessments (WCAs) -- and to help an increasing number appeal against the removal of their benefits under the new system.

Key findings include:

• 94% of GPs say their workload has increased in the past year because of financial hardship among their patients
• Doctors working in deprived inner city areas are most severely affected
• More than half of GPs (57%) say they have filled in more WCAs for their patients in the past 12 months than in the previous year
• More than two-thirds (68%) of GPs say they have seen evidence that their patients' health was being harmed by reduction to their benefits
• 68% also say the new under-occupancy penalty or "bedroom tax" has increased their workload to some degree
• Many GPs feel their professional opinion is too often disregarded by assessors sticking to a crude scoring system

Alongside the survey, The BMJ conducted a series of interviews with doctors, staff and patients at three GP practices.

Jonathan Gore, GP partner at the Lawson Practice in Hackney says the reforms have generated more work for the practice and diverted GPs' attention away from other areas, while Paul Driscoll, GP partner at Haven Health in Felixstowe is critical of the way WCAs are being carried out and is unhappy that the information GPs provide is often ignored.

John Canning, GP at the Endeavour Practice in Middlesbrough, believes older people in manual jobs may feel pressured to work beyond their physical capabilities and says GPs are in a difficult position when patients ask them to support their appeals against benefit reductions.

All three practices are increasingly referring patients to employment advisers and welfare rights officers to help with financial problems.

Hackney WellFamily Service runs a weekly session at the Lawson Practice for patients who have fallen into financial difficulty because of changes to the welfare system, while Felixstowe Citizens Advice Bureau holds weekly sessions at Haven Health to help patients with debt, employment and housing issues.

The Endeavour Practice employs a welfare rights adviser and an employment adviser to help patients with non-medical issues.