Can GPs provide a letter supporting a patients’ application for a bus pass, blue badge, housing, or other application?
These are common requests from patients of their GP. Some council websites and advice lines appear to ask applicants to seek a written letter from their GP in support of their application. However, this is not something GPs are required to do, nor should they be expected to do. If they do undertake the work, they may charge for the service.
The reasons for this are as follows:
- Bus passes, blue badges, council-provided housing, and other council-provided aid, are important ways the government can support those in need. However, asking a GP to pass judgement on whether someone is eligible for this state support or not is asking GP to make a judgement that may negatively affect someone (for example, if the GP feels they should not have what they are applying for). It also asks GPs to choose between patients (‘I think Ms X can have one, but Mr Y cannot’). GPs are advocates for all patients and should be completely unbiased and independent of these decisions. Putting a GP in a position where they have to decide for their patients, or choose between patients, compromises the doctor-patient relationship.
- GPs are usually not formally trained to make what can sometimes be very technical assessments, and they may not have the detailed knowledge of what is being applied for to pass meaningful judgement.
- GPs are not funded to write letters to support, or process forms for these applications. Unfortunately, using GP appointments and any subsequent administration time for these tasks takes away from the practice’s ability to deliver their contracted services in what is an extremely challenging time for General Practice.
Cambs LMC has devised some example guidance pages, posters and template letters that GP Practices might find helpful in respect of blue badge applications, DWP appeals and Social Housing (see below)
How can an applicant provide the local authority with the medical information they need to help them make a decision?
A patient can always gather supporting material for their application, such as clinic letters and lists of medical conditions and medicines. These are now available to all patients online without needing to contact their GP directly. The following NHS Website gives advice on how to do this. For example, GP Practices support the use of the NHS App to allow people to access their records from their mobile phone (other apps available), and you can even prove your identity from home. Practice administrators are able to support patients in accessing their notes where online access is not possible. But there should be no need to involve the GP in this process.
As long as the GP is not being asked to give an opinion on eligibility for an applicant, their knowledge of the patient and their context can be helpful for the independent assessors of the applicant’s needs; sometimes GPs letters can be helpful. The Blue badge guidance (below), for example, also acknowledges this.
Such letters, or any relevant forms requiring GP signature, however, do take GP and administration time and GPs are not commissioned by the NHS to provide these. The GP practice may therefore charge a fee for that service (an amount which is at the discretion of the practice). A GP practice may instead choose to decline a request – for example, for any of the reasons listed above. They are allowed to do this.
A list of forms that GPs are required to provide as part of their everyday care for patients, without charging a fee, can be found below:
General Medical Services Contract Regulations (2015), Schedule 2
The Department for Transport Blue Badge scheme local authority guidance (England) explains the process by which Blue Badge decisions are made. It makes it clear that eligibility decisions should be independent [which the GP cannot be assumed to be] to ensure fairness and equality. For example, regarding expert assessors for eligibility, the guidance states:
4.37 The role defined in regulation 2(1) of the Blue Badge scheme regulations [footnote 16] confirms that an expert assessor needs to be someone who is recognised by the local authority to which the application for a disabled person’s badge:
- is recognised as having a professional qualification recognised in the United Kingdom which enables them to diagnose, treat, or provide specialised therapeutic services to people with the same, or a similar, disability to that of the applicant; and
- is recognised as having the necessary expertise to assess the presence, in the applicant, of any of the effects listed at paragraph 4.26, resulting from their disability on their capacity to walk during the course of a journey
- is not employed or engaged by any person as a General Practitioner (GP) for the provision of medical services to the applicant
- is not, in the opinion of the local authority, precluded by reason of their relationship with the applicant from providing an impartial assessment of whether or not the applicant meets the prescribed criteria at paragraph 4.26
A list of circumstances under which a GP may charge for an activity (such as letter writing or form processing) can be found below:
GMS Contract Regulations (2015), Part 5, Regulation 25.
Blue Badge Scheme Local Authority Guidance (England)
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