11/23/22, 8:35 PM Doc­tors’ warn­ing: poverty for­cing sick people to keep going to work

Doc­tors’ warn­ing: poverty for­cing sick people to keep

going to work
Fears cost of liv­ing impact is leav­ing GPs’ sur­ger­ies stretched

The Guardian · 23 Nov 2022 · 1 · Denis Camp­bell Health policy editor

Patients are refus­ing sick notes from their GP because they can­not afford time
off work, while phys­i­cians suf­fer “moral dis­tress” at their inab­il­ity to do more
to help the most vul­ner­able, the new leader of Bri­tain’s fam­ily doc­tors has
revealed.

More patients are exper­i­en­cing asthma attacks or other ser­i­ous breath­ing

prob­lems because they can­not afford to heat their homes, said Dr Kam­ila
Hawthorne, the head of the Royal Col­lege of GPs, while many have repor­ted
deteri­or­at­ing men­tal health due to fin­an­cial stress.
Soar­ing food costs are also lead­ing to a rise in fatigue, mouth ulcers and weak
muscles, with people defi­cient in key vit­am­ins as they can­not afford to eat
any­thing other than a poor diet.
So many patients are present­ing with com­plex phys­ical and psy­cho­lo­gical
prob­lems related to poverty, domestic viol­ence, child­hood abuse or poor hous­-
ing that GPs are suf­fer­ing psy­cho­lo­gic­ally from their inab­il­ity to take the
requis­ite action, she said.
Hawthorne, a GP in the Welsh val­leys, warned that ill­ness linked to rising
pres­sures on house­hold budgets would put even greater strain on already
over­stretched GP ser­vices. She said: “Recently I’ve had patients refus­ing sick
notes because they can’t afford not to work. Quite often, when it’s clear that
some­body needs time off, they won’t take it.
“These are people who ideally, med­ic­ally, should not be at work [because] they
have a chronic con­di­tion such as asthma or dia­betes, but quite often men­tal
health prob­lems, quite severe men­tal health prob­lems, I [see] some cases that
really do require a bit of sick note peace and quiet to try and help them get bet­-
ter.

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11/23/22, 8:35 PM Doc­tors’ warn­ing: poverty for­cing sick people to keep going to work

“I’ve been really sur­prised in the last year that when I’ve offered a sick note
they’ve said: ‘Oh no, no, I can’t take time off. I need the money from work.’
They’ve refused. They say: ‘I need to keep work­ing to earn and to feed myself
and my fam­ily’.
I don’t take it per­son­ally,
‘For a few minutes you enter their lives and it’s really tough’
Dr Kam­ila Hawthorne Royal Col­lege of GPs
of course, but I feel sad for people because for a few minutes you enter their
lives and see that it’s really tough.” Those refus­ing sick notes are mainly
young or middle-aged adults, includ­ing people who work in call centres,
Hawthorne said. But she had also seen people with young fam­il­ies and older
people doing it too.
Soar­ing food and energy prices have left some patients unable to afford trans­-
port to appoint­ments at the GP sur­gery she and her col­leagues run near
Pontyp­ridd – or even to get to hos­pital for pre-booked treat­ment.
Her com­ments came as Rishi Sunak warned that this winter was going to be
“chal­len­ging” for the UK. The prime min­is­ter told the cab­inet yes­ter­day that
the months ahead would bring wide­spread misery as they dis­cussed how to
alle­vi­ate the crises. A spokes­per­son for No 10 said: “Look­ing ahead to winter,
the prime min­is­ter said this would be a chal­len­ging period for the coun­try
caused by the after­shocks of the global pan­demic and the con­flict in Ukraine.”
The com­ing cold spell will make things even worse for patients’ health and
wel­fare, Hawthorne fears.
“I’ve now got patients who are wor­ried about fuel costs this winter, who’ve not
turned on their heat­ing yet and are keep­ing their win­dows shut. People are
very, very anxious about what’s to come and whether they’re going to have to
choose between heat­ing and eat­ing.
“The moral dis­tress among GPs comes from not being able to do more [to help
people with com­plex prob­lems]. We can help most people who come to see us
as they have for example a skin rash, period prob­lems or anxi­ety and depres­-
sion. More and more, however, we’re see­ing people with intract­able social and
psy­cho­lo­gical prob­lems that are very dif­fi­cult to solve,” she said.
She added: “That sense of hope­less­ness that the patient brings with them gets
trans­ferred to you as a GP … you go home really at the end of the day feel­ing
like a wrung-out lemon. It’s quite exhaust­ing.”

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11/23/22, 8:35 PM Doc­tors’ warn­ing: poverty for­cing sick people to keep going to work

GPs are also dis­tressed at see­ing patients’ health worsen because they have
been stuck for so long on NHS wait­ing lists, she added, “par­tic­u­larly people
with pain­ful hips and knees; people who are now crawl­ing up stairs because
they can’t walk up any more and the only toi­let is upstairs”.
Hawthorne had also noticed a rise in folate defi­ciency – a lack of vit­am­ins B9
and B12 – in some patients. She urged min­is­ters to spend more on energy and
food vouch­ers for the most vul­ner­able patients.
Expand­ing eli­gib­il­ity for free school meals would also help alle­vi­ate the des­-
per­ate situ­ation some fam­il­ies have found them­selves in.
Hawthorne cri­ti­cised min­is­ters for “GP-bash­ing” and their recent pledge that
patients would be able to see a GP within two weeks, and on the day if it was
urgent, which she said ignored the under­ly­ing issues. “Min­is­ters must know
that this policy is undeliv­er­able. The num­ber of GPs is fall­ing and the num­ber
of patients we’re see­ing is rising. Being a GP is becom­ing unten­able, unwork­-
able.”
In 2022, 4,032 trainee GPs were accep­ted on to place­ments, accord­ing to new
fig­ures pub­lished by Health Edu­ca­tion Eng­land. Hawthorne said she was
“encour­aged” by the num­ber of new recruits, but warned that it “won’t be
enough to meet cur­rent or future health­care needs”.
A gov­ern­ment spokes­per­son said: “We value the hard work of GPs and we’re
doing what we can to sup­port them and patients in these chal­len­ging times,
includ­ing pri­or­it­ising the NHS with an extra £6.6bn.”

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