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Last Updated: Wednesday, 7 September 2005, 16:33 GMT 17:33 UK
Plans for job advice at the GP's
By Adam Brimelow
BBC health correspondent

A job centre computer
People may soon be able to get employment advice at their GP surgery
Employment advisers could be placed in GP surgeries, as part of a government drive to help get people off incapacity benefit and back into work.

Ministers believe this would cut the huge cost of the benefit and improve the health of many thousands currently deemed too sick to work.

Doctors representatives have broadly backed the idea.

But there are worries that if this is done in the wrong way, it could damage patients' trust in their GPs.

Traditionally, as doctors, we've often seen ourselves as not going beyond the prescription pad
Dr Sam Everington

This summer, patients and practice staff at Bromley by Bow health centre in east London have been digging and shifting soil and laying turf in the small park behind the surgery.

It slopes back to a new workshop for a landscaping company - Green Dreams. This is just one of several spin-off firms from the practice.

There are also graphic artists, a pottery workshop, an internet cafe and more.

Many of the staff are patients who were referred on to the firms. A number of the patients were chronically depressed and out of work.

But now they're back in a job as a result of going to see their GP.

Long term unemployment

One of the doctors, Sam Everington said: "What we're absolutely clear about is that unemployment is makes people unwell.

"People are often unwell and become unemployed, but it's the other way round too.

"Traditionally, as doctors, we've often seen ourselves as not going beyond the prescription pad.

"But it's absolutely clear with patients that so often if you're to deal with their health issues, you must deal with employment."

The government wants to encourage this proactive approach.

The prize - apart from improving health - could be enormous savings on incapacity benefit.

There are over 2.5 million claimants - nearly a million of them have mental health problems.

The overall cost of the benefit is 12 billion a year.

While many want to work, research shows if someone is not back in a job within twelve months, the chances are they will not be for many years, if at all.

There are already pilot programmes across the country, with nurses, physiotherapists, and psychologists helping people on benefit take the first steps back to work.

This idea is about to go a step further, with the government putting employment advisers into GP surgeries.

Trust 'crucial'

Faruk Noor has been working in this role for the charity Tomorrow's People at a practice in north London.

The service was set up to help doctors stop signing long-term sick-notes for patients who might benefit from employment and welfare advice.

The great majority who have completed the programme are back in work or training.

The government's is watching this project closely, but has not said whether it will follow this model of independent advisers rather than jobcentre staff.

But Mr Noor says the job demands absolute trust.

"It will not work when you've got a civil servant. There is automatically going to be a suspicion.

"And there's no way of getting over that. This works because of trust. This works because it's my job to actually make them aware of the benefits.

"Now I know the job centre will say all this. But the difference is the patients trust me and know I'm working for them.

"Whereas in the job centre they know that they've got other agendas."

'Policing by the state'

The doctors here say the scheme has saved an average of five consultations for each person on it, and it's cut their use of anti-depressants dramatically.

The charity puts its success down to its independence from government - and spending a lot of time to build trust.

A Green Paper on welfare reform, due in the next couple of months, will give more detail about how the government wants employment advisers to work with doctors and patients.

Dr Sam Everington - who is also deputy chairman of the British Medical Association, supports the idea - but he says it won't work if patients feel they're being put under pressure.

"I think the thing that would worry me and would worry patients is this is almost an imposition by the state. It's the state telling people what to do.

"It's part of policing by the state.

"And if you go down that pathway, you will not gain the trust of the patients, and actually you won't get the advantages of an employment adviser."

Employment minister Margaret Hodge said nine out of 10 people on incapacity benefit said they wanted to work, and advisors would be put into practices in the pilot schemes to see how they could be helped.

She said the pilots would evalute if patients were concerned about the presence of job centre workers in surgeries.

"Job centre personal advisors are not seen as a threat.

"But if people see them as a threat when they are working in GP surgeries, we would look at using independent and voluntary sector advisors."

Incapacity Benefit to be replaced
02 Feb 05 |  UK Politics

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