Should doctors be encouraged to question unemployed patients on their career goals?
Doctors are being encouraged to question unemployed patients on their career goals as part of sweeping welfare reforms, which critics fear will penalise the disabled.
But advocates say getting patients off the benefit is part of a GP's job, and work-focused conversations need to start in the doctor's clinic.
The biggest changes to the welfare system in more than two decades came into play last month, with seven main benefit categories cut to three.
The previous sickness and invalid benefits, collected by about 140,000 people last year, have been replaced with either Jobseeker Support or Supported Living payments.
The Ministry of Social Development has set up a health and disability panel to determine how the medical profession can help remove "barriers to work".
Documents released under the Official Information Act reveal the development of the new work capacity assessment tool, including suggestions of rewarding doctors who get their patients off the benefit.
The Government estimates 28,000 to 44,000 people will come off benefits by 2017 because of the reforms, saving up to $1.6 billion.
In a speech at the Conference for General Practice last month, ministry principal health adviser David Bratt said that it was important GPs talk to their unemployed patients about working. This included asking people "what they wanted to do for the rest of their life".
But CCS Disability Action chief executive David Matthews said it had concerns about doctors grilling already stressed patients.
"Disabled people tell me they feel checked up on and questioned all the time. Another set of questions just seems to be more and more pressure.
"I think it's great people are being encouraged to explore options about their future, but it's not a simple solution of telling them to go off and get a job."
Disabled people often had other barriers to work, including transport, security and access to suitable jobs, which had nothing to do with a GP, he said.
But health and disability panel member Ben Gray, a GP and senior lecturer at Otago University's Wellington School of Medicine, said there was no doubt that the physical and mental health benefits of working were huge.
"On one level, finding them a job is not our job. But our ability to manage some of the problems that are the barriers to why they can't get jobs are our core business.
"If someone can't get a job because they are stoned all the time, then I should be talking to them about what we can do about their addiction."
International research has shown consequences from being out of work include poorer mental and physical health, increased rates of mortality, and risk of cardiovascular disease, lung cancer and respiratory infections.
It was hoped that more government funding would accompany the shift towards working more closely with the ministry, Dr Gray said.
But lack of communication from Work and Income staff was a problem at present, and this should be resolved if they were to work "collaboratively" in future, he said.
Health and disability working group discussion documents show panellists decided a "culture shift" was needed.
"Work-focused conversations need to start in primary care," they wrote.
"GPs are [the] main health worker, not employment adviser, though if work ability assessment is in primary care, setting a client's healthcare would benefit from ‘work' focus."
The panel identified risks, including whether doctors could take on the workload. But they said the current model of having a GP simply fill out a medical certificate wasn't working.
"It is currently an inhibitor - a source of contention that gives the GP a perverse incentive to advocate for the client," they said.
Dr Bratt was unavailable yesterday. In a statement, the ministry said: "Work and Income is engaging with health professionals, the disability sector and employers . . . to improve opportunities for people now and in the future.
"Rather than focus on what a person can't do, we are looking at what they can do and providing them the support to do it."
- The Dominion Post
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