GP / Primary Care

Fit notes, HRT, ADHD paperwork, reasonable adjustment flags, communication needs, and DWP evidence.

Hospital and Discharge Planning

Unsafe discharge, pain management, inaccessible housing, mobility risk, and environmental barriers.

Physiotherapy and Equipment

Wheelchair suitability, toilet access, equipment delays, installation failures, and functional safety.

Mental Health and Crisis Pathways

Distress being treated as the primary problem while the practical causes of crisis remain unresolved.

PALS, SARs and Records

The administrative burden of chasing complaints, records, missing documents, and disconnected NHS departments.

System Impact

How failures in one service create consequences across health, housing, benefits, access, and safeguarding.

On 16 June 2026, my support worker arranged a GP appointment at Scott Arms Medical Centre in Great Barr.

The appointment was booked to discuss three linked issues:

1. 1. HRT and menopause-related symptoms

   2. A fit note that accurately explains my functional barriers and support needs

   3. Help chasing outstanding ADHD assessment paperwork, because the missing paperwork is affecting my ability to access reasonable adjustments from the DWP

This was not a vague or casual appointment. It was an access-to-support appointment.

By this point, I had already been trying repeatedly to explain the same problem in writing, by phone, in person, and through support workers: I need medical evidence that describes my actual barriers and the support that would help me move towards work.

A fit note that simply says “depression” does not explain autism, ADHD, executive function difficulties, sensory overwhelm, communication barriers, mobility impairment, pain, fatigue, or the practical reasonable adjustments needed to support work-related activity.

It also does not explain why I cannot simply navigate complex systems, forms, appointments, phone calls, deadlines, benefit rules, housing problems, medical correspondence, and diagnostic paperwork without support.

This is not just about one appointment.

My NHS correspondence record this year shows over 230 NHS-related emails across 47 NHS email addresses. Of those, 52 relate to GP Reception / Scott Arms, including reasonable adjustments, fit notes, and advocacy coordination.

That is not normal patient administration. That is a disabled person being forced to act as their own care coordinator, caseworker, evidence manager, complaints officer, and legal clerk just to access basic support.

This is the hidden labour of disability.

It is the unpaid admin that sits behind every phrase like “you need to provide evidence” or “please ask your GP.”

When I arrived at the surgery, the receptionist confirmed that my communication needs were recorded and flagged on my file. These include the need for things like extra time, face-to-face appointments, written information, and clearer communication.

That matters because I am autistic and ADHD. I need time to process questions, retrieve information, explain things accurately, and avoid being pushed into overload.

Despite those needs being flagged, the appointment still operated as though I had no access needs.

The GP, Dr Akbar Aleem would not simply issue a fit note that reflected my functional barriers and support needs. I had to explain that the DWP were sanctioning me because I had not been able to provide the right medical evidence. I also had to explain why the wording mattered.

Dr Aleem refused to include autism or ADHD because the final diagnosis paperwork has not yet arrived, even though both are already referenced in NHS and hospital correspondence.

Instead, I was made to recall and list individual symptoms and functional difficulties from years of medical records, including things like sensory issues, time management difficulties, executive function problems, mobility impairment, and support needs.

That process used up the appointment.

Then I was told there was no time left to discuss HRT, even though HRT was one of the reasons the appointment had been booked.

This is how inaccessible systems fail disabled people.

A disabled person asks for support.

The system asks for evidence.

The evidence is delayed.

The person asks for help chasing the evidence.

The system says the evidence is not available yet.

The person asks for a fit note describing functional barriers.

The system writes something too vague to unlock support.

The DWP sanctions the person.

Housing payments stop.

The person is pushed further into crisis.

Then every service treats the crisis as if it appeared from nowhere.

I have been sanctioned and have had no housing payments since Easter 2024.

For the first year of that mess, I was in Cornwall. The Jobcentre still has not chased and resolved the Cornwall payment issues properly.

This matters because benefit problems are not separate from health problems. They are not separate from housing problems. They are not separate from disability access.

When the DWP requires evidence, the NHS delays paperwork, the GP writes a vague fit note, and housing payments stop, the disabled person becomes trapped between systems.

Each service points to another service.

Nobody takes ownership.

The disabled person is left carrying the risk.

The central issue is not whether a flag exists on a medical record.

The issue is whether the service changes its behaviour because of that flag.

A reasonable adjustment flag is not inclusion if the patient still has to:

• explain the same needs repeatedly

• manage random phone calls instead of planned communication

• attend appointments without enough time

• reconstruct years of symptoms under pressure

• chase paperwork across disconnected services

• lose essential appointment time because the clinician has not prepared

• leave without the booked health issue being addressed

Inclusive practice is not a note on a screen. It is the practical design of the appointment.

A properly adjusted appointment should have included:

• enough time booked from the start

• the GP reading the relevant correspondence before the appointment

• a clear written agenda

• written follow-up after the appointment

• acknowledgement of the pending autism and ADHD paperwork

• a functional fit note describing support needs, not just a generic label

• help chasing the missing diagnostic paperwork

• HRT being discussed as planned

• recognition that DWP sanctions and housing payment failures are safeguarding concerns, not just admin problems

This would not have required anything extraordinary.

It would have required the system to use the information it already had.

This is a Sandwell inclusion issue because disabled people cannot participate equally if essential services operate in ways that exclude them.

Disabled tenants, autistic people, ADHD people, wheelchair users, chronically ill people, and people with complex access needs are often told to “just ask for help.”

But when we ask for help, we are asked for paperwork.

When we chase the paperwork, we are told to contact someone else.

When we explain the barrier, we are treated as difficult.

When we cannot complete the process alone, we are punished for non-compliance.

That is not inclusion.

That is procedural exclusion.