Intended for healthcare professionals

Opinion Talking Point

John Launer: Battling bureaucracy

BMJ 2023; 380 doi: (Published 01 February 2023) Cite this as: BMJ 2023;380:p206
  1. John Launer, GP educator and writer
  1. London
  1. johnlauner{at}
    Follow John on Twitter @johnlauner

I recently spent two hours helping a young refugee friend sort out a couple of money difficulties. Many of us sometimes spend a few minutes in our professional roles helping patients complete a form or telling them how to deal with an official agency. It was still educational to go through the whole process and discover how many obstacles face someone who lacks funds, time, or social capital.

My friend first had to sort out a tax matter. After deductions, she’d received less than half the salary she’d expected because she was on an emergency tax code. I explained to her why this happens, but I couldn’t offer a reason why a new job is described as an emergency for tax purposes, or why people on very low salaries are automatically put on codes that may leave them in dire debt, while the government extracts overpayments and accrues interest.

I filled in a raft of details for her on the HM Revenue and Customs website, which directed us to another website to acquire a government ID. After we’d spent around 45 minutes circling between the two websites, an algorithm informed us that she didn’t have the requisite British documents to proceed further. Neither website had made it clear that these documents were mandatory, nor given the phone number we had to call. It took a further 45 minutes clicking numbers on the phone (“Press 8 for refunds” and so on), and listening to jingles, before we got through to a human being. He was brusque. I guess I’d be brusque too if I had to deal all day with people who were anxious about not having enough to live on. He did, however, arrange for my friend to get her money back. It will take a month.

We used the internet again for the second task: an appeal against a fine from a bus company. It took another half hour to fill in a complicated online form and write a statement explaining that her travel card had failed to register on the card reader. We also described how the inspector saw that there were funds on her card, her payment record showed that she took the journey every day and always paid, and CCTV footage might show that she’d presented her card on that day too. From her account of the unpleasant way the inspector spoke to her, it seems likely that her age, gender, and foreign accent played a part when he ignored all of this. Her appeal has now been refused. She doesn’t have the time or energy to take it further, and there’s no procedure for doing so anyway.

Money problems figure more in most people’s lives than medical problems, especially now that we’re in a serious cost of living crisis. Perhaps we should ask medical students and GP registrars to spend a little of their time sitting alongside patients in their battles with bureaucracy. It would be a worthwhile learning exercise. It might even help some of our patients have enough money to travel to work, heat their homes, or feed their children.


  • Competing interests: None declared.

  • Consent obtained.

  • Provenance and peer review: Commissioned; not externally peer reviewed.