discussion forum

response from GP in relation to our request for supporting information for DLA appeal.

I am sure there is a thead here somewhere about this but cant find it.

Would glady recieve anyone else opinion on this.

This is only one practive e usually get good response however if this stance becomes the norm how will anyone have a hope in hell of winning.

“GPs in North Cheshire have made representations on many occassions to the Benefits Agency with regard to this topic and are continually informed that supplementary evidence from GPs is not required for appeals.  There is a mechanism in place, whereby the Benefits Agency writes to GPx for supplementary evidence and pays appropriate fee.

Unfortuanetly in the days of increased paperwork and the pressures of trying to provide high standard patient care, it is not possible to spend time doing lengthy reports for no fee.  If you wish to take this matter further, the local medical committee represents all GPs in this area and would be happy to discuss this with you further.

I’ve more or less ceased to request specific evidence from surgeries for DLA/ESA disputes (other than in exceptional cases).

DP request can be made to surgery for copies of records (fee for computerised notes is £10 though it can be more for copies of paper records as well) but there are many other sources of evidence you can consider, including OT assessment reports, CPN’s, support workers, physiotherapists, school reports/SEN’s (in case of DLA child claims), family members, etc, all of which can be just as (or even more) helpful than surgery records.

Hi Gail,

Here is a thread on the same theme; http://www.rightsnet.org.uk/forums/viewthread/2144/

The maximum fee for copies of health records is £10 (reg 3 of The Data Protection (Subject Access) (Fees and Miscellaneous Provisions) Regulations 2000.  I don’t think there has been any amendments since.

FtT Rule 2(2) states: Dealing with a case fairly and justly includes -
(a) dealing with the case in ways which are proportionate to ..... the anticipated costs and the resourses of the parties.

It would be interesting to see the response if the Tribunal Service were requested to pay for medical evidence under this provision given that the DWP has the resourses to pay for ‘medical’ evidence from Atos but many claimants cannot meet the charge their GP requires. Equality of arms?

We are fortunate that only a few surgeries charge as a matter of routine - but those that do charge £50 - £95. Thats a big wodge of cash for a claimant on assessment phase rate of ESA to find!

We certainly anticipate that GPs may increasingly request payment given the current surge in WCA appeals with migration cases, increased frequency of WCAs and the forthcoming joy of PIP appeals!

Has anyone specifically requested a judge to direct that TS obtain a response in a case where a GP etc requires payment for a response (rather than the situation where a judge adjourns a hearing of their own volition and directs TS to request medical evidence)?

I think it is important not to get too hung up on medical evidence. At tribunal too often I used to see medical “evidence” put in that had clearly not been understood: it might undermine the claimant’s case, it might just be a recital of things the claimant has told the GP (“she tells me that”); it may contain only information that is not germane to anything that has to be proved. Gps too rarely have any real knowledge of how a medical condition affects a particular individual (no two people are affected or have their functioning impaired in the same way by any given condition, and GPs don’t see them much at home trying to cope so just don’t know the answer to the questions. Mind you, that is no excuse for this fact being used to “prove” there isn’t a problem).

The medical evidence is often really only an indicator of what the condition(s) affecting the claimant are and how it is being treated. Tribunals don’t want all the appellant’s medical history since the age of 2, they want things that really help. It can be quite hard to decide whether any piece of evidence is valuable, though medication can indicate how well controlled a condition is, how bad the pain is, etc. A diagnosis can give you an idea of what range of impairment and symptoms are likely but not what they are in any given case. Spinal x-rays are useless: I have heard it said that if you x-rayed the spine of every person over 50 in the country you would be hard-pressed to find one who did not show a greater or lesser degree of degenerative diseas, and that the amount of degeneration would have no correlation whatsoever with any pain, stiffness or mobility problems experienced.

In my experience a GP who is genuinely concerned about a patient may well volunteer “this is one of the most profoundly disabled patients in my practice” or something equally compelling, especially if they are outraged by a negative decision. Those do carry weight. And never ever submit a letter that indicates the GP thinks the claimant is not badly affect, swinging the lead or says (as I have seen ) “He is not fit to return to his work as a warehouse operative becsue he is unable to carry out heavy lifting”. Concentrate on the evidence the cleint can give in the tribunal, if ther is nothing inherently implausible in it. Oral evidence from a person who can be questioned is, in all courts, the very best there is.

The fee for accessing health records depends on a few factors:

http://www.nhs.uk/chq/Pages/fees-for-accessing-medical-or-health-records.aspx

Hi Tony

I think the info’ on the NHS site is misleading.  See reg 6 of the Data Protection (Subject Access) (Fees and Miscellaneous Provisions) Regulations 2000.

http://www.legislation.gov.uk/uksi/2000/191/regulation/6/made

nevip - 18 June 2012 10:25 AM

Hi Tony

I think the info’ on the NHS site is misleading.  See reg 6 of the Data Protection (Subject Access) (Fees and Miscellaneous Provisions) Regulations 2000.

http://www.legislation.gov.uk/uksi/2000/191/regulation/6/made

See subpara 2. (£50)

Only applies to requests made before 24/10/01 (para 1(c).

Reg 6 was amended to remove 6(1)(c) from 23/10/2001.

http://www.legislation.gov.uk/uksi/2001/3223/pdfs/uksi_20013223_en.pdf

After 11 years I couldn’t believe that everyone would be giving wrong information, especially as there is a link to the DoH guidance directly from the ICO’s website.

Thanks to the ICO helpline for helping me track this down.

Thanks Tony.  I stand corrected.

We are finding increasingly that when we go to the appeal it is adjourned for medical evidence, but, whilst this is often fairer to the client it puts them through the ordeal of turning up for a hearing and then having to wait for a second date. One of my colleagues frequently writes to the Tribunal Service well in advance requesting that they obtain medical evidence and he is usually successful. This avoids the client having to turn up for no reason.  Ruth

For what it’s worth, that letter from North Cheshire GPs is exactly the same, word for word, as the letter I got from them in 2002 when I was working in Warrington. I suspect it’s down to local prejudice, I have never come across anything like it anywhere else in the country. I took to looking for alternative ways of getting medical evidence.

HK - 22 August 2012 01:59 PM

...I took to looking for alternative ways of getting medical evidence.

I have regularly and consistently advocated that GP’s should, in most cases, be the LAST port of call for supporting evidence because they tend to know the least about the patient. Certainly far less than, for example:
- social worker
- visiting nurses
- physio
- consultant
- etc.

The first three on this non-exhaustive list tend to deal with the effects of disablement, which is what is important for most disability related benefits.

GP’s, as you’ll know if you regularly read factual reports (those things alluded to by the North Cheshire GP), are very frequently ignorant to the effects of disability on their patient. That’s not say this is something for which they ought to be admonished. Instead, we advisers and the DWP should recognise and accept that GP’s are just not the right people to contact in most cases.

Where’s there’s no other health professional there’s little option, but in that case we should not be asking for any more than confirmation of disagnosis and treatment, with other ‘disability related’ information coming from:
- carers
- family members
- close friends
- support groups
- anyone else that deals with the client regularly and who the client trusts.

I find the most successful way to get valuable medial evidence is to quote, word for word, the HCPs or DMs opinion such as “unlikely to have any significant disability” or “we acknowledge claimant unable to walk 50 metres but they could use a wheelechair to move…”
Giving these quotes to the GP and asking for their opinion more often than not outrages them and they provide very good information to the contrary as a matter of course - as follows:

“He has quite a significant L2 - L3 disc prolapse and is also suffering from quite severe arthritis of the lower spine. He is on quite a cocktail of medications which unfortunately does not allow him to walk a distance of more than 50m”

“It is difficult to understand how the Healthcare professional who examined him felt that he would be able to mobilise well in excess of 200m by using a wheelchair. Normally it would be my opinion that this skill would not be achieved unless he had considerable input over a considerable amount of time through a physiotherapist in order to guide him and give him the necessary strength in his upper limbs in order to use a wheelchair, this at present has not been done and indeed at the present time I think it would be entirely inappropriate to advise xxxxx that he should be using a wheelchair.”