Hi everone

Do you have standard letters when requesting medical evidence or evidence from support workers , and social workers for DLA application or supersessions?

Jeff

Hi Jeff, we do but I'm not happy with them. We created various letters/questionnaires over the years trying to put ourselves in the shoes of the person doing the report but most of the time I'm not happy with the results.

Everyone's so busy all the time but we obviously need (succinct?)comprehensive views of care/mobility needs which is not so time consuming for respondents. We struggle so I'd appreciate having a look at any well devised ones we could possibly plagiarise.

Sue

We used to have pro-forma letters for everything, including this, but do not any more.

I was not happy that we were using a system which was basically the same as the DWP - the GP's were merely completing a form much the same as an EMP does.

We now write a letter requesting evidence that is unique to each client, who all have very different needs.

It's more time consuming but IMO results in a better, more personal letter/report.

they're not specifically in relation to requesting medical evidence or evidence from support workers and social workers ..... but neil bateman has a host of other standard letters ... see rightsnet swopshop @

Standard letters for welfare rights work

I would go a bit further and try to dicuss with the doctor etc what evidence they can provide and why it is needed. You get more detail that is relevant that way. If you send a copy of the letter you send asking for the supporting points you can show the tribunal that you have covered specific points that can then be added to the other evidence that you are presetning to give a nice clear overall picture in your submission. With luck this way the tribunal will love you for ever!

Good luck etc.

I tried standard letters but they are not really flexible enough and have now gone back to individually written letters asking for specific points to be explained or clarified. Don't forget to include your letter with the reply when it is submitted as evidence as it helps the tribunal to know what questions were asked. i have ha one or two problems with GPs (or more likely their practice admin managers) sending an invoice with the reply which can cause problems as we don't have a budget to cover these costs - is this a widespread practice amongst GP surgeries?

"sending an invoice with the reply which can cause problems as we don't have a budget to cover these costs - is this a widespread practice amongst GP surgeries?"

This has been discussed before. Have a look at the follwoing discussion as a starting point:

http://www.rightsnet.org.uk/dc/dcboard.php?az=show_topic&forum=100&topic_id=2028&mode=full

Thanks for that link. It seems that i should be grateful that so few local doctors ask for a fee!!! Pete

You might like to know that Tribunals Service guidelines ask for lettters requesting reports from doctors to be sent with the replies, so that the Tribunal can see if the doctor has essentially been told what to say by the rep. In the past people used to send doctors what were basically checklists to tick. I should warn you that this sort of medical report carries very little credibility to a Tribunal!

Brigid

I agree that a checklist type report is basically useless but, as quite a lot of the report that is completed by a visiting Dr is made up of tick boxes maybe it's time there was a change?

Many EMP reports we get have very little actual writing on them and so, based on what you say Brigid, shoudn't they then carry little credibility too?

Nicky

Absolutely agreed on the issue of weight given to any "checklist" per se....I sometimes think we live in a world of scripts/checklists/triage/questionnaires, ranging from our banks, insurers, the health service, social services, DSS, advice seeking et al!!!!

However, as highlighted in the last posting, it would seem that checklists are seen as a perfectly reasonable source of evidence for a DM to review/remove/decide a claim when it is procured by the Department, and tribunals do often appear to give a significant amount of weight to such reports.

The real issue for me here is that trying to obtain ANY evidence from GPs is hard enough, especially when asking them to comment on such specific areas as mobility and care/PCA descriptor activities etc.

Furthermore, we here are constrained to a very large degree by limits of LSC funding/disbursements for these kind of reports (and I know that even such restricted funding is a lot more than some agencies get to do this work, often relying on goodwill from GPs alone).

We are under pressure from GPs Practice Managers and PCTs not to offer minmal amounts for these reports, from the LSC not to pay too much for them, and from the poor old client who just wants help!!)

The format of our letters to GP's/Consultants etc is now - I admit - basically a letter inviting them to complete a checklist, for a flat fee.

We have found that any other approach either leaves us with GP's who take a fee but produce a list of diagnoses and little else, or - if we make their job "too complicated" (our previous letter of instruction went over 3-4 pages in order to elicit the correct info/comply with the evidence required of us by a tribunal etc) many of them just don't want to know!


This was - I believe - the purpose of the thread.....in a perfect and just world we would all work together for the truth of any given situation...DSS, GPs, Tribunals...all of us......but hey! checklists are a poor form of evidence, but they are what we in the advice sector (and I assume Tribunals) see all the time as the ONLY evidence on many cases!!!

Pete, you say you get GP's who take a fee and then only produce a list of diagnoses.

Does this mean that you pay for something before you get it?

Nicky

You seem amazed!

Unfortunately, but essentially (maybe amazingly), the answer is yes....many GPs and consultants require payment up-front these days...others (whether up-front or not) will send through a "report" which is basically a list of diagnoses with some (limited) background info, and has little to do with ability/disability relating to a specific benefit...even if they are specifically instructed!!!

We have of course (both prior to, and after receipt)on numerous occasions entered into some very interesting negotiations/arguments with GPs and Practice Managers over this in the past....to be positive, asking them to please do what we asked in the first place has (almost always) led to an amendment....BUT the downside of this approach is that such negotiation/chase up/further letters etc eats away at the fixed fee funding which we will all (in LSC work anyhow) soon be under. For example, the cost of a couple of extra telephone calls and a couple of letters amounts to around 10-15 % of the whole fixed fee we get for undertaking a welfare benefits case, and would of course be better spent on advice and/or expert preparation etc!!!

More worryingly - in a significant number of instances where we have ended up renegotiating with the Doctor as to what we want (and asked for from the start) - this has affected our ability to secure similar evidence for other clients from those same Medical Practices....they obviously begin to see it as "too much work for too little money" (particularly if dealing with a "solicitor", where they seem to assume that the question of funding is not an issue)..many are, after all, used to medico-legal expenses covering the cost into many hundreds of pounds.

So, we have had to take a view on these issues, taking into account a number of factors, some of which are described above, and in order to obtain the best, most cost-effective, most available evidence for ALL our clients.

I have to say that under a fixed fee, procurement of evidence is a veritable "nest of vipers" on a number of levels.

I must add - to clarify - that at present, LSC disbursements for medical reports are incorporated into the fixed fee we get for the entire case...when Carter kicks in, we are told that they will be paid separately, which is a much better idea...however, the point remains that work undertaken in trying to secure this evidence eats into the fixed fee for the case...when you have a fixed fee of some £150-£170 per case (inc VAT, inc Disbursements, inc admin, inc overheads) every penny counts...and I don't mean profit, I mean advice time for clients!

No not amazed just curious.

We refuse to pay for a report until we get it - we are part of a consortium of bureau who work under the LSC and it is a rule that we do not pay before we receive the report.

Disbursments come out of public funds after all and so we feel payments can only be justified for something that is worth having.

I have sent back a "report" and invoice before and said that we will not pay as the report was not worth it.

This does work and there is only one GP practise who will not "play ball" so we don't write to them any more and explain to clients why we can't.

If there is any chasing up to do due to something like this our Admin does it - this is not something a caseworker should be doing anyway under the contract.

As i say this is working at the moment, i've absolutely no doubt that it'll all change in the future!

Couple of points...

1. the work in negotiating a "proper" report from a GP is not an Admin task, but is central to ensuring best prospects for a case...of course "chase ups" would be admin...I was not describing chase up work, but the often mire-filled discussions we have with GPs etc to try to elicit the right info which we all - as you point out - should expect. I could (and would) not expect an admin worker to do this!

2. I think you must be very lucky in your consortia's rule/approach, though the clients of the one practice which you say "won't play ball" would seem to become very unfortunate clients indeed as a result, and this itself would also seem to go some way to demonstrate the very real problems I was suggesting in this thread...

Unfortunately, we here have a number of GP practises who "won't play ball" (or worse, sometimes do, sometimes don't), and - whilst I appreciate the points you make re public funding et al, the issue remains a very real one. I too (as I stated) have sent back many a report, but the effect of this on future procurement of reports for the same, or other clients can be very detrimental.