I'm represent client at IB appeal and asked GP to give opinion on relevant descriptors (tick boxes with space for further comments).

I sent copy of GP report to DWP and requested an anytime review, om attempt to avoid tribunal (has worked before) - on basis of GP report, cl passes PCA easily.

Decision Maker says no because:
"I feel little weight can be given to this report as a piece of evidence. The GP has selected a descriptor for each activity as requested without the benefit that the examining practitioner has from the medical services handbook and their training. This training deals with the application of the prescribed activities and assessment of a persons functional ability. It is is not dealing with either the diagnosis or treatment of the incapacity as is the case with x's GP."

I'm not sure I understand the last sentence - is the DM saying that only a report from a GP that talks about diagnosis and treatment is evidence that can be given any weight?
I wondered if anyone had any thoughts on this. What training do medical services doctors have that makes them better able to pick a descriptor than a GP who knows the patient?
Thanks.

Jo

The DM is probably following his own DM guidance on GP's reports (see below) - now if the GP's evidence you had sent in had been "weighted" towards his case, the DM would have been quoting it line by line. In answer to your last question, I'm sure that there are a number of views held by advisers, some of which could be libelious, unprintable and/or could frighten horses and young children.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

51. FURTHER EVIDENCE AND ADVICE
51.1 Contents Paragraph
Introduction 51.2
Sources of Further Evidence 51.3
Advice from Medical Services Doctors 51.4
51.2 Introduction
51.2.1 At various points in this book suggestions are made concerning the sources of further evidence which are most likely to be of assistance in particular types of case. The purpose of this chapter is to describe the various sources of further evidence and to indicate the sorts of information which can be obtained from
each one. Providers of further evidence should not be asked to answer direct questions on whether the qualifying conditions for the benefit are satisfied. In general terms they can be asked for information which will fill gaps in the evidence which would otherwise be incomplete. They can also provide evidence which will help the adjudication officer deal with inconsistencies or contradictions in the information already held.

51.3 Sources of Further Evidence
51.3.1 General Practitioner Factual Reports (GPFRs)
(i) A special fee payable to individual GPs has been agreed whereby factual information based on a patient's clinical records will be provided. The fee does not extend to the provision of an opinion and so, unless the information is already contained within the clinical records, the GP will not be in a position to provide it. It has to be understood that individual entries in a patient's clinical record are relatively brief and will usually concentrate on diagnosis, clinical
findings and treatment plan.

The records will not really contain any meaningful information relating to care and mobility needs. In general therefore GPFRs can provide useful information on the diagnosis and overall severity of a person's disabling conditions. It will not usually be appropriate to ask specific questions about the help a person requires unless there appears to be gross under-or over-representation of those in the claim pack.

(ii) Where a person has a number of different conditions which are being investigated and treated by a variety of hospital departments, the GP's records will be the place where all this information is co-ordinated. In these circumstances the GP may well be able to indicate the relative importance of the various conditions in terms of their effect on the patient's day to day life.

Does anybody have any info on what training EMPS undertake? I'm the teensiest bit sceptical as to just how expert in disability asessment they are.

not sure ... but apparently they're better trained than medical members on appeal tribunals

see the rightsnet new story EMPs better trained than medical members on appeal tribunals: DWP evidence to Commons committee

If you read the DWP evidence a couple of times, what strikes you is the audacity: it's not the DWP that gets it wrong, but in 60% of Appeals, it's the Tribunal that doesn't understand the evidence....?

I must admit I would be fascinated to see the DWP try to use that as an arguement before a Commissioner. How can anyone with such a track record sit there with a perfectly straight face and say to a House of Commons committee "it's not us Gov, it's everyone else........"



"The ultimate result of shielding men from the effects of folly
is to fill the world with fools".

Herbert Spencer, English Philosopher (1820-1903)

You might find the Commissioners comments re internal guidance in CI3758/2003 useful

"The Medical Assessment Framework

7 There is a further point that must be raised. It is clear from the decision that the tribunal was relying on and applying the Department’s Medical Assessment Framework in grading the claimant’s disability and setting the level of disablement. That is the only conclusion I can draw from the comments of the chairman that:

We are, as indeed examining assessors are, guided by what are called Medical Assessment Frameworks, by statutes such as the War Pensions Act, and by General Benefit Regulations of 1982. All of these documents available to ourselves and indeed to examining medical assessors give guidance with regard to specific injuries.

That is fundamentally wrong. If that is the approach this tribunal took, then it undermines the whole independence of the tribunal. If it was guided by (underlining mine) the Departmental Framework, it was patently in breach of its duty of fairness to both parties under common law and to preserve an equality of arms between the parties as required by Article 6 of the European Convention on Human Rights. It cannot be emphasised too strongly that the Medical Assessment Framework does not give guidance to tribunals. It states the views of a government department that happens to be one of the parties before the tribunal in this appeal and it may explain those views, but it is no more than that.

8 Further, if the tribunal did take account of the Medical Assessment Framework in this case it was also acting unfairly for two separate and further reasons. It had at no time raised this matter with the claimant, and the Secretary of State had not put it in evidence, so the claimant was not aware of it. The Medical Assessment Framework is not law, and cannot be assumed to be known by anyone to whom it has not been notified. And it is not the job of the tribunal to put the views and evidence of one party about levels of assessment before the other party. That itself would call into question the equality of arms. For the Medical Assessment Framework to be put in issue, the Secretary of State must put it fully into the submission made to the tribunal, or otherwise notify the claimant of it, and the tribunal must make it clear how far it is considering that framework in reaching its own decision, or at least invite comments on it. And the tribunal can accept it only as part of its own decision having considered the matter for itself. That must include whether it accepts the analysis of the framework as related to the particular injury, as well as the level of assessments indicated.

9 As I have stated in other decisions, the only objective set of criteria in this area is the Guidelines for the Assessment of General Damages in Personal Injury Cases produced by the Judicial Studies Board (the latest, 6th , edition is published by Oxford University Press). I set out the framework for back injuries as an annex to this decision. If the tribunal seeks guidance on assessment of back injuries, then it should use the JSB guidelines. I add the following comment from Lord Phillips MR in the foreword to that edition:

If … victims of negligence are to feel that justice has been done, they must be treated consistently. These guidelines assist with that task in that they provide an almost up-to-the-minute distillation of the damages that are being awarded by courts throughout England and Wales. Anyone using this book, and everyone concerned with the assessment of such damages would be wise to use it, will swiftly be able to identify the scale of the damages that are being awarded …

I have included the sums in the annex although they are of indirect relevance to industrial injuries assessment. But the general approach and the views of Lord Phillips are, with respect, as relevant here as in the civil courts. (I defer to my Scottish colleagues with respect to cases in Scotland).

10 Unless, therefore, the Secretary of State puts the framework in evidence before the new tribunal, and the tribunal invites the claimant’s comments on it, I direct the new tribunal to ignore the Framework entirely and also to ignore that part (namely the assessment of disablement) of the decision of the tribunal now under appeal entirely. "

In other words, the evidence stands or falls on its own. Internal hadnbooks are only relevant if they have something to contribute directly, they are not authorities in their own right

I went to one of Atos Origin's seminars on medical evidence. This included a deno by one of the doctors on how a musculo skeletal examination is done (on a fully physical fit person so not sure what the point was) as well as a number of presentations.

One of the slightly worrying claims they made was that GPs are only concerned with diagnosis whereas EMPs are concerned with functional ability. They also have a rolling programme to ensure their doctors pass a diploma in disability analysis but, of course, there is no way of finding out whether particular EMPs have passed or not. They also banged on a bit about how rigorous their training was etc.

I can see this argument about the different roles of EMPs and GPs becoming the standard 'reach for' excuse for preferring EMP reports over GP reports instead of the old chestnut about independence. I'm not sure how we would argue this as it has a certain logic, although I cannot see how any doctor could realy have no idea of functional limitations bearing in mind that they are charged with treating them appropriately and with the correct amount of medication. It seems rediculous to imagine that GPs don't have a feel for what their patients will and will not be able to do bearing in mind the severity of their illness.

As with many of the functions of the DWP in general, the theory as envisaged by London does not always translate into good practice at the grass roots level.

Lets look at exactly what many tribunals place their faith in: a Doctor visits you in your own home - he has no access to your medical records, hospital test results what have you - all he knows about you is what you tell him. OK, some clients are quite articulate and have made it their business to ensure that they are well informed as to their medical condition etc: however, there are many more who know that their back/legs/arms/hands or whatever else hurts, and that they take this or that medication - but often they are'nt even sure what the diagnosis is.

Secondly, many disabling conditions vary in their severity on a day to day basis. How can a Doctor, who has never met you before and never will again, accurately gauge how those medical conditions will affect you on a day to day basis on the strength of a visit lasting less than an hour? It is after all a theoretical exercise and as such is prone to a wide margin of error.

A good example of this is an EMP report that I obtained a couple of weeks ago which basically arrived at the conclusion that my client was only mildly disabled and was perfectly capable of caring for himself etc.
However, he was also in receipt of SDA, and had been through a medical in connection with that benefit only two months prior to the EMP visit - that Doctor had found that his condition had in fact marginally worsened since the last SDA medical, and that he was now in fact 90% disabled.

However, no matter how open to error the whole EMP procedure is, and how contradictory their reports are, many Tribunals still look upon them as the holy grail, whereas they, and GP reports should be treated as being of equal value. Of the two, GP's are surely in a better position to judge functional ability being as they have access to the clinical record, test results:- Xrays, Scans, blood tests etc, and based on their personal knowledge of the patient.

also discussed in previous threads

http://www.rightsnet.org.uk/forum/appeals/523.html

http://www.rightsnet.org.uk/dc/dcboard.php?az=show_topic&forum=100&topic_id=799&mesg_id=799&page=

Have a look at CIB/14442/96

There is a way to find out if individual doctors have passed the
exams for the Diploma in Disability Assessment Medecine all you need to do is phone the Royal College of Physicians Faculty of Occupational
Medecine who are the examining body.

Their phone number is 020 7317 5890.

They do not keep a comprehensive list of all those who have passed the exams but last year there were 28 passes but this year only 8.

If you type Diploma in Disability Assessment Medecine into Google
you will be taken to that part of their website that gives the exam
regulations, details of those who offer the training and the books
etc that are needed. Once you have the books you will be better able to judge whether or not a GP would know this stuff. What has been noticed is that carrying out full assessments as outlined in the books on occupational medecine would be much more detailed and
time consuming than the methodology adopted by some examining doctors.

GP's have been charged with the responsibility for certifying claimants incapable of work since 5/7/48 and earlier, and suddenly their evidence is not good enough for the decision-maker, and a computer program is preferred.

there is a program to 're-educate' doctors in their whole _attitude_ to unfitness for work (as opposed to promoting training in skills, if the above figures are anything to go by.

it is also proposed, in all seriousness, that GP's surgeries will have a state-salaried JSA adviser planted in it. no doubt GP's are thrilled.

with the Secretary of State systematically dissing GPs, one wonders what pressures are brought to bear on tribunals regarding the weight that can be attached to GP's evidence, eg training, guidance other than that issued by commissioners...? and whether it will become impossible for even exemplary tribunals, to give fair decisions...

i mean, if GP's can be made to have 'JSA advisers' in their surgeries...

jj