Search rightsnet
Search options

Where

Benefit

Jurisdiction

Jurisdiction

From

to

Forum Home  →  Discussion  →  Work capability issues and ESA  →  Thread

Free copy of GP records vs chargeable letters

Mr Finch
forum member

Benefits adviser - Isle of Wight CAB

Send message

Total Posts: 444

Joined: 4 March 2011

I have a client who’s just paid £30 for a one line letter that says he has been diagnosed with X and Y,  one of the symptoms is Z, and he is signed off work.

Since this is substantially the same as information held in his medical notes, is this really a valid charge?

Paul_Treloar_AgeUK
forum member

Information and advice resources - Age UK

Send message

Total Posts: 2252

Joined: 7 January 2016

You think that’s bad?

When I was at Mary Ward Legal Centre a few years’ back, we wrote to client’s GP to ask for short supporting letter.

They asked for £50 to provide said letter. We coughed up and the GP replied by saying “I’m unable to comment on the issues that you have enquired about”.

Ruth_T
forum member

Volunteer adviser - Corby Borough Welfare Rights & CAB

Send message

Total Posts: 275

Joined: 21 June 2010

A few years ago we asked a hospital consultant to supply a letter of support for a client.  He wrote back stating that he would be happy to oblige, for a fee of £100.  We responded that we were a charity and were unable to meet charges for doctor’s letters.  His reply:  “I work for the NHS.  That’s charity enough”.

Paus17
forum member

Epping Forest CAB

Send message

Total Posts: 74

Joined: 6 May 2014

In my view paid-for GP letters are a waste of money for the client and a waste of time for the doctor. If the GP knows the client really well and is concerned about them they will provide a letter for free. Otherwise the request goes to whichever doctor happens to be available who has to try to cull something from the notes for their £25-£50.

Tribunals now seem to ask for the client to provide full medical records for whatever is the relevant period, pointing out that the patient is entitled to these for free. From the tribunal’s point of view they are probably better evidence than a letter because they are contemporaneous and comprehensive. They should include any consultant letters to the GP which should tell the tribunal everything it needs to know.

Va1der
forum member

Welfare Support Worker - Community Renewal Edinburgh

Send message

Total Posts: 271

Joined: 7 May 2019

I’m sure most advisers who request evidence will have a varied experience with this. I’ve seen free letters that directly address descriptors with reference to specific conditions and medical history - which the GP elected to provide on his own initiative, to the equivalent to OP - £30 for 4 lines of text that achieved nothing at all.

There are 4 surgeries in our catchment area, and they all respond differently.

I suspect I tickled one of them the wrong way, when I requested evidence twice for one client, for ESA and PIP. They are now pretty much refusing to provide evidence at all => cue SARs -> which they are now trying to escape by some creative means…

With regards to tribunals now wanting full medical records, I haven’t seen any of that in Edinburgh. And in terms of requesting the records, I’m reluctant to just submit SARs en masse, tempting as it may be. Because I know it creates a big workload for an overstretched NHS and a pile of paperwork that I don’t have the time to go through, or the expertise to understand.

EDIT: ‘Social Prescribing’ is a buzzword with the NHS at the moment, as they look to address wider impacts on people’s health, rather than just medical treatment etc. May just provide an avenue to establish a better route to medical evidence for benefits - in time.

[ Edited: 20 Jan 2020 at 10:12 am by Va1der ]
Mike Hughes
forum member

Senior welfare rights officer - Salford City Council Welfare Rights Service

Send message

Total Posts: 2409

Joined: 17 June 2010

General experience now is that tribunals don’t ask for all medical records but maybe for a year or two prior to the date of claim. I have yet to come across a case where this has been wholly relevant. It has either confirmed other credible evidence which ought to have been accepted anyway or, as appears to more often be the case, it’s either sheer laziness on the part of the tribunal or a tactic from a judge to avoid confrontation with another panel member.

I am aware that periodically, particularly in unrepped cases, it can cast things into a clearer light as regards mental health or learning disability but beyond that it’s just a HMCTS work creation scheme.

As regards GP letters I literally have not bothered in years. Totally with Paus17 on this. Might be relevant where the claimant lacks insight into their own conditions but, if they’re that bad, there will almost always be other better evidence anyway. Anecdotally I’m not aware there’s been any detriment to my clients. My instinct is that it’s actually enabled things to move quicker; focused the client away from an obsession with more medical evidence being the solution to a problem which is really about anecdotal examples of functional impairment and helps me produce better focused subs where needed.

Mr Finch
forum member

Benefits adviser - Isle of Wight CAB

Send message

Total Posts: 444

Joined: 4 March 2011

Perhaps I should clarify that I agree that paying for letters is useless, and I was nothing to do with the request made in this case.

My question is really just whether in my case, should the client be pursuing a refund, as the information provided should not have been subject to any charge?

Dan_Manville
forum member

Mental health & welfare rights service - Wolverhampton City Council

Send message

Total Posts: 2262

Joined: 15 October 2012

Mr Finch - 20 January 2020 11:49 AM

My question is really just whether in my case, should the client be pursuing a refund, ?

GPs see these letters as private work; last time I looked the BMA recommended rate for that work was £210 an hour. £30 for a glimpse at the records and a quick letter’s pretty reasonable from that perspective.

Va1der
forum member

Welfare Support Worker - Community Renewal Edinburgh

Send message

Total Posts: 271

Joined: 7 May 2019

Mr Finch - 20 January 2020 11:49 AM

My question is really just whether in my case, should the client be pursuing a refund, as the information provided should not have been subject to any charge?

Should is different from could…

If you have a good relationship with the surgery you might get a refund, or perhaps a bit more likely, get the letter rewritten to better meet the client’s needs.

If the client just wants to punish the surgery for wasting his money he’d be better of with a complaint (unlikely to achieve much), or submit a SAR, which would provide his records, and probably annoy the staff as an added bonus.
Of course, this may also sour his relations with the surgery, which may be detrimental in the long run.

Paul_Treloar_AgeUK
forum member

Information and advice resources - Age UK

Send message

Total Posts: 2252

Joined: 7 January 2016

We’ve got a factsheet Resolving problems and making a complaint about NHS care which might help if your client decides to pursue a complaint against the practice.

Va1der
forum member

Welfare Support Worker - Community Renewal Edinburgh

Send message

Total Posts: 271

Joined: 7 May 2019

Mike Hughes - 20 January 2020 10:29 AM

As regards GP letters I literally have not bothered in years. Totally with Paus17 on this. Might be relevant where the claimant lacks insight into their own conditions but, if they’re that bad, there will almost always be other better evidence anyway. Anecdotally I’m not aware there’s been any detriment to my clients. My instinct is that it’s actually enabled things to move quicker; focused the client away from an obsession with more medical evidence being the solution to a problem which is really about anecdotal examples of functional impairment and helps me produce better focused subs where needed.

I have the opposite experience (sometimes, not always). I’ve had tribunals who seemingly completely ignore the claimant, and base their decision entirely on medical evidence. And, where that evidence is lacking, doesn’t award any points at all.

Of course that could be entirely blamed on my (lack of) experience/skill as a representative.

Elliot Kent
forum member

Shelter

Send message

Total Posts: 1745

Joined: 14 July 2014

I don’t know that Mike’s views on this are necessarily representative of the mainstream (if he doesn’t mind me saying…)

I can think of a number of cases I’ve done recently that have either been won mainly or largely because of GP records or where the claimant has had a much easier time because of them than they otherwise would.

One case I did, the gent’s assertions about the level of pain he was in were extremely difficult to believe on his own account and were initially supported only with an X-ray of the offending body part which showed no abnormalities. The account had been rejected by the assessor and a previous tribunal but the GP records turned up along with half a dozen specialists letters to the tenor of “this person’‘s pain is definitely genuine and we have tried everything to figure it out and treat it but we can’t”. The Tribunal then accepted his account which had become way more plausible as a result of the records.

Another recent case, very little information in the bundle until the claimant took it on herself to get all her hospital records from epilepsy clinics going back to the 1980s. Tribunal gave her ER/ER in very short order.

Plenty of cases beyond that where a few choice quotes from the records cause the appeal to lapse, or where the records confirm a suspicion of a mental health condition which the claimant didn’t mention at first due to a lack of insight or what have you.

We have to remember that it is a valid answer to an appeal for the Tribunal just to say “we don’t believe you” (okay - the UT may require a bit more nuance than that, but fundamentally). Anything which can assist in helping them believe your client is potentially useful.

Of course we also have cases where the records are completely useless - e.g. my client who was directed to provide her medical records notwithstanding that she had not seen a doctor for 10 years as she was of the view that it was pointless because of her incurable MS.

Just the counterpoint - you’ll figure out what you make of it.

(And I agree with Mike almost entirely on GP letters - you can get some good ones if they know the patient really well and are invested in the case, but often they will fall into the camp of being either far too general so as to be of no use or far too specific that they just make Tribunals suspicious e.g. “Mr X cannot walk 50m without stopping and cannot use a wheelchair” might sound good but unless it is supported by something, a Tribunal is probably just going to think it was led. They are sometimes useful for persuading the DM though.)

Peter Turville
forum member

Welfare rights worker - Oxford Community Work Agency

Send message

Total Posts: 1519

Joined: 18 June 2010

This issue has been discussed many times over the years on Rightsnet without consensus. I suspect its a ‘horse for courses’ question.

We find a carefully worded (but short) request to GP (or other appropriate HCP) focused on client’s symptoms and the relevant criteria can be very useful particularly in cases where there has been no recent specialist input and conditions are GP managed / client does not engage with appropriate service / service is very difficult to get a reply from etc. If nothing more they help to ‘fill in the gap’ between client’s own evidence and available medical records.

Of course it is difficult to know what weight the tribunal actually gives to such evidence in a particular case (short of requesting a statement of reasons) but they do sometimes ask why we haven’t requested such a letter (e.g. because the patient’s surgery is one that charges for letters)

Local tribunals appear reluctant to take the ‘GP has been led’ approach (a long standing narrative of Govt, DWP, DMs etc) if the reply directly addresses the relevant qualifying criteria probably because (a) we send a copy of the criteria (b) GPs etc are likely to give their professional opinion rather than simply repeat what the patients advises (or reply ‘the patient tells me….’).

One new issue we experience now that HMCTS will not request medical records directly is the tribunals often direct the claimant to request their records for X (short term) years when records for Y (much longer years) would be more appropriate - perhaps because the condition has been GP managed for a long periods and all the specialist input was at an earlier period. As Elliot notes a discharge letter Z years ago from specialist stating ‘there is nothing more we can offer’ can be valuable evidence for example.

Mike Hughes
forum member

Senior welfare rights officer - Salford City Council Welfare Rights Service

Send message

Total Posts: 2409

Joined: 17 June 2010

Elliot Kent - 21 January 2020 08:49 PM

I don’t know that Mike’s views on this are necessarily representative of the mainstream (if he doesn’t mind me saying…)

I think that’s fair comment. They just should be :) “Stamps foot”.

(And I agree with Mike almost entirely on GP letters - you can get some good ones if they know the patient really well and are invested in the case, but often they will fall into the camp of being either far too general so as to be of no use or far too specific that they just make Tribunals suspicious e.g. “Mr X cannot walk 50m without stopping and cannot use a wheelchair” might sound good but unless it is supported by something, a Tribunal is probably just going to think it was led. They are sometimes useful for persuading the DM though.)

There is the case law on the whole issue of how repetition by a GP of what the claimant tells them should not be treated as leading. Rather it is evidence of credibility as a good GP would not repeat verbatim something they believed was not credible. Sadly, we all know exceptions to that rule so one does understand why tribunals take the approach.