Appeal Evidence - Gp letters v ‘patient print outs’

The news story about GP’s charging for letters raised a some questions with me. In our area some GPs charge around £30.00 for a letter, quite a lot don’t charge and one or two just refuse to have anything to do with the appeal process at all.

Many clients have asked for ‘patient print outs’ of their medical records for the period in question and these have proved much easier to get and are either cheap or free. They often contain a lot of extra information of help to Tribunals, such as results of tests, frequency of visits to the GP, copies of letters etc.

I was wondering if anyone had any thoughts or anecdotal evidence about the efficacy of ‘print outs’ as opposed to specific letters- there will of course always be a place for the letter asking something very specific but for the typical ESA appeal (for example) my experience is that the Tribunal welcomes the print out for its comprehensiveness and the fact that it was made at the time rather than ‘after the event’.

Any thoughts or observations gratefully recieved

The medical evidence debate comes up on a fairly regular basis doesn’t it?

I would say that in my experience it really does depend on the client, the condition, the strength of the case, etc. Sometimes I will go all out to try to obtain a specific letter from the client’s GP, sometimes I’ll request a print-out of the consultation records and sometimes I’ll seek supporting evidence from other sources (support workers, housing officers, CPN’s, psychiatrists, Blue Badge assessment reports, OT reports, physios, etc, etc) as being more appropriate and representative of the client’s difficulties. Horses for courses.

What I DO do is, where there is little or no other source of independent evidence and the client’s surgery is one of those surgeries who won’t produce anything without a fee, is to raise the issue in my sub and invite the tribunal to adjourn if they feel the surgery records are necessary. That way, at least the tribunal is aware of the situation.

I have usually found the best sources of evidence are the letters that go back to the GP from a specialist after a referral.

when the gp sends a patient for further tests or treatment at the hospital or clinic I have found that the specialist often writes back detailing what has been found/done.

These letters often contain clinical findings and as it is a letter that hasn’t been specifically requested to support an appeal there can be no question of bias.

1964 raises a good point, Tribunals never seem to ask for anything except the medical records ( I can’t recall one ever asking for specific medical evidence, although I’m sure it is within their powers to write to a doctor for something specific) so perhaps they appreciate it when we   give them what they would have asked for themselves.

Print outs make a lot of sense to a medic, but not to us lay people.  They can also be lengthy. 

This means that we are faced with trying to work out what is relevant and/or helpful and what is the significance of things like test results, symptoms, dosages, etc when we lack medical knowledge. 

I think that one effect is to then place far too much power in the hands of the Doctor on a Tribunal.  Generally I don’t like having to run an appeal with the GP records, though given the inquisitorial role of Tribunals, they are within their rights to ask to see the full works.

One compromise may be for the client to ask for copies of specialist letters and reports which the GP has using the access to records rights.  These make a lot more sense to most people.

here’s a link to rightsnet news story -

http://www.rightsnet.org.uk/news/story/half-of-gp-surgeries-providing-evidence-for-esa-appeals-charge-a-fee

and Citizens Advice press release on survey of GPs -

http://www.citizensadvice.org.uk/index/pressoffice/press_index/press20140514.htm

I find tribunals more often adjourn for medical records and schedule an independent examination. That way, the doctor on the tribunal can draw impartial conclusions about the appellant’s condition.

In reply to Pete’s point, they can and do (on occasion) ask specific questions of a consultant or GP.

I take Neil’s point that we are lay people, but most test results are measured against known ranges and some records even give that information. I am not alays sure that GPs do more in a lot of cases than take a certain course of action if the “numbers” indicate a certain condition. For example, after several months of tests because of reporting a general fatigue, my mother was told she is diabetic on a blood test result of just over 7 (it was 57 on the new scale, against a normal range ending 53). She was commenced on medication for type 2 diabetes because of that, although it seemed unlikely to us as a family that such low readings really caused the awful fatigue she was experiencing. Some months on, and we now know she has heart failure. Similarly, her warfarin is adjusted if INR results go above 3 or below 2 - she knows that, and we know that.

What I mean to say is not that we are, or should try to be, pseudo-medicos, but that there is a lot of information out there which we can all access, and which may not be as impenetrable as we may think. Generally, if tests produce an abnormal result, some action is going to be taken, if only to record that no particular treatment is required at that time.

Clinic letters (from hospital appointments) can be very useful, although clients often report that something they are told by the consultant is not recorded in the letter, or is recorded inaccurately.

Overall, however, I prefer to have the GP records and clinic letters, as you often do get a pretty good picture which will either support what your client says, or raises issues that you can deal with before any hearing (e.g. you are told person visits GP every two weeks, yet records show twice in last 6 months, and for unrelated issues)