Hi please see below scenario and if you can help in any way or comment or tell me your experiences I would be grateful....
Client comes in for ESA appeal We write off for Med Ev from Clients GP Quote comes back £176 Limit according to LSC for GP reports is £99 or £135 (depending on who you ask) I called LSC to ask if we can pay this bearing in mind that this particular GP is the only one that we can approach for this report. LSC says no its above the limit This happened around 3 weeks ago and I was told yes - it was reasonable to incur it. This time they are saying no I dont want to pay it unless i get something from them in this particular instance to say yes
What do people think?
Please also note that they were not willing to get into a conversation as to whether they had the discretion to allow it in individual cases or not and this is the crux of the problem as it has been allowed in the past - it seems that it depends on who you get through to.
Doctor (GP) £99/hour (non-London) £90/hour (London)
Thus, for a "Records Report" (have to say not sure what LSC mean by this - is this a report prepared just from perusal of the patient's medical records without an examination? surely that is most GP reports?) then a max fixed fee is payable.
For any other type of GP report than there is a max hourly rate payable and so GP will need to break down amount of time spent on preparing the report in order to satisfy LSC that max hourly rate not exceeded.
That is how I read it, but would be interested on others views on this and the other proscribed rates for experts.
We had one local GP whose standard fee was above £99 per report. When the fee cap was brought in and we needed another report from him, we wrote to him explaining about the cap and he agreed to reduce his fee to £99. We've had a couple more reports from him since then and he has charged £99. Unfortunately, this has had the knock-on effect whereby a couple of our other local surgeries have realised through the grapevine that they were charging well below the £99 cap and they have now increased their fees considerably!
Post by Richard Wilkinson on Mar 21, 2012 17:38:23 GMT
I think this GP wont budge, so Apars helpful suggestion wont work in this case. I think the question is also whether the LSC have power (based on the individual circs) to pay a higher hourly rate. I think some staff think they have the power so seem to act as if the power is not there at all. Any thoughts?
Post by Patrick Torsney on Mar 21, 2012 19:53:33 GMT
I was thinking about this the other day. I think what the LSC is saying here is that the GP Records Report is what you would see as your typical medical report from a GP to support, for example, an appeal against benefits withdrawal
On the other hand, the GP hourly rate would be where the GP is more actively involved in the case, such as being called as an expert witness to substantiate or otherwise support the client's claim. Perhaps the difficulty is in the fact that the fees and descriptions of services that may be covered are actually cross-category, so are necessarily vague in terms of specific category references
Anyway, that was my quick take on it - I admit that I haven't looked into it in any detail. Perhaps the quickest way to get to the answer would be to ask the LSC whether what I have said above is correct or not
Post by nickd (Mylegal) on Mar 21, 2012 22:12:01 GMT
Perhaps, slightly aside from the LSC take on disbursements; - I've very much changed our take on disbursements since the introduction of the fixed fee regime - prior to which we fairly regularly requested medial reports and paid for these out of our disbursement allocation. Life being somewhat simpler in those days!
In the majority of WB appeal cases in which we deal, it is very often a question of interpretation over the evidence contained within the Secretary of State's submission, usually it's the dreaded ESA 85 which becomes a focal point in terms of a questionable assessment. As I see it, there is in a fair number of cases less of a need to obtain additional evidence, which isn't to say it's not helpful. Indeed, doctors and consultants in our neck of the woods seem to be fairly incensed by the questioning of their respective medical judgements and therefore seem quite willing to provide F.O.C reports to refute whatever ATOS say. The client will quite often have taken this up with their doctors and medical experts prior to coming to see us and it isn't unusual to see it already included in the appeal papers. The problem is that the DWP are time and time again ignoring a whole plethora of evidence and preferring the findings of the ATOS healthcare professional (HCP) despite the strength of the evidence to the contrary. It is also questionable whether a client's doctor or consultant can (in the eyes of DWP and in some cases the Tribunal) provide an evidence based assessment of the client's limitation in ESA appeal cases or on their care & mobility needs in say a DLA appeal.
We seem to be getting the results by effective challenge of the DWP's evidence without having to obtain additional medical evidence. The usual approach being to challenge specific descriptor related findings made by ATOS and their HCP's. The exception being where I believe exceptional circumstances may apply in ESA cases; - in which case the client's doctor seems to be quite prepared to provide a F.O.C report to the effect that it would be harmful to their patient's health to find them capable of work even if none of the LCFW descriptors appear to apply.
In summary, wherever possible we try and get a result without incurring any cost. Tribunals seem to be leaning towards accepting that a lot of errors are being made in these healthcare assessments.
It's also worth bearing in mind that if you really do get stuck you can always request the Tribunal use its powers to request medical evidence from your client's clinicians; - in which case it won't cost you a penny.
Wherever possible I try and avoid getting into any more bureaucracy with the LSC by leaving them out of it!
My take on this is that as most GP reports are from notes then it is the fixed fee. Sometimes GP do call in clients and do a consultation with the client. Problem is if you request this then the price will go up. Some tribunal can interpret these reports as if from notes based on little evidence or if in a consulatation the GP simply writing down what the clients answers so are not evidence at all. We request a report starting with with medical condition questioniare and then more questions on abilities with requests for medical records and copies of consultant letters. You have to know you GPs. Some will be expensive. Some will not fill questionares in. Some will only comment on medical diagnosis. Other areas should be consulted CPN, Teachers, DLA evidence, ESA evidence, Communit Care Assessments, Occupational therapyst. personel injury ETC. I think that it is a key role of Caseworkers/Reps to gather medical evidenmce from GPs or any other sources even with the good resuilts of NickD and the restrictuions of the fixed fee cases. This helps to assess chances of success or not and the possibility of a lost opportunity at tribunal and client complaints that we have not done everything.
Post by Richard Wilkinson on Mar 26, 2012 15:33:57 GMT
Thanks everyone. Agree with everything everyone has said. I think the question is trying to clarify what the process is for requesting the exceptional circumstances provisions for breaching the limits as set out in the contract.
The issue is not restricted to gp reports, its also come up on age assessments, voice analysts etc. For cert files there is a form and a process, but for LH files its a bit unclear. If you ring the LSC they are not entirely whether it can be done and how. Some verbally authorise on the phone so say no power to.
I agree with everything everyone has said but its also about challenging the LSC rather than just conforming to whatever payment regime is enforced on clients.
Post by Richard Wilkinson on Apr 3, 2012 12:06:46 GMT
Just an update on this. Actually managed to speak to someone with some sort of sensible perspective on this. It appears that a gap between the LSC policies and the procedures/processes has been identified. It appears that PA needs to be asked for, but there isnt a clear procedure for doing it. Its still being looked at, will update when we hear anything else
Post by StephenMichael on Apr 4, 2012 10:06:16 GMT
We are having a meeting with the lead consortium GP for our area (Wirral) in the next few weeks over the vexed issue of providing us with medical reports. It appears some GP's are getting nervous about supplying us with the reports (However funded), so we aim to head them off at the pass and allay their fears. They are not sure about what information we are requesting and the reasons for it. Lots of GP's and Consultants in our area are appalled that their patients are being found fit for work when clearly they are not. There seems to be no clue about mental illness and mental health issues. Further, their diagnoses, findings and opinions are not respected by ATOS HCP's.