«Updated on 28 July 2015 Foreword This document has been produced by the Department for Work and Pensions (DWP) to provide guidance for providers ...»
5. Reports are graded as A, B or C depending on whether they are acceptable and whether or not they contain significant learning points.
4.5.6. The full audit criteria and further explanation of each attribute in relation to grades is included at appendix 5.4.
* not applicable in all cases
4.6. Rework 4.6.1. Where the Department considers that assessment reports are not fit for purpose it may return them to providers for rework, which will be carried out at their expense.
4.6.2. The criteria are that reports will be:
1. Fair and impartial.
2. Legible and concise.
3. In accordance with relevant legislation.
4. Comprehensive, clearly explaining the medical issues raised, fully clarifying any contradictions in evidence.
5. In plain English and free of medical jargon and unexplained medical abbreviations.
6. Presented clearly.
7. Complete, with answers to all questions raised by the Department.
4.6.3. Providers should develop procedures for accepting, recording and dealing with rework quickly and effectively.
Rework Action 4.6.4. The action to be taken in relation to rework will vary on a case-bycase basis. Wherever possible, cases should be discussed with the original HP or referred back to them for further action to be taken.
4.6.5. In some cases it may be necessary for an additional face-to-face consultation to be carried out, either with the original HP or a different HP. The impact of any such consultations on claimants should be considered when making the decision to carry out a repeat consultation. Where possible further consultations should be avoided, so as not to place extra burdens on claimants. However, this should not compromise the quality of the advice to DWP.
4.6.6. If clerical report forms are being used, Rework activity should result in the production of a new report form (PA2, PA3 or PA4).
Feedback and Record keeping 4.6.7. Providers should establish procedures to ensure that feedback is provided to HPs whose reports require rework.
4.6.8. Providers should record the feedback given and remedial action taken as a result of rework. Providers should consider targeted audit of HPs where rework is required.
4.7. Assessment quality feedback from Her Majesty’s Courts and Tribunal Service 4.7.1. The PIP assessment specification made clear that PIP Assessment Providers may receive feedback from Her Majesty’s Courts and Tribunal Service (HMCTS) about the quality of the assessment reports. Providers should consider this feedback and take the appropriate action.
4.7.2. Where a medical member of an appeal tribunal identifies that an assessment report is below the standard expected of providers, they may consider giving feedback on the report to the provider in
question. The criteria are that reports will be:
4.7.3. Providers will need to work with the DWP and HMCTS to develop the processes for receiving this feedback.
4.7.4. Providers will also need to develop internal processes for recording referrals from HMCTS, action taken and responding to HMCTS. This should include processes for considering feedback from HMCTS, and where they agree that quality is substandard, steps to ensure that the feedback is passed to the relevant HP where appropriate and any necessary improvement activity taken.
4.7.5. Providers will also need to develop processes for liaising with HMCTS where they do not agree with the feedback received and for escalating any unresolved disagreements to the DWP Chief Medical Officer, who is the final arbiter on assessment quality standards.
4.8. Complaints 4.8.1. A complaint is an expression of dissatisfaction about the services delivered by providers which originates from a claimant. They may be made verbally or in writing by the claimant or their representatives.
4.8.2. Providers should put in place processes to effectively manage complaints.
Serious Complaints 4.8.3. A complaint in which there is an allegation of professional malpractice against an HP is classed as a Serious Complaint. This
includes, but is not limited to, allegations of:
4.8.4. Providers should develop processes to manage Serious Complaints separate to the overall complaints processes, with escalation routes to appropriately senior staff.
4.8.5. Where a Serious Complaint is made against an HP, the DWP CMO should be informed immediately. Providers should also consider suspending the HP from carrying out PIP assessments until any investigations into the complaint have been completed.
4.8.6. Providers should liaise with the DWP CMO on the outcome of any investigation into a Serious Complaint. If a Serious Complaint is
upheld, providers should consider:
5.1 Fees for further evidence 5.1.1. DWP pays fees for General Practitioner Factual Reports (GPFRs);
GP and Consultant completed DS1500s.
5.1.2. Fees are not paid by DWP for other sources of evidence, such as Hospital Factual Reports from NHS hospitals and clinics; Local Authority funded clinics; or factual reports / GPFRs completed by professionals other than GPs or Consultants.
5.1.3. For many years the Department has not accepted “Treasury fees”, which doctors often quote.
5.1.4. The DWP sets its own fees for factual reports and information where a fee is payable and providers should not negotiate individual fees with doctors (GPs or hospital staff). Payment for evidence other than the GPFR or DS1500 should be discussed with the Department on a case-by-case basis.
General Practitioner Factual Reports 5.1.5. As independent contractors, GPs are permitted to receive a fee for completing GPFRs and providing factual information unless the information required is included in their contractual agreement.
5.1.6. Where it is permissible to pay a fee, this should be the standard fee that the Department pays – currently £33.50 for a GPFR and £17.00 for a DS1500 completed by a GP (although providers will usually not need to seek DS1500s from GPs). If the GP’s surgery is VAT registered, VAT should also be paid in addition to the appropriate fees.
Hospital Factual Reports
5.1.7. Under a longstanding agreement (which dates back to the start of the NHS and is sometimes referred to as the ”concordat”) hospitals and Trusts are obliged to provide hospital case notes (or copies), Xrays and Factual Reports, on request, within laid down time scales, and free of charge to the DWP and providers working on their behalf.
5.1.8. Hospital Factual Reports from NHS hospitals, hospitals who have Trust status, and clinics financed from the NHS or Local Authority are therefore provided free of charge and should not be paid for.
5.1.9. Care should be taken to ensure the hospital etc. is funded by the NHS. Private hospitals are not covered by the agreement with the NHS.
5.1.10. The responsibility to provide factual reports lies with the hospital, and requests should be addressed to the hospital as opposed to a particular member of staff - though the requests may specify the type of information that would help (e.g. from a physiotherapist).
5.1.11. No fee is payable to the person completing the report.
5.1.12. Sometimes hospital staff state that they are not contracted to carry out this work on behalf of the hospital. If so they should ask the hospital to arrange for someone else to complete it on behalf of the hospital.
Rejecting requests for payment 5.1.13. Providers are responsible for making payments for the above evidence types where they have sought them, with DWP reimbursing them the fees paid.
5.1.14. Where requests are made for payment that do not meet the above criteria, providers should issue a notice rejecting the request.
5.1.15. Requests may also be rejected where a professional has responded to a request that would normally be payable but the response was not of an acceptable standard and provided no help in the case – for example, where the professional has made no effort to provide useful information – or the professional has returned their report significantly later than the date requested. However, judgement should be applied when making such decisions, as incomplete returns may be as a result of professionals having insufficient information about the claimant, rather than an unwillingness to help.
Such rejections are likely to be rare.
5.2. The principles of good report writing Clarity 5.2.1. Good quality reports should:
Clear English 5.2.2. When HPs explain medical reasoning or expressing opinion, it is essential that there should be no misunderstanding. As in all forms of medical (and other) writing the guiding principles should be that
5.2.3. Use of vague or ill defined words such as “may”, “possibly”, “occasionally”, “sometimes” do nothing to refine an account of a case; they merely generate uncertainty. The HP should assist the Case Manager by providing quantifiable data wherever possible.
Appropriate language 5.2.4. PIP assessments are a serious matter that have a direct bearing on benefit entitlement. As such flippancy in reports is not appropriate.
Light-hearted remarks about the claimant, the domestic environment, the forms, the benefit and the system in general should not be made as these can cause offence and difficulty.
5.2.5. Reports should not include terms which could cause offence.
Appropriate language should be used when describing the claimant, for example "overweight" or "obese" as opposed to "fat". Unless it is essential to the determination of the claim, any information that may be construed as a value judgement should be avoided in advice. For example, comments about the claimant appearing dishevelled are inappropriate, unless they are part of the evidence supporting a level of self-neglect due to mental health problems.
Explanation of technical terms 5.2.6. Attempts to express medical terms in non-technical language can often be difficult and confusing. It is usually preferable to use medical language to describe medical issues and then to explain what they mean.
5.2.7. The functional implications of any findings must be explained in the summary justification. For example, “the claimant has reduced shoulder movement – this means that he needs to use an aid to dress and undress and wash and bathe.” The avoidance of medical jargon 5.2.8. Medical jargon should be distinguished from technical medical
language. Jargon is medical slang, or shorthand such as:
5.2.9. Such jargon may not be understood by the CM or the next HP to read it and should be avoided.
Avoidance of internal contradiction 5.2.10. Medical reports must be internally consistent.
5.2.11. If the HP makes the observation in one part of the report that a claimant has only minor restriction of lower limb function due to osteoarthritis, and in another section gives an opinion that he is unable to negotiate stairs due to painful arthritic knees, the reader will question the point.
5.2.12. If the HP’s opinion does conflict with information provided by the claimant, the HP should fully explain why there is an inconsistency and the evidence on which their advice is based.
Correctness embraces a number of principles:
5.2.14. Prescriptive language which quotes or reflects phrases (e.g.
’reconsideration’) used to define conditions for entitlement should be avoided.
Completeness 5.2.15. It is very easy to miss out a key factor in a consultation. Good preparation is important and it can be helpful to write down a checklist of all the salient aspects of the case before embarking on the consultation.
Facts versus opinion 5.2.16. A fact is a verifiable statement about the claimant – for example, "He takes paracetamol as required for pain in his left knee".
5.2.17. An opinion is the perception or view of an individual – for example, "In my opinion, he only has mild pain"; "In my opinion, she requires supervision in the kitchen". Unsupported opinion should not be included in reports.
5.2.18. Facts provide strong evidence for opinions because they are verifiable. Facts should be used to support descriptor choice.
Opinions are most robust if they are based on fact – for example, "In my opinion, his level of pain from osteoarthritis is mild, as he only needs to take paracetamol twice a day"; "She is not safe unless she is supervised while cooking, as she has several times burned saucepans by forgetting them on the hob".
5.2.19. When the HP evaluates the opinion of a third party that provides evidence – for example, a carer or health professional - the HP should evaluate the strength of the opinion being expressed. The HP’s evaluation should include the level of expertise of the individual offering the opinion; their direct knowledge of the claimant; and whether it is medically reasonable. An unsupported opinion will carry no weight, whereas an authoritative, well-justified opinion from an expert source will carry far more weight, especially if it is supported by factual evidence. The HP should also consider whether the third party is acting impartially or as the claimant's advocate.