Employment & Support Allowance (ESA) Doctors Factual Report
When you apply for ESA and complete your application form, you will provide the DWP with a lot of information about your health and the people that look after your health. It should come as no surprise to learn that the DWP will still, in most cases, write to your doctor and ask for some more information.
If the DWP decide they need more information your doctor will have been sent a "Factual Report" for completion, which means the DWP need further information about your medical condition(s) and the impact your condition(s) have on your day-to-day life in order to decide your claim.
What information does the DWP ask for and is your doctor allowed to write whatever they want?
The DWP issue doctors with guidance on how to complete the Factual Report and what information they are interested in.
So what do they say a doctor can and cannot put in the "Factual Report"?
To ensure compliance with ‘Rehabilitation of Offenders Act 1974’, the doctors report should not contain any reference to criminal convictions, whether spent or not, unless the information is directly relevant to your condition or disability.
This report is not subject to the Access to Medical Reports Act 1998. Therefore your doctor does not need to ask you to read it before it is returned.
General guidance from the DWP on completing the Factual Report
Doctors must record relevant information based on their knowledge of you and your medical records. It is not necessary for them to interview you to to complete this form.
Doctors are advised to write down facts rather than opinion. The DWP state that they require an objective report - Doctors are told to only include information about symptoms that are recorded in your patient records and information about disabling effects that they or another healthcare professional have directly observed.
Doctors are advised that it may be helpful to your claim to enclose any relevant correspondence contained in your patient file, for example recent consultant letters, letters from the Community Mental Health Team etc.
Doctors are told to ensure that any third party information is removed. Third party information is any sensitive information that refers to someone other than yourself, for example your family.
Doctors are told to complete all sections as fully as possible but write “not known” if appropriate. The DWP state that “Not known” can be helpful in their guidance to doctors.
Relevant information is anything that relates to health conditions or disabilities which impact on an individual’s functional ability
Guidance to doctors on completion of section on effects of the disabling condition
The assessment for Personal Independence Payment considers your ability to carry out a series of everyday activities.
In this section, doctors are told to provide information on the your ability to carry out the relevant activities, if they are able. The relevant activities that doctors are asked to comment on are:
- Managing your health conditions and treatment
- Reading and understanding information
- Walking or moving around
- Getting somewhere on your own
- Making simple budgeting decisions
- Preparing, cooking and eating food
- Washing, bathing and using the toilet
- Dressing and undressing
It should be noted that this list of activities is not a complete list when compared to the actual activities assessed for eligibility for PIP.
If you find yourself in a position where you need to challenge a DWP decision not to award you PIP, this is an area that you should ask your adviser to look into, to see if the doctor could have provided evidence in relation to the activities not included in this list.
Doctors are told to only write what has been observed by them or another healthcare professional. For example;
self care – “rose unaided from a chair in surgery, no bending difficulty noted.” Getting around – “walks slowly with marked right sided limp using a walking stick, not breathless or very breathless when attends surgery for routine check.”
Doctors are told to only include observations, not opinions.
The following are examples of information that the DWP suggest it may be useful for doctors to comment on.
Respiratory conditions including asthma and COPD – exercise tolerance, recorded variability, peak flow readings (including serial readings), spirometry results, treatment and compliance – prescriptions requested regularly / when was last prescription, oral steroids and hospital admissions in last 12 months.
Ischaemic Heart Disease – investigations including results of formal exercise testing, exercise tolerance, clinical findings, response to treatment including nitrates, treatment compliance, hospital admissions in last 12 months.
Musculoskeletal conditions – recorded symptoms, recorded history of falls, detailed clinical findings including range of joint movements, treatment including planned surgical treatment with dates, response to treatment and compliance - prescriptions requested regularly / when was last prescription.
Mental health conditions – documented history of self harm, self neglect, detailed mental state findings, history of admissions – voluntary or compulsory, regular prescriptions and last one ordered.
Sensory impairment – visual and auditory acuity
Clearly this list isn't extensive and we would suggest that in these days of over worked doctors who are being advised by the British Medical Association that they only need to do the minimum requirements in relation to providing supporting evidence for patients benefits claims, that it wouldn't be a surprise to find some Factual Reports being submitted on an "include only the minimum" basis.
The regulations state that the person making the claim may, at any stage, request a copy of the doctors Factual Report to be sent to them by the Department for Work and Pensions. We would advise that unless you have a very good long term relationship with your doctor, it would be prudent to ask the DWP to send you a copy of any report the doctor has sent them relating to your claim for PIP. If you find you have to appeal a decision not to award you PIP, a copy of the report may provide vital clues as to why you were not awarded PIP.