GETTING THINGS RIGHT
A complex and detailed medical legal report will inevitably go wrong sometimes. We want to prevent things from going wrong and are open and transparent about what we offer. The legal framework is complex and Dr Burgin must follow it but the framework is to protect you too. Here are some of the options you have to help the process stay on track.
Send an email: In legal circles this is called The Approach and gives you a chance to ask a few questions without it costing you anything. You may want to be certain that Dr Burgin is the right expert for your case or advice as to the right expert. You may not be sure what a report would do for your case. You may want to know how an expert would consider your case and what information you should send.
Speak with Jenny: Jenny is Dr Burgin’s office manager and she has 20 years of experience in dealing with some of the most complex cases. She will know the answer or know where to find it. Her training includes finding ways of helping those with disability. She has the patience and time to listen to you at your own pace. She is good at walking you through the process and problem solving.
Information: The more information you provide before the assessment the less chance of you making an error during the assessment. This can include your medical records, employment records, photographs and statements. There is a medical questionnaire that lists the areas that will be covered (what happened, treatment, symptoms, past history, effects on your life) and you may wish to complete it. If you are worried about not being able to explain what has happened in the assessment then this is good way of making sure that you have covered everything. We do not charge more if you choose to take this service.
Special questions: By writing down all the areas that you want the report to cover the expert can ensure that they deal specifically with those issues. Although the report will deal with everything these questions can ensure that the expert provide a targeted answer. If you or your solicitor realises that they have forgotten to ask these questions before the report is written then they can be asked after. We try not charge extra unless they are unreasonably long.
Have a chat: Dr Burgin is always happy to have a chat if you do not understand something. Just email saying what you are struggling with and ask for a chat. This may be after The Approach, after the assessment or after you get the report. The purpose of The Chat is to help Dr Burgin understand what you need and find a way forward. As the expert is independent it is not an opportunity to ask the expert to change their opinions but it does not cost extra.
Articles: Dr Burgin has written a large number of articles on the problems that can occur. You can Google them or ask Jenny to find a suitable article to help you. CPR35 is available online and is surprisingly easy to understand, please feel free to quote relevant sections.
Conference: This is where you and your solicitors meet Dr Burgin for you to formally plan the case. This is expensive as it can involve raising new issues and then including them in the report. In general, if you need a conference then something has gone wrong with the process as there are better and cheaper ways to solve most problems. Do not be afraid to use one of the other approaches if you feel they will help get you a better result.
Complaint: We have an in-house complaint process which is integrated into our processes. We understand that you just want things to be right and need to understand what has happened. A formal complaint to us or to authorities will be answered in a legally appropriate way referring to the practice directions and the duty of the expert to the court. This formal method may not be able to address all your issues. Please feel free to use another approach even if you have already made a complaint.
EMPLOY A GENERAL PRACTITIONER FOR ADMINISTRATIVE SUPPORT
Most GPs have a high clinical workload and struggle to process all their paperwork. This leads to long work hours and the risk of missing an important detail. Some practices delegate administrative work to other professionals but they then require supervision. Head hunting one of the 35000 GPs who are not on a provider list to do this work makes more sense. One GP administrator can manage 3 front line GPs administrative workload.
GP administrators are GPs who have stepped back from front line clinical practice. They often work from home and require little supervision. They have their own professional insurance and can interpret test results and letters, make clinical recommendations and write referral letters. They are comfortable with speaking with patients and have the time to provide emotional support.
They are used to working autonomously and providing advice to empower GPs rather than add to their workload. As they only need speak to a few patients a day they can take time to develop rapport. This improves the chance the patient will comply with the GP’s plans and reduce DNAs. They can add clinical experience to the team and their holistic approach means that they will notice gaps in care.
AI tools are being widely used by GP administrators to support their work from differential diagnosis to creating easier to read text. AI can be used as a second pair of eyes to identify issues that might have been missed by humans. AI is not reliable enough to replace humans but can collaborate effectively.
Cost is a key consideration and GP administrators add significant value to the practice. Their experience allows them to work faster than other practitioners because they recognise patterns and know what to do. They can ensure that patients are prepared before they see the GP, reducing the number of GP consultations needed to sort the problem. The consultations are simpler as much of the complex work has already been done.
It takes about 14 hours of GP administrator’s time to cover a full time GP and they charge up to £50 per hour. The savings to the practice will include reduced need for locums, less appointments for GPs and GPs freed up from administration. In most cases the cost will be neutral and may even save money. By allowing GPs to focus on their clinical duties they will suffer less stress and burnout.
Dr Mark Burgin BM BCh, MA (oxon), MRCGP has over 35 years of experience in hospital medicine, general practice and medical legal work. Registered as a GP with GMC but not on a performer list and enjoys office work. He undertakes GP knowledge tests every 5 years and has improved his performance from 73% to 82%. Medical legal experience has included how to avoid clinical negligence, GMC processes and completing forms correctly.
THE CHILD DISABILITY REPORT
Understanding Your Child's Needs: Is your child facing challenges at school or home, and you're feeling lost about how to help? You are not alone. Many children face difficulties, and getting the right support should not feel overwhelming. The Child Disability Report offers a faster and more affordable way to support.
Uncover the Full Picture: We offer a comprehensive alternative in a fast and affordable way. Our report provides a valuable investment in your child's future using the whole child biopsychosocial model. This model explores physical, psychological, and hidden limitations impacting your child's life.
Empowering You, Supporting Your Child: Our focus is on understanding your child as part of your family. Through a relaxed assessment in your home or clinic, we explore physical, psychological, and hidden limitations impacting their daily life. A diagnosis can be helpful, but we go beyond labels to provide actionable solutions.
Personalised Path Forward: The Child Disability Report doesn't just identify issues; it offers a clear roadmap for moving forward. You'll receive a concrete recommendation to support your child's development and access the resources they deserve. We can even help navigate collaboration with schools and other agencies to create a positive and supportive learning environment.
The Child Disability Report Advantage:
Fast Turnaround: Receive your report within weeks.
Understand your child: Discover hidden features.
Empowering parents: Gain the knowledge and skills to support your child.
Actionable Steps: Start making a positive impact on your child's life immediately.
Cost-Effective: Access affordable support compared to traditional assessments.
Stress-Free Assessment: Relaxed environment promotes open communication.
Focus on Solutions: Move forward with a clear plan for your child's future.
Take the first step towards removing barriers to your child’s happiness. Contact us today to book an appointment.
The report will not always be comfortable reading but avoids blame. The focus is on honesty, finding out what is wrong and moving forward to a happy childhood.
FAILURE TO PROVIDE
Drink and drug driving is common and the consequences of being caught can be serious to the person and their family. Having a ban can lead to losing one’s job, not being able to care for dependants and social embarrassment. It is important to provide evidence to support your case in the courts.
Solicitors cannot guarantee success but remain the gold standard approach if you have the tens of thousands of pounds required. The solicitor will obtain an expert report but typically pays 3-6 times as much as contacting the expert directly. They will arrange a barrister to explain the legal options and represent you in court.
Barristers can be instructed directly and generally this saves 50% of the cost compare with when arranged through a solicitor. Barristers cannot obtain evidence so you would need to arrange this yourself including a medical report. They will attend court and cross examine witnesses such as the Health Care Professional and the Police Expert on the testing procedures. You may wish to obtain a copy of police procedures to ensure that they were complied with in your case.
Disability analysts can provide a report that assesses if you have a reasonable excuse for not giving the sample when the police asked you to. The CCTV and BWV, the form MGDD/A, printouts of breath samples and your GP records can all help with this assessment. The expert will prefer an in person assessment so that they can perform spirometry. If your practice nurse does the spirometry a cheaper virtual assessment may be appropriate.
Drug and alcohol testing is available privately and through the GP (ask for CDT blood test). This can show that you are not dependent on drugs or alcohol which is important if they send your case to the DVLA. It can also help the expert because they can then confirm your history which strengthens your case.
Pleading guilty has a number of advantages because only small percent of those who go to court are found innocent. This means that you will save any money that you were going to spend as well as avoiding the court processes. You may get a lighter sentence if they give you time off for guilty plea. You may be unable to drive due to the DVLA anyway and it is best if these both run at the same time
SECOND OPINION MEDICAL REPORTS
If you are worried that something is going wrong with your care then it can be difficult to know what to do. A second opinion report can provide you with the information that you require to move things forward. It can help reduce your anxiety whilst waiting for treatment or investigation but importantly windows of opportunity are not missed.
One step forward is Martha’s Rule which gives 24/7 access to critical care outreach if the relatives or staff are worried. The first stage will be available by 2025 but it will take many years to fully implement. It is not likely to help people who are not seriously ill or who are in the community.
Private second opinions reports are of three basic types, the first is a full body MRI scan which acts as either a baseline or a way of ruling out any structural problems. The cost is about £1500 and can be obtained without a doctor’s referral. The reports almost always find something so be prepared to have a repeat scan in 6 months to reassure that those changes are not a problem.
The second type is after death and will be usually conducted under orders from the coroner. The postmortem MRI scan has advantages of not involving any disturbance with the body and can be rechecked if there is a later question. The undertakers are happy to arrange this service on request.
The third type of second opinion report is a based upon a review of the medical records and usually an examination. The expert can make a visit at home or hospital and provide a detailed report that the family can use to negotiate care. If you are not sure whether a Second Opinion Medical Reports is necessary then you can contact an expert for free. Experts are used to providing guidance and helping you make sense of things.
SCREENING FOR CLINICAL NEGLIGENCE
When things go wrong with your clinical care you have a choice of options to make things better. You may want compensation for care needs or to get treatment to fix the problem. You may want the professionals to understand and learn from their mistakes. The first step is a screening level one from an experienced medical expert.
The screening level one report is free and gives you the tools to decide upon the next step. You email the expert with a short description of the problem and what you want to achieve. The expert will respond in a few days with what the medical and legal issues are and your options. You may then wish to get a screening level two report to look at all the evidence.
The screening level two report costs £120 and is a full review of all the medical records and any other evidence. The doctors cannot charge you for providing copies of these records although you may have to wait for a month or so. The screening level two report takes about 14 days to write and will give you a compete picture of the case. At this stage you may wish to get a full medical report or to instruct a clinical negligence lawyer.
The clinical negligence lawyer can only take on a case if you pay for it or they believe that it is likely to win. The no win no fee system (CFA insurance) is limited to the best cases with the strongest evidence and the highest payouts. Only 1% of all clinical errors are successfully litigated mostly because the cost of clinical negligence is so high. Most people who have excellent cases are unable to get a lawyer.
To instruct a clinical negligence specialist you need the material issues, the type of specialist who can deal with those issues and a summary of the notes. The screening level two report has this information so you can approach a specialist directly. The cost is likely to be around £600 subject to negotiation. The turnaround averages 3 months and all reports contain errors.
Once you have a specialist report you may wish to contact a clinical negligence lawyer again. Having a specialist report that supports your case means that their costs are lower and your chance of winning is higher. You may prefer to be a litigant in person and issue the claim yourself with support when you need it. A complaint including the report will often trigger a full investigation and this may be a better outcome.
There are 7 different systems to regulate doctors and most are accessible at no or limited cost. There are many experts and lawyers who are happy to have a chat about different approaches. They will normally advertise that they are happy to work with litigants in person. Some will make a small charge for this service and others will be happy to offer a chat for no charge.
DWP APPEALS
The DWP has been struggling for years with inaccurate assessments and accusations that some people are overclaiming. This has led to many claimants facing having to repay tens or even hundreds of thousands of pounds or prison. To effectively defend against the DWP the claimant needs a report that explains why the problems occurred.
The reasons for the problems suggested include:
Complex forms. Forms such as attendance allowance are easier to complete than PIP but few disabled people are able to complete the forms alone.
Poor quality assessments. Mismatch between the claimant’s disabilities and the assessor’s expertise and rushed assessments can decrease the accuracy.
Activities of daily living. Using activities of daily living as a proxy for functional restrictions means that the report can oversimplify a person's disability.
Non medical decision makers. Applying functional criteria can require understanding of the medical condition and lead to inconsistencies in decisions.
Tribunals overturning decisions. The law does not recognise subtleties in the language of disability and a tribunal decision does not protect the claimant from later challenge.
Subjectivity. People’s statements are open to interpretation and can be truthful but misleading.
Legal costs. No funds are available to assist the claimant and legal costs are proportionate to the seriousness of the likely finding against the claimant.
Biased advice. There is little professional oversight in disability advice and some use loopholes in the system to get a more favourable results.
Disability analysts can identify the likely functional restrictions at each stage of the claim. They can provide explanations for the inconsistencies in a single report based upon an assessment of the person and their records. For those who cannot afford to instruct a full legal team the disability report is an alternative.
The report takes several hours to write and considers evidence not available to the DWP assessor. By looking at functional restrictions the analyst can give a full description of the person’s disabilities. This methodology allows the analyst to provide an authoritative level of detail. The report is robust and independent and is an essential part of ensuring a just outcome.
DVLA APPEALS
The most common appeal against driving licence removal is when the GP has put alcohol dependency rather than alcohol misuse. The reason why GPs mix the two is because the DVLA definitions are difficult to interpret. The diagnosis of alcohol dependence has functional aspects that depend upon a knowledge of the person beyond the medical records.
Disability experts have the expertise to consider these functional aspects and give a balanced opinion. The expert will need all the GP records as well as the examination to provide a complete assessment. The detailed and comprehensive assessment ensures that the diagnosis is based upon the evidence.
Alcohol Misuse
There is no singular definition to embrace all the variables within alcohol misuse – but the DVLA offers the following:
A state that causes, because of consumption of alcohol, disturbance of behaviour, related disease or other consequences likely to cause the patient, their family or society present or future harm and that may or may not be associated with dependence.
Alcohol Dependency
There is no singular definition to embrace all the variables within alcohol dependence – but the DVLA offers the following:
“A cluster of behavioural, cognitive and physiological phenomena that develop after repeated alcohol use, including:
a strong desire to take alcohol
difficulties in controlling its use
persistent use in spite of harmful consequences
and with evidence of increased tolerance and sometimes a physical withdrawal state.”
Indicators may include any history of withdrawal symptoms, tolerance, detoxification or alcohol-related seizures.
CDT blood test. The DVLA use this blood test to determine the level of alcohol that a person is taking, people can use the same test every 3 months to prove that they are not taking harmful levels.
Esser MB, Hedden SL, Kanny D, Brewer RD, Gfroerer JC, Naimi TS. Prevalence of Alcohol Dependence Among US Adult Drinkers, 2009–2011. Prev Chronic Dis 2014;11:140329
Most excessive drinkers (90%) did not meet the criteria for alcohol dependence.
CRIMINAL DEFENCE DISABILITY REPORTS
Any person facing a criminal charge requires a comprehensive disability report. Without an understanding of the person’s functional restrictions the court will not be able to make adjustments for the person in the court process. If they do not understand the person's limitations with respect to the alleged offence they will make assumptions about their motivations.
Criminal Defence Disability Reports involve speaking to the expert either virtually or in person for an hour or two. The questions can appear odd as they include the personal life, family and friends and the difficulties that they have with activities of daily living. Problems in these areas can give clues as to missed medical diagnoses and explain any inconsistencies in the case.
The criminal justice system does not automatically arrange a Criminal Defence Disability Report. This can lead to the legal process being delayed by a judge asking for further evidence. Many remand prisoners suffer significant mental health problems which could be avoided by prompt assessment of their disabilities.
Without a Criminal Defence Disability Report there is a high risk of something going wrong. Few people involved in the criminal justice system do not have some type of disability. These problems are often hidden and often the reason why the person is in the system to start with. The accused or their family can also instruct an expert privately without waiting for the lawyer.
Most causes of disability are treatable or adjustments can be made to mitigate the risks. Without these interventions the person also has a high risk of returning to the criminal justice system within a short period of time. This is bad for the person but also society as a whole. The relatively low cost of a direct to expert Criminal Defence Disability Report compared with other types of report makes it a clear first choice.
LIFE EXPECTANCY REPORTS
Lawyers request life expectancy reports when a person’s risk of death has changed due to an accident or negligence. The effects of an accident on activity and obesity would need to be calculated to establish likely loss of life expectancy due to the accident. In more complex cases there may be multiple risks to life expectancy such as direct effects of the injury and behavioural changes.
Another area where life expectancy reports are necessary is when care needs are assessed. The risk of overestimating the life expectancy is that the award will last decades longer than the person. Equally underestimating can cause the care to run out before they die leaving them in poverty. Where the claimant has died and they were caring for a dependent elderly person the increased costs of that person’s care may be material. It is important to ensure that the expert deals with all the material issues.
A life expectancy report is based on age and sex and the ONS tables then is adjusted for risk of cardiovascular disease, cancer and accident as well as any medical condition they have. The calculations must be performed for each risk and based upon the best available actuary evidence. The expert’s working and assumptions must be clear and easy to follow so that the court can alter the estimate if new information becomes available.
Cancer risk can be derived from population data and then compared with the person’s risk. Where their risk is significantly different from the population data the excess or reduced risk must be calculated as a number of days. This variation can be added or subtracted from the ONS data to give a new estimate. For a young person a small increase such as doubling of the lifetime risk of cancer can be significant in terms of life expectancy.
Cardiovascular risk requires a calculation of baseline risk and then predictions based upon the effect of treatments. Risk calculators such as QRISK3 can give lifetime predictions but must be adjusted with chance of compliance. A person who has a long history of poor compliance or behaviour problems may live less long than a person who takes their medication properly and follows a healthy lifestyle.
Risk of accidental injury will depend on behavioural factors such as work, hobbies and risk taking. Frailty is a key aspect of the assessment as the risk of injury following an accident increases with frailty. Specific diseases such as balance problems, visual problems, osteoporosis and eating difficulties can all be associated with a raised risk. The risk of suicide is increased by chronic pain and severe enduring mental illness.
Life expectancy is often included in a disability report as an issue that the solicitors may wish to address. A formal life expectancy report is a systematic and detailed assessment of all the risk factors. It is important to check that the expert has fully addressed all the potential factors for life expectancy.
PERSONAL INJURY PI
Personal injury covers a wide range of situations where a person has suffered an injury. Although typically mild some people suffer substantial life changing injuries. A tariff system has been brought in to reduce the value of whiplash claims. There are also substantial restrictions put upon other types of claim for instance CICA will not pay out to a person with a criminal record.
There are hundreds of experts who accept direct referrals, thousands available through agencies and many solicitors who are happy to take this type of work. If you have a RTA you must go through the OIC portal and select either an expert or an agency. The compensator will pay for the expert report and will make you an offer.
RTA (Road Traffic Accident)
Slip and trip (Public Liability)
Occupational injuries
CICA Criminal Injuries Compensation Authority
Food Poisoning
Mould
There are suggestions that other types of claim will be brought under the portal however the portal is a little difficult to use. The portal helpline is available and if you are persistent you will be able to get it to work. Although you can get a solicitor in any PI case, they are only essential if the other party denies liability.
You do however need an expert report and this will cost £180 plus VAT (2024). If you need a home visit then you will be charged about £300. Once you have a report you can make your claim online as a money claim. It is worth remembering that any PI claim is a money claim and that is all the court can order. The court cannot make the person learn their lesson, or apologise, or stop it happening again.
You should avoid experts who are in a hurry, get their assistants to take your history, write superficial reports without detail and are too nice! Having an independent expert who writes a robust, detailed and balanced report that you do not fully agree with is better than having one who says everything you want them to. This is because the robust report will not collapse when the other side challenge it.
INVESTIGATING A SUSPECTED MEDICAL NEGLIGENCE DEATH
Medical Negligence Death Reports are only part of a bigger process. If you suspect medical negligence caused a death there are procedures that will help. The Postmortem based upon autopsy or 3D scanning and blood tests is helpful. The witnesses will give statements to the coroner and these can help fill in gaps in the clinical records.
You may have access to reports such as the CQC or the hospital review but they are difficult to read and use technical language. They may not reach a conclusion but instead criticise specific issues. These criticisms can be distracting and often have nothing to do with the cause of the death.
It can take hours or days of work to collate all the records and other evidence. Each individual in the coronial process will only consider their part of the puzzle as they are specialists. Having a report from a generalist who has seen all the evidence may allow a more complete picture to emerge. Often the Medical Negligence Death Report uncovers clues or provides questions that would otherwise be missed.
The coroner’s role is to determine by what means the person died. This is often not what the family want. They want to understand how a person who might have been previously well died without the right treatment. They want justice for their loved one and want a clear statement of who was to blame. The coroner cannot provide any of these answers.
Often a person dies because they have a serious condition but do not receive prompt or proper treatment. The current system of death certification makes it difficult for this to be included. Although a coroner can make a finding of misadventure, contributed to by neglect or a narrative conclusion these are rare. The coroner needs to be convinced that the person would have survived if they had the treatment.
A full Medical Negligence Death Report considering the death and all the evidence includes a chat with the family. It will provide an overview of the events from a neutral perspective can help direct efforts to obtain missing evidence. A list of questions to the specialist experts can ensure that the coroner’s court gets a full picture. The report can also help address the family’s needs for answers.
The cost is from £360 plus VAT.
MENTAL HEALTH REPORT
Mental health is a complex issue and although over 95% of sufferers could achieve a full recovery only about half do so. This poor outcome is mainly due to difficulties with accessing good quality mental health treatment. GPs largely prescribe medication and refer to the overburdened health services. The waiting lists are lengthy and most people are only seen once and then discharged.
An option is a Mental Health Report that describes the person’s problems, how it affects them, what choices they have and how quickly they can recover. People use the Mental Health Report to access therapy, to apply for benefits, in court cases and sometimes just to help understand themselves better. The Mental Health Report is not intended to replace healthcare but to empower people to get the best health they can.
The assessment is very different from a psychologist or psychiatrist report as the focus is on understanding not labelling. The assessment focuses on who the person is and what they want from life. It is more like a MOT for the brain so is suitable for those who do not have a mental illness. Many people find the assessment itself helpful to keep the person’s mental health running smoothly and prevent problems.
The report uses a technique from general practice called the Biopsychosocial Model. GPs in the past used to have the time to take an interest in the person rather than their diseases. They would find ways of helping the person improve their life in a series of ‘psychosocial steps’. They listened rather than reaching for the prescription pad or referral letters. Their results were impressive as they often prevented a person with problems from becoming unwell.
Modern understanding of mental health has led to medicalising of many emotional conditions and increased dependency. There are increasing numbers of people who are unable to work, marry or live independently. Paradoxically as mental health treatments have become more effective the delivery has failed. Partly this because it is now more difficult for anyone to know the right way forward and partly because services are becoming overloaded.
The GP used to manage 95% of mental health problems without referral but this fell to 90% by 2019. This was a small reduction for GPs and was mainly due to having larger list sizes and less staff. For secondary care it meant a doubling of the workload but the increase in staffing has not kept pace. Since 2019 the proportion managed in primary has fallen further with secondary care simply not keeping pace.
The cost of a mental health report is typically around £360 with a turnaround of 14 days. The report is written free of jargon and identifies simple practical options to restore or improve mental health. Interpretation of medical records and review of other reports is included free of charge.
