Memorandum submitted by SchlumbergerSema
This memorandum is intended to give an update
to the original memorandum provided to the Social Security Select
Committee in 2000. It provides an overview of all the initiatives
instituted to-date and confirms the status of those initiatives.
Much of the work undertaken during the past two years has been
as a direct result of recommendations made by the Social Security
Select Committee in its report of 2000. In addition, we have taken
account of the Government's response to the Social Security Select
Committee Report published in June 2000 and also the recommendations
within the National Audit Office report "The Medical Assessment
of Incapacity and Disability Benefits" published early in
There are a number of highlights that we would
particularly wish to draw to the Committee's attention.
Most significantly, Sema Group, of which Medical
Services was a part, was acquired by Schlumberger Limited in April
2001. The change in ownership has resulted in key senior management
changes in SchlumbergerSema and Medical Services, together with
a renewed and strengthened commitment to the medical services
provided to the DWP. This is evidenced through a number of important
recent developments that have considerably built upon and enhanced
the improvements that were already starting to be made under the
Sema Group ownership.
Firstly, there has been a sustained, continuous
and in some cases dramatic rise in Medical Services' performance
during the past 12 months. The quantity of medical examinations
being carried-out by Medical Services has increased by 17 per
cent over the previous 12 months and a further 10 per cent rise
is planned and agreed with the DWP for the next 12 months. Whilst
achieving this increase in output, new and more rigorous targets
in terms of quality and customer satisfaction which were implemented
by the DWP following the original Select Committee Report have
been and are being consistently achieved. By March of 2002 we
were meeting 43 of 45 key performance indicators laid down by
the DWP. The two which were being narrowly missed related to output
and both will be achieved from April 2002 onwards.
Secondly, there has been a significant restructuring
of the operational and contractual management relationship between
the DWP and Medical Services which has been particularly linked
in the past six months to the emergence of JobCentre Plus. This
has resulted in a far greater degree of joint planning and co-operation
than before and a much clearer understanding of the DWP's requirements
and the needs of the overall end-to-end Benefits Process. This
has been entirely beneficial and has contributed in no small way
to the overall improvement in operational day-to-day delivery.
The greatest evidence of this new partnership
is the existence of the Medical Services Change Programme which
formally kicked-off in November 2001. This is a joint programme
with six key projects which have already started to deliver further
improvements to the overall service delivery and will especially
deliver additional improvements in the areas of quality, customer
satisfaction and medical resources during the next 12 to 24 months.
Whilst this is entirely a joint programme in its design, management
and delivery, it should be noted that the vast majority of the
multi-million pound investment required to finance the programme
is coming directly from SchlumbergerSema.
Thirdly, SchlumbergerSema has particularly recognised
the need to continue to improve the recruitment, retention and
development of its critical medical resources in order to deliver
increased volumes of medical advice and examinations with improved
quality. We have embarked upon an intensive recruitment campaign
with the aim of bringing in an additional 100 full-time employed
doctorsa campaign which in its first six months has delivered
48 acceptances with 28 new doctors having commenced work by 1
April 2002. In the meantime, we have continued with a progressive
programme of training and development of our existing medical
workforce that includes an active sponsorship of employed doctors
to study for and obtain the DDAM underpinned by a financial reward
to those who are successful. Additionally, we have introduced
a series of measures to improve the overall remuneration of both
our employed and contract doctors (supplied via Nestor Healthcare
Group plc) which has resulted in a near 50 per cent reduction
in doctor turnover during the last year and significant increases
in earnings potential.
Lastly, whilst we have made real, measurable
and demonstrable progress since the original Social Security Select
Committee Report in March 2000, we are by no means complacent.
It is not just through the existing Change Programme
that we are demonstrating our commitment to continuous improvement
to the medical services delivered to the DWP. We have also signed-up
to even more stringent targets on quality of medical reports for
all benefit strands, on the ongoing quality and capability of
our medical workforce and new customer satisfaction measures which
we will be striving to achieve during the next 12 months. Additionally,
we have signalled a clear commitment and intent to pro-actively
support the DWP with its Welfare to Work challenge and review
of Incapacity Benefit and the programme of modernisation for Disability
Living Allowance and Attendance Allowance.
2. WORK OF
2.1 Services Provided
SchlumbergerSema Medical Services provides a
national medical advice and examination service as defined in
a Contract Specification laid down by the DWP. Medical Services
play no part in the decision making process that is the remit
of the Department's own Decision Makers.
Approximately 826,000 examinations are conducted
annually at over 150 examination centres or in people's homes
throughout England, Scotland and Wales for the following Benefits:
Industrial Injuries Scheme Benefit;
Disability Living Allowance;
Severe Disablement Allowance;
Medical Services select subcontractors on the
basis of their ability to meet specified quantitative and qualitative
Nestor Healthcare Group plc is the primary subcontractor.
They have a contractual obligation to supply medical staff who
meet the requisite competency levels demanded to undertake examinations
carried out in Medical Services Examination Centres and also in
In addition, where the services of a specialist
practitioner are required by Medical Services, another subcontractor,
Definitech Ltd, arranges for claimants to be examined by a specialist
in the appropriate field of medicine and reports are supplied
which meet the necessary quality requirements of both the relevant
Government Department and Medical Services.
3. DOCTORS' PAY
3.1 Employed Doctors Salary Profile
Employed doctors' salaries are regularly reviewed.
Recently and in line with market forces the minimum salary for
a medical adviser has been increased to £46,000. Doctors
also have the opportunity to increase their earnings by carrying
out additional examinations whilst maintaining proper quality
We have recently introduced a review in pay
for employed doctors, the fourth review since March 2000. In addition
to raising the minimum salary, the review offers bonuses equivalent
to £4,000 and £6,000 pa linked to examination productivity.
Quality and customer service standards are an integral part of
the system which also offers additional rewards for other doctors
who are engaged in quality improvement activities, mentoring,
auditing and training delivery. A further element of our new approach
provides an enhancement to consolidated pay, by £2,000, for
those doctors who have acquired the DDAM.
A further pay review will be implemented in
May, backdated to 1 April. The salary review is linked to the
results of annual appraisal and starts with a minimum level of
increase of 3 per cent.
3.2 Contract Doctors Remuneration
Medical Services has now moved away from paying
those sessional doctors who carry out examinations in Medical
Services Centres on an hourly basis and now pay them for each
examination and report. Approximately 96 per cent of doctors have
opted to be paid on this basis and it is anticipated that this
will rise to 100 per cent in the near future. The doctors are
no longer constrained by an artificial "session" of
3.5 hours and are therefore able to continue to spend the optimum
amount of time with each person being examined. Quality measures
are an integral part of the system. To support this initiative,
systems have been introduced which identify any doctor who suddenly
alters their working pattern to show a significant increase in
the number of examinations they carry out. The reasons for that
change are then investigated to ensure that standards have not
There have been two pay increases for doctors
which averaged 3 per cent in September 2000 and 15 per cent in
Set rate payments are made by examination type
for each report completed. The amount payable per case will be
dependent on the benefit type involved. This is significantly
different to the hourly rate scheme, which usually compensates
doctors for the amount of time worked, irrespective of the number
of claimants seen. The doctors, for their part, commit themselves
to a specific working pattern which make the scheduling of examinations
much more effective. This payment system provides the opportunity
A significant increase in payments
for those who want it.
Better use of medical time.
Recognition for those doctors who
are able to stay longer to make sure that everyone who attends
for examination is seen.
Smoother running of sessions with
reduced waiting time.
Flexibility in working times for
the doctors, suiting those who have domestic or other commitments.
An analysis of the payroll figures for the contracted
doctors reveals the following:
The figures for June 2001 show an
average of a 25 per cent increase in pay (the highest percentage
is well over 100 per cent).
The figures for Feb 2002 show an
average of 35.7 per cent increase in pay (the highest percentage
is well over 150 per cent).
This is due to the combined effect of the recent
increases to levels of pay, the introduction of Fee Per Case and
the increase in the average amount of work done by the average
An analysis of the turnover of contracted doctors
since January 2000 to January 2002 is shown in the table below.
This clearly demonstrates the turnaround that has been achieved
in the past year in the retention of doctors and the recruitment
of new doctors.
|Jan 00 to Mar 01 (15 months)
|Jun 00 to Mar 01 (10 months)
|Apr 01 to Jan 02 (10 months)
4. RECRUITMENT AND
As at 1 April 2002, Medical Services employs directly 194
doctors. This figure is increasing on a weekly basis as a result
of our on-going, successful recruitment campaign. In addition,
there are 2,160 doctors undertaking medical examinations who are
subcontracted via Nestor Healthcare Group plc (Nestor). These
doctors work on a part-time basis, at times agreed with Medical
Medical Services recognises the value of employing doctors
in not only carrying out examinations and giving advice but also
conducting the audit, training, mentoring and feedback which contributes
to the delivery of a high quality service. We therefore intend
to increase the number of employed doctors to over 250 during
2002. In spite of a national shortage of doctors, we are running
a successful recruitment campaign to attract them. Already 48
new doctors have accepted an appointment within Medical Services
whilst a further 10 offers are under active consideration. A total
of 28 doctors have already started work. A number of these doctors
are currently under training. The recruitment campaign includes:
An extensive national advertising campaign in
the medical press.
Medical Services recruitment events held locally
to introduce the service to interested medical personnel.
A bonus to attract new doctors to particular areas
where doctor recruitment generally is more difficult.
The recruitment criteria are defined in the contract between
Medical Services and the DWP (See Appendix A). Additionally, Medical
Services has strengthened its interviewing of potential recruits
testing not only their medical knowledge, but also their interpersonal
To assist in the recruitment campaign, Medical Services has
developed a new Resourcing Model that demonstrates at a local
level any gaps that exist between actual and forecast doctor requirements.
The overall gap is 30 full-time equivalents in March 2002.
Based on our current planning this will reduce to seven in December
2002. However even when this shortfall is taken into account,
experience has shown that the contractual requirements can be
securely delivered by strategic use of the flexibility that is
inherent in a pool of over 2,000 doctors.
It is recognised that, key to a stable professional workforce,
is the satisfaction that comes from the role being carried out.
However, the skills of the disability analyst are unique, encompassing
not only clinical acumen, but also critical evaluation of evidence
from many sources and the ability to demonstrate empathy in sensitive
situations. In order to promote the role as a career option which
is recognised by the external medical profession, Medical Services
has embarked on a series of initiatives. Some of these initiatives
are being taken forward in the Change Programme, the overview
of which is at Section 9.
The Viable Doctor Pool Project, as part of this Programme,
will promote additional experience in, for example, audit, training
and management. It will also ensure that doctors are capable of
fulfilling the General Medical Council's requirements for revalidation
as Disability Analysts. As part of the project, we will continue
to offer doctors sufficient educational support to achieve the
DDAM, which professional qualification we enthusiastically endorse.
In the Evidence Based Medicine Project, we will pilot and
then roll out the structured use of computer assisted report writing
backed by researched medical protocols, which will enable each
doctor to produce a more consistent, totally legible and medically
sound report for Incapacity Benefit.
Underpinning all of the initiatives is the commitment to
an ever-improving training programme. Our intensive induction
course has already been well received by newly recruited doctors
and we intend to further exploit more imaginative ways of delivering
training with the increasing use of computers.
As Medical Services moves even further into the field of
Occupational Medicine, doctors will be able to develop a broader
portfolio of knowledge and skills. This will not only offer the
doctors personal satisfaction but, we believe, will also bring
benefits to the DWP through the broadened and deeper understanding
of what is really meant by fitness for work.
5.1 Induction Training
An extended induction course has now been introduced for
all new employed entrants to Medical Services. This course lasts
a total of eight days, covering the following main subject areas:
An introduction to the company and an explanation
of the chief features of the DWP contract.
An exploration of the role of the disability analyst,
highlighting those areas in which the role differs from that of
Guidance on the conduct of examinations carried
out for the purposes of disability analysis, focusing on the claimant
interview, observed behaviour, and the physical (particularly
musculo-skeletal) and mental state examinations.
Guidance on the critical evaluation of evidence
and on effective report writing.
Modules on multi-cultural awareness and dealing
with potentially aggressive situations.
A full Incapacity Benefit course.
5.2 Initial Benefit Specific Training
Medical Services have developed in conjunction with the DWP
an Approval process for doctors. All doctors must obtain Approval
from the Chief Medical Adviser in order to undertake work on behalf
of the company. Part of the Approval process is the initial training.
All doctors who join Medical Services are provided with an
initial theoretical training course, covering such areas as customer
service and the principles of disability analysis, as well as
providing detailed technical information relevant to the benefit
concerned. This training course culminates with a multiple-choice
examination, which must be taken and passed by the doctor before
they move on to the next stage of practical training. The initial
work undertaken by new recruits is produced in a controlled environment.
For examination centre based assessments, the trainee is supervised
and appraised by an experienced Medical Adviser as they complete
their introductory cases, with the following cases subjected to
100 per cent audit. In the domiciliary visit based benefits, initial
cases are 100 per cent audited immediately on return to allow
feedback to be given without delay. This high level of supervision
is not relaxed until it becomes apparent that the doctor demonstrates
that he/she can produce work of an acceptable level.
Separate approval is required for each benefit area in which
the doctor works and is dependent upon the successful completion
of all stages of the training programme, together with an ongoing
demonstration that the work performed reaches the required standard.
During 2001, revised and updated initial classroom training
was introduced for EMPs (doctors who undertake Home Visits) carrying
out examinations for Disability Living Allowance/Attendance Allowance,
and for doctors working in the area of Industrial Injuries Scheme
Benefits. Medical Services is currently collaborating with the
Corporate Medical Group in the development of a revised course
for Respiratory Disease assessments.
5.3 On-Going Training
In response to the Government's Command Paper, Medical Services
developed three specific trainer-led courses, which were delivered
to all doctors carrying out benefit related assessments, and which
will continue to be delivered to all new recruits in this field
within 12 months of their initial approval. These courses cover
the following subjects:
Distress-avoiding techniques for the examination
of people with musculo-skeletal conditions (clinical skills training).
Behaviours, attitudes and sensitivities for dealing
with people with disabilities (multi-cultural awareness training,
developed in association with the Equality Foundation).
The assessment of people with mental health problems.
In addition to the above-mentioned generic course covering
the assessment of claimants who have a mental health condition,
further specific training has been delivered on "The conduct
and reporting of the Mental Health Assessment in IB-PCA".
This has taken the form of a trainer-led course and a Professional
Standard Guidance document.
An annual Training Needs Analysis is carried out in conjunction
with the Department's Chief Medical Adviser (CMA). Reference is
made to information gleaned from audit and recorded on the Medical
Skills Database (MSD), comments received from claimants and Welfare
Rights Groups, and the views of the Decision Makers and of the
doctors who carry out the assessments. The Training Needs Analysis
provides the basis of each year's programme of Continuing Medical
Education (CME), which is developed by Medical Services and delivered
The 2000/2001 CME programme consisted of modules
Changes to the mobility component of DLA in children.
Assessing mobility in younger children.
Assessment of illness behaviour.*
The conduct and reporting of the Mental Health
Assessment in IB/PCA.*
Exemption advice at the examination stage in IB-PCA.
Regional musculo-skeletal examination techniques.*
Dealing with potentially aggressive situations.*
Dealing with potentially violent people.
Providing advice to the decision maker at the
accident consideration stage.
Critical evaluation of evidence.
Update on occupational asthma.
Assessment of claimants with drug or alcohol problems.
Fibromyalgiaguidelines for the disability
Professional standardsThe conduct and reporting
of the mental health assessment in IB/PCA.
NB. Modules marked (*) were delivered as trainer-led courses.
Approximately 900 courses were run during 2001. Other modules
were distance learning.
The 2001-2002 CME programme that is already underway includes:
Rehabilitation (Distance learning + trainer-led
Caring for clients, helping doctors (Distance
learning + trainer-led course).
Guidance for doctors providing reports for the
War Pensions Agency.
Sensory problems including visual and hearing
problems (trainer-led course).
Statement taking, recording and gathering information.
Computer Based Training on the Evidence Based
Medicine musculo-skeletal protocols.
All Medical Services' training material is reviewed and agreed
by the Chief Medical Adviser prior to implementation. The Continuing
Medical Education programme is subjected to ongoing detailed evaluation,
with an annual report produced for the Chief Medical Adviser.
Input from specialist groups such as NACAB, The Equality
Foundation, RNID and RNIB is actively sought as appropriate during
the development of training material, as is medical input from
specialists in particular fields (eg for rehabilitation).
We would be more than happy to welcome members of the Committee
to participate in any appropriate doctor training sessions if
that was felt to be beneficial to the Committee members in furthering
their understanding of the style and content of our approach to
this important subject.
5.4 Remedial training
Remedial training is provided to individual doctors when specific
areas for improvement are identified either under the Approval
process or via the various types of auditing that take place.
The Medical Skills Database is now operational and together with
other management information assists managers with the identification
of either individual training needs or trends that develop over
a period of time.
Remedial training is implemented through local medical managers,
usually on a one-to-one basis and by a variety of methods. It
may, for example, comprise a doctor being accompanied by an experienced
mentor when carrying out medical examinations and receiving feed
back. Or, the doctor may be expected to attend afresh a specific
training course or work through a distance learning training document.
In all cases, the doctor will be required to demonstrate
their improved understanding before the remedial training is deemed
to be successful.
6. PROFESSIONAL AND
6.1 Professional Standards
Medical Services have a contractual obligation that all doctors
carrying out work for the DWP will adhere to a series of professional
standards specified by the Department. Compliance with Equal Opportunities
Legislation is required.
The subject of professional standards is discussed during
initial training and the standards are listed in full in the guidance
notes given to each doctor.
Part of the auditing/monitoring processes focuses on professional
standards and reports are judged against these in addition to
other attributes required to produce a report that meets the appropriate
6.1.1 Diploma in Disability Assessment Medicine (DDAM)
The DDAM is sponsored by the Faculty of Occupational Medicine
of the Royal College of Physicians together with the DWP and SchlumbergerSema
Medical Services, and is an external recognition of the professional
standards expected of doctors providing services to the DWP.
To date 35 SchlumbergerSema doctors have achieved the Diploma
whilst working for Medical Services. A further 26 SchlumbergerSema
doctors are planning to take the examination this year, in addition
to a number of NDA doctors.
The diploma is regarded as a standard of excellence and is
SchlumbergerSema have demonstrated their commitment to the
DDAM by recognising, by an increment to their salary of £2,000,
the achievement of those employed doctors who are awarded the
6.2 Quality Standards
Medical Services has two inter-supporting systems that assist
in assessing, recording and managing medical quality.
6.2.1 Quality Systems
126.96.36.199 Integrated Quality Assurance System
The IQAS is based upon:
A standard process that allows suitably trained
and experienced doctors to audit completed work against defined
standards of professional practice.
Systematic feedback of results and trends linked
to the need for ongoing training and guidance.
A mentoring system with each doctor having a nominated
experienced professional colleague responsible for continuity
of advice and development.
The Quality Audit System is based on an evaluation of all
reports and identifies the professional standards under four main
Presentation and process
legibility, completeness, and clarity (assessed
by a non-medical person).
the medical examination, including history and
statement-taking, formal clinical examination and the recording
of clinical findings.
the step-by-step medical reasoning and deduction
which ensues after the consideration of medical evidence;
performance of a medical examination and the decision
making or advice which follows.
the general principles of medical good practice
which underpin all Medical Services work.
6.2.2 The Medical Skills Database system
The system records a variety of information, including:
GMC Registration number which will be the unique
identifier for each doctor.
First Name and initials.
Employment Status (ie Currently Employed, Not-Employed,
Whether NDA, FTMA or Other Doctor Type.
Doctor Benefit Training Details.
The Benefit Training record will include:
approval Status (not approved, awaiting approval,
approved, Approval removed);
date Refresher training completed.
We intend to maintain improvement of the quality of reports.
6.2.3 Achievement of Government Targets
Particular attention has been paid to the recommendations
of the Social Security Select Committee (Session 1999-2000), the
Government's response to that report and the National Audit Office
Report 2001. Targets relating to medical quality were accepted
by Medical Services. These targets were:
Within six months to reduce the proportion of
"C grade" medical reports which fail to meet the Department's
standards by 10 per cent; and within one year to reduce the proportion
of "C grade" reports across all benefits to less than
5 per cent;
Within one year to demonstrate improvement in
compliance with the agreed medical scrutiny guidelines for Incapacity
Benefit claims so that the proportion of non-compliant reports
is less than 5 per cent;
Within one year to deliver training to all doctors
covering: the assessment of people with mental health problems;
behaviours, attitudes and sensitivities for dealing with people
with disabilities; and distress avoiding techniques for the examination
of people with musculo-skeletal conditions;
Within two years to improve customer satisfaction
rates to at least 90 per cent.
ALL of these targets have been and are being consistently
achieved. For example:
188.8.131.52 Percentage of "C" grade reports
184.108.40.206 Scrutiny to Exam ratios
Scrutiny to Exam ratios have settled between 50 and 55 per
cent following the introduction of the New Scrutiny Guidelines
which were issued in November 2000 and which initially led to
an increase in the ratio from around 35 per cent to 65 per cent.
We are continually exceeding the target of 95 per cent compliance
with these new guidelines.
The Rework volumes have remained well below the 1 per cent
target throughout the last 12 months.
6.4 Appeal Service feedback
A process has been implemented to facilitate the flow of
information between the Appeals Service, Corporate Medical Group,
IMPACT and Medical Services. This process allows appropriate feedback
where the Appeals Service has identified any report supplied by
Medical Services that falls below professional standards.
6.5 Revocation of Approval
Experience has shown that, on occasion, doctors do not meet
the requirements of the work of a disability analyst. Under those
circumstances, the Chief Medical Adviser will revoke the doctor's
Approval to prepare reports for the DWP. To date there have been
22 instances where a doctor's Approval has been revoked. These
included 13 who had their approval revoked due to performance/conduct
There is one more revocation that is currently in the pipeline.
7. OPERATIONAL PERFORMANCE
Medical Services has now recovered from a dip in performance
against service levels that came about in late 2000. The reasons
for the initial drop in performance are understood by both the
DWP and Medical Services as follows:
Doctors leaving when work volumes were low;
An intensive programme of essential training in
2000 which kept doctors away from the workplace;
The very significant increase in the numbers of
claimants being examined following reworking of the scrutiny guidelinesthe
ratio climbed almost overnight from 35 per cent to 65 per cent.
A recovery programme has been successfully implemented and
has resulted in a 17 per cent increase in the number of examinations
performed in 2001 compared to 2000, with a further 10 per cent
increase expected in 2002.
Present operational performance is illustrated below:
7.1 IB Examination Performance
Service performance is measured contractually by service
level targets set by the DWP. These mainly measure turnaround
Medical Services managers and employees have achieved significant
improvements over service levels since the time of the last Social
Security Select Committee report.
Below is a table that shows examination performance over
the last 12 months. The target is 95 per cent of IB examinations
turned-around within 50 days.
7.2 IB Volumes
IB Volumes have continued to rise as medical capacity has
7.3 Examination performance
Daily examinations performance has steadily increased to
accommodate the rising volumes received and assist in reducing
8. STANDARDS OF
The contract provides for a wide range of service standards
a number of which are referenced in our Customer Surveys.
Improvements were sought in several areas and work has been
undertaken to make these improvements.
8.1 Waiting Times
There has been a steady rise in the percentage of claimants
seen within 10 minutes of their arrival.
The Medical Services target for seeing claimants within 10
minutes is 77.15 per cent
8.2 Unseen Claimants
Reductions have been achieved in this area as can be seen
from the graph below.
The Medical Services target is to reduce Unseen Claimants
to below 3 per cent. We are on target to achieve this in March.
8.3 Time spent with Claimants
The figure reported at the Social Security Select Committee for
IB examinations was 46 minutes. At the time this was the figure
which approximated most closely to the time spent with claimants.
It was derived by dividing the standard session time by the average
numbers of claimants seen.
Since then, as a result of fee per case and the recommendations
of the Social Security Select Committee, we have moved to a recording
system, which more approximates to the time spent with claimants.
Fee per case and the flexibility it has brought to scheduling
has meant that the concept of the 3.5-hour session has disappeared
(salaried doctors work longer than a 7 hour day). The best measure
of time spent with claimants has to exclude the downtime between
cases and that wasted at the end of the 3.5 hour sessions when
there was insufficient time for doctors to see an extra case.
Information about time spent is recorded on the front of
the IB85 (the examination report form). The figure that is recorded
on the IB85 excludes all dead time and shows an average of 37
minutes over the past 6 months. The time spent by the doctor pre-reading
the file, introducing himself or herself to the claimant and collecting
the claimant from the waiting room is also excluded from this
figure and therefore, at least a further 5-10 minutes should be
added to obtain the most reliable comparator.
Time spent completing IB85s is closely monitored and is one
of the factors used to trigger further investigation to ensure
that customer service is not being compromised.
8.4 Special Needs Provision
A new leafletAL1 C has been developed and updated
in line with "The Better Letters" initiative which provides
more targeted information for the claimant.
The new leaflet allows claimants the opportunity to contact
Medical Services prior to their examination to advise that an
interpreter will be required, or that they can provide their own
via friends and family. The target of 95 per cent of requests
to be met has been achieved.
The AL 1C also provides the claimant with the opportunity
to request a doctor of the same sex. The target of 95 per cent
of requests has been achieved. Where possible, Medical Services
endeavour to do this in all cases.
8.5 EMP Home Visits
A new leaflet has been developed which mirrors the information
contained on the AL1C. It is sent out on receipt of the case within
Medical Services to provide information prior to the home visit
and examination. The leaflet was introduced from 2 April 2002.
8.6 Complaints Leaflet
Provides information about how to make a complaint. The new
leaflet has been developed and issued giving greater detail on
how to make comments, complaints and suggestions about Medical
Services performance. It is in a more user-friendly format and
has a tear-off page at the back for use by the claimant.
8.7 Cultural Sensitivity
There is now a training module on Multi-Cultural Awareness,
which has been delivered to all Medical Services doctors.
A new Multi-Lingual notice is being developed for 12 specified
languages, which allows the claimant to contact Medical Services
requesting an interpreter.
Medical Services introduced a new national complaint management
system from 1 June 2001, which captures all customer complaint
issues, under designated issue codes. The code relating to cultural
insensitivity shows a very small number of issues relating to
this category nationallyreducing each quarter from 10 (June
to Aug 2001), 7 (Sept to Nov 2001) to 5 during the most recent
quarter (Dec 2001 to Feb 2002). We investigate all complaint issues
and this has resulted in management action being taken in respect
of the examining doctor where appropriate.
8.8 Claimant Satisfaction
Medical Services survey over 30,000 claimants every year,
with a 50 per cent return rate, for all types of benefit examinations.
Our findings, provided to the DWP, show well over 90 per
cent satisfaction levelswe have consistently exceeded the
90 per cent customer satisfaction criteria set by the DWP. At
no time has Customer satisfaction score dropped below 96 per cent
since March 2001.
We have also reviewed our survey methodology with National
Medical Services are working with the DWP currently to explore
additional ways of further improving the surveys and the robustness
of sampling methods.
We analyse and use the valuable information from these surveys
to improve our service nationally and locally.
8.9 Complaints in Medical Services
Medical Services welcomes feedback including complaints,
which contain vital information to improve our service and we
investigate all complaints received.
The definition of a complaint is an expression of dissatisfaction
about services provided by Medical Services, that originates from
a claimant. In our communications to claimants it is clearly explained
that dissatisfaction with the outcome of a claim as a result of
the decision of the DWP Decision Maker is a matter between the
claimant and the DWP. Claimants have a right to request reconsideration
of the decision or to submit an appeal and are advised to contact
the DWP office dealing with their claim. We therefore make the
distinction between an appeal and a complaint about our service.
We have extensively revised our complaint procedure and provided
improved guidance and training to all Customer Relations Managers
about roles and responsibilities. The new procedure includes:
Greater accessibility through the introduction
of a new complaint leaflet and advice to customers with all appointment
letters. We have also explained the new procedure to many interest
groups such as at the National Conference of NACAB held in York
in September 2001.
A new national complaint management system, which
enables analysis of all complaints and ensures appropriate action
is taken following each complaint investigationwhether
this relates to the doctor or our administrative service.
A clear escalation route in the event that a complainant
is unhappy with the way his/her complaint has been handled including
referral to an independent tier.
Contractually agreed contract standards and targets
relating to response times and the standard of responses to claimants.
The main categories of all complaint issues for quarter ending
February 2002 are shown in the following chart:
For the most recent quarter ending February 2002 new complaints
have fallen to 1,029. Overall the number of new complaints about
our service is now less than 0.5 per cent of all examinations
completed. Of these new complaints, issues relating to doctor
manner has declined from 35 per cent for the quarter ending August
2001 to 30 per cent of all issues during for the quarter ending
February 2002. The training programmes for all doctors and the
quality monitoring system are key contributing factors.
We are achieving all contractual complaint targets relating
to response times and quality, set by the DWP during 2001. However,
we are never complacent and use complaint feedback to continually
improve service on a national, local and individual basis.
9. CHANGE PROGRAMME
Medical Services and The Department for Work and Pensions
have worked together in order to put this programme together.
It is aimed at delivering service improvements that will enhance
the running of the Medical Services business and the interface
between Medical Services and DWP. The detail of the individual
projects is set out below.
9.1 Evidence Based Medicine (EBM)
This project's objectives are to:
develop protocols based on medical best practice;
develop an IT system which enables doctors to
use these protocols in a systematic way.
Successful completion of this project will generate high
quality, legible reports and will provide a more sustainable working
environment for examining doctors. It will also give better information
to Decision Makers which should enable them to make better informed
benefit decisions. Initially this project covers musculo-skeletal,
mental health, cardiovascular and respiratory illnesses. The IT
system and medical protocols will be rolled out to all Incapacity
Benefit (IB) medical examiners from the summer of 2002 onwards.
Not only is this massive logistical undertaking in its own right
but there is a high level of doctor training required and so it
will take until early 2004 to fully complete the implementation
9.2 DNA-Did Not Attend
The objective of this project is to reduce the number of
missed appointments. It is doing this by using best practice in
scheduling appointments which essentially means tele-programming.
This project will should improve customer service and reduce expenditure,
whilst creating more effective and efficient internal procedures
for MS and DWP.
The project has already considerably reduced DNAs and is
now installed in Stoke, Derby, Bootle, Acton and Euston with full
roll-out scheduled to be achieved by the end of June 2002.
9.3 Evidence Gathering
The objective of this project is to provide better initial
medical evidence to medical assessors. It will do this by setting-up
a new system with GP practices to receive up to five years of
patient information before examination. This information will
enable decision makers to disallow invalid claims with confidence
whilst also ensuring the best use is made of doctor capacity and
improving customer service for the most seriously ill. GPs responses
have been mixed but so far 76 practices with around 248 GPs have
agreed to participate in the pilot which is running in the Sheffield
and Rotherham areas.
9.4 Viable Doctor Pool Project
This project was set up to:
recruit 100 employed doctors by June 2002;
improve retention of the existing workforce;
integrate employed and sub-contract doctor recruitment
put a career structure in to disability assessment
equip Medical Services for GMC revalidation; and
ensure the size of the future doctor pool is appropriate
to the size of the business, through better joint resource forecasting
To-date 73 doctors have been offered employment with Medical
Services, 48 have accepted our offer, a further 10 are actively
considering and 28 have actually started working with us.
9.5 Governance, MIS and Project Management Enhancement
These projects were initiated in order to:
give targeted and better information to customers
ensure a more focused strategic and operational
relationship between DWP and Medical Services,
excel at project delivery, project management
implement project management best practice.
Governance changes were made in December 2001, formats and
content of KPI reports were agreed with IMPACT and the first sample
reports were sent in January.
Project management standards for initiation and closure have
been developed and agreed. All project managers have consolidated
their understanding of project management standards and will be
applying them consistently in the future. Competency-based assessments
have been carried out with all project managers and action plans
5 April 2002
The CONTRACTOR shall ensure that its Medical Personnel, whether
employed or fee-paid, are registered with the General Medical
Council. In addition, they must have either at least three (3)
years post-registration experience, including one (1) year in
general practice and at least six (6) months experience of psychiatry,
rheumatology, rehabilitation medicine or occupational medicine;
or at least five (5) years post-registration experience as a principle
(or equivalent) in general practice. The CONTRACTOR shall ensure
its Medical Personnel have broadly based medical experience unless
specialist knowledge and experience are required as detailed in
this Schedule 4.
The CONTRACTOR shall ensure that Medical Personnel providing
the Respiratory Disease Service shall be appropriately trained
and assessed as being fit to provide the Services to the standards
laid out in Schedule 4 Section 4.1 of the Agreement.
When providing Specialist Medical Services the CONTRACTOR
shall use only a Medical Specialist as defined in Schedule 1 who
shall have training, qualifications and experience pertinent to
the condition under consideration.
The CONTRACTOR shall ensure that all radiographers and audiometric
technicians have contemporary and relevant specialist qualifications.
The CONTRACTOR shall ensure that all Paramedical Personnel
providing or supporting the provision of Services have appropriate
qualifications, experience and training.