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Intolerable Regulation or Necessary Progress: has MedCo lost its way? - Dr Mark Burgin

20/04/20. Dr Mark Burgin considers why MedCo’s brand has become tarnished and how reducing costs, improving representation and recruitment could repair the damage.

I am a big fan of the work that MedCo is trying to do, improving medical reports and challenging cosy relationships and an IT solution that works.

In doing these good works MedCo has developed an unwarranted reputation of overbearing regulation, out of control costs and the accusation that it is ‘run by solicitors for solicitors’.

MedCo has the opportunity to rebuff these accusations with a recent FOI request asking about their progress with the key aims of better reports and breaking links.

A recent reduction to the number of experts that MROs require to cover the whole country indicates that there are also real problems as many MROs are finding it difficult to recruit.

Gaming the system

At first it was dodgy MROs that were targeted but now as well-run MROs have given up there are only 51 MROs left to serve 400k claimants and MedCo is having to raise fees.

This number (51) fails to capture a sense of the monopoly that the 10 tier one MROs have over the market and the ease with which solicitors can choose an expert.

As all Tier one MROs have all the ‘favourite’ experts a solicitor who wants a hired gun only has to choose a Tier one MRO to have access to that expert.

MedCo has neither analysed the figures for this type of behaviour nor taken steps to increase the numbers of MROs in the MedCo system.

A Fair Price

It was clear from the earliest meetings with MedCo that, for political reasons, their hands were tied in terms of the way that they could charge their users.

Any fair ‘charge for case’ system would have led to the Tier ones having 80% of the costs of running MedCo so Tier 2 MROs shouldered the burden but now many T2 MROs have left.

MedCo has continued to use expensive face to face audits despite the much cheaper remote access to data being offered by many MROs.

MedCo intends to audit 847 experts in the same way which will increase costs both for MedCo and also for the experts concerned, I am budgeting a minimum of £2000 for my audit.

Missing the point

As many readers of PIBULJ know well, I perform independent audits on medical reports and have written about the tendency for reports to aim for the minimum necessary.

MedCo has taken a few steps towards improved quality of reports such as a minimum 15 minutes (rather than 10) for an expert to see the claimant and maximum 35 per day.

On the other hand, solicitor-oriented pressure on speed and cost has led to some experts concerned that the numbers of lower quality reports may be increasing.

Representation on MedCo has largely been token for smaller MROs and particularly experts so that these concerns have largely been ignored in writing the recent MedCo audit advice.

Conclusions

A face to face audit of 847 experts will take several years and cost both MedCo and the experts millions of pounds and needs expert involvement to be effective.

Given the transparent nature of the expert’s job the rules do not seem to have considered whether it is either necessary or proportionate to have expensive face to face audit.

Expert’s work is the production of the medical report and audit of 1% of reports is the best (and cheapest) way of assessing whether the expert is doing their job well.

MedCo cannot deregister poorly performing experts if there are insufficient numbers to provide a good service so recruitment must become a key marker of MRO performance.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted for audits on This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website drmarkburgin.co.uk

References

Performance by medical experts on MERA http://www.pibriefupdate.com/content/law-journal-summaries/news-category-4/4639-medical-expert-report-audit-mera-opening-the-black-box-2018-dr-mark-burgin

Numbers of Experts https://www.medco.org.uk/media/1182/medco-factsheet-march-20-040320.pdf

List of MROs https://www.medco.org.uk/media/1185/operational-mros-19-march-2020.pdf

Audit for Experts Rules www.gov.uk/government/publications/medco-new-rules-and-audit-process-for-direct-medical-experts

FOI to MedCo https://www.whatdotheyknow.com/request/auditing_the_performance_of

_medc#incoming-1413048

MROs criteria https://www.gov.uk/government/publications/medco-qualifying-criteria-stakeholder-engagement-exercise

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