GP Template PIP
To whom it may concern,
Ref: NiNo
I am this patient’s General Medical Practitioner/Psychiatrist/CPN and the custodian of his/her primary/mental health medical records in the UK.
I understand my patient has recently received a Personal Independence Payment questionnaire/assessment date, and this letter is in support of him/her meeting (continuing to meet the award levels currently set for his/her existing DLA award) the following award levels:
Mobility Component: XYZ of the mobility component
This is applicable because… for example, (for higher rate) the patient cannot follow the route of a familiar journey without another person, an assistance dog or an orientation aid. Also, s/he can stand and then move more than one metre, but no more than 20 metres, either aided or unaided.
Daily Living Component: XYZ rate of the Daily Living component
This is because… for example, (for higher rate) my patient cannot prepare and cook food; needs prompting to be able to take nutrition; needs supervision, prompting or assistance to be able to manage medication or monitor a health condition; needs assistance to be able to wash either their hair or body below the waist; needs assistance to be able to manage incontinence of both bladder and bowel; cannot dress or undress at all, needs communication support to be able to express or understand complex verbal information; needs social support to be able to engage with other people, and needs prompting or assistance to be able to make simple budgeting decisions, etc.
It is my understanding that Mr/s XYZ, my patient’s partner/husband/wife takes care of my patient’s entire care needs and assists him/her with his/her mobility issues.
Furthermore, my patient suffers from multiple complex conditions with cumulative impact.
The following information is provided based on my knowledge of my patient over time and under clinical assessment. I will be supporting my patient in this matter and would be grateful if the details of my medical knowledge regarding my patient are not ignored.
Conditions:
E.g.: Primary condition is XYZ, followed by secondary conditions, etc.
Treatment:
E.g.: Specialist care at ABC hospital, medication and counseling for depression, etc.
Medication (daily dosage): State what the medication is for: depression, pain, etc.
Conclusion: It is my opinion that my patient’s conditions have not improved since s/he was last assessed for DLA and should continue to meet the higher/medium/lower rates of Mobility and/or Care, as detailed above.
Or
It is my opinion that my patient’s conditions are long term and will not improve, and that s/he meets the higher/medium/lower rates of Mobility and/or Care, as detailed above.
Avoiding a F2F:
Furthermore, I understand that my patient has a face-to-face assessment arranged at an assessment centre on date and destination/may be asked to attend a face-to-face assessment with a contracted HCP. However, in view of my patient’s continuing and long lasting symptoms I do not feel s/he would cope with a face-to-face interview, as the associated stress and anxiety would be extremely detrimental to his/her physical/mental health, as detailed above. I would ask that any further information to be gathered about his/her mental/physical health and functioning should be sought by you via paper forms rather than face to face interview. Should you require further information regarding this letter or my patient then please contact me directly on the telephone number/address given.
If you have any queries regarding this letter or require more information, then please contact me directly.
Yours sincerely,
Dr. XYZ
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