Six Top Tips for getting the most out of prep

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Firstly…What is prep, and why is it important?

EXAMPLE: Let’s imagine a referral. In activity 1 the claimant writes:

‘I can’t stand for long as I have pain in my back and my husband and daughter help me to make my meals as my hands are weak and I can’t grip’

Instead of rewriting this information word for word in the prep box the HP can write / note some prompts:

‘standing, poor grip, pain and help’ - this will prompt the HP while assessing to make sure they probe with detailed questions to really understand in what areas the claimant has restrictions, and why. It will also remind them of the relevant restrictions claimed.

EXAMPLE:

‘The questionnaire indicated difficulty standing, with reduced grip in hands and the need for help with making a meal, this is……….’

Using prompts on the prep form will also support with proofreading and the HP can go through ticking off the prompts as each one is justified.

Prep is a key part of the assessment process. It is the process of reviewing all information on PIPCS in order to plan the assessment, think of further questions you need to ask the claimant, and what examinations you will need to perform. Good prep ensures a smooth assessment with all areas identified for further clarification which should ensure that the right questions are asked and nothing is missed out. ALL further evidence should be viewed PRIOR to the assessment commencing in order to ensure all reported restrictions are covered in sufficient detail during the F2F component.

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1.6.5 Before starting the consultation, the HP should read the claimant questionnaire and all other evidence on file. It is also recommended that the HPs could also consult with Clinical coaches or other experts prior to the face-to-face assessment for advice and support on how conditions present and how this might affect function.

The PIPAG states:

Best practice prep

• Making simple prompts in the prep box rather than lengthy notes will reduce prep time. Keep it short and snappy and don’t just copy the questionnaire! Remember the prep notes are just for you - no one else will see these!

• The prompts will be present during the functional history and should be used to ensure that probing takes place in all relevant aspects of that activity.

• The prompts should be reflected on when justifying the descriptors and using clinical and logical reasoning. These can be used to ensure all claimed restrictions are covered in the justification.

• The HP is to view PIPCS and look at the PIP Questionnaire (and other evidence) to pull out information as to what the claimant feels their restrictions are…

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EXAMPLE: in the PIP2 it says:

PREVIOUS REPORT DESCRIPTOR

PREVIOUS REPORT JUSTIFICATION STYLE

AR1 CURRENT ASSESSMENTPROBLEM INDICATED

CURRENT REPORTDESCRIPTOR

CURRENT REPORTJUSTIFICATION NEEDS TO BE

A Tick box No change Yes A Free text

A Free text No change Yes A Free text

A Tick box No change No A Tick box

A Free text No change No A Free text

‘I can’t cook for myself due to tiredness, I only cook for my 3 year old who is too young to do it herself’.

Make a prep note of the other areas of childcare which may be pertinent - and questions you would want to explore - such as ‘ask about school run’, ‘who washes and dresses the child?’ etc.

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Prepping with an AR1

Multiple pieces of evidence

Handy Hints

• HP reviews the AR1, noting in the prep boxes where the claimant has indicated this is harder, easier or no change along with brief prompts as to why.

• HP reviews the PA4 (or PA3) and notes the restrictions which were justified last time in the prep box, making prompts to ensure they cover all the restrictions identified.

• The AR1 must be compared to the previous PA4 (or PA3) report and all evidence with this claim reviewed in addition to this.

• The HP is then able to use their prep to consider specific points they need to justify based on the prep notes they will have created in the Java PA4 ensuring all inconsistencies are clarified.

• It is useful to keep in mind what you will be justifying in regards to the AR1- considering the below table and what needs to be justified.

• HP to view the evidence sent with the most recent claim, so if the claimant has 40 pieces of evidence but this is third assessment, view the evidence which has been sent in for this claim, and the previous PA4 only - it is useful to also read any evidence used for the previous PA4 that you may be discounting or which is still of benefit.

• Open all FE relevant for this claim; if there are 6 GP letters for the same department in the evidence box you can write ‘6x GP letters’.

• Always scroll to the bottom of the evidence as sometime a scanned document may be attached to this in error.

• Use prep time to pull key restrictions and causes which you need to focus questions on in the assessment to ascertain why. Remember to use open and clarifying questions to ensure lots of positive ‘can do’ information is gained.

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Condition History

Medication

• Make a note of all of the listed conditions under the ‘condition history’ section to ensure you remember to cover all of these off. Consider the restrictions identified in the activities of the PIP2; would they usually be seen in the conditions listed? For example; Consider a claimant who reports a hand restriction but there is no medical condition listed which supports this symptom. This symptom will also need to be probed at condition history - so make yourself a note to ask this.

• All conditions detailed throughout all of the FE and PIP2 (on any page) should be probed at condition history (including specific symptoms such as incontinence, deafness). The claimant may not have mentioned incontinence in the PIP2 but it could appear on a consultant letter and clarity therefore should be sought.

• You can make a note of any medications or questions you want to ask directly into the medication section of the PA4. You may have noticed a difference in dosage of a particular medication between the PIP2 and piece of FE so it is useful in this instance to make a note to remind yourself such as:

• If medications are listed clearly with the dose and frequency keep the PIPCS questionnaire open (minimise this and open when you’re covering the medication section). Ask the claimant to clarify medications, check these off the system to save having to write these out one by one; again if there are changes note these on the PA4 in medication section along with what these are used for and side effects.

• Consider if medications are consistent with the reported conditions. If not, ask questions around the medications that are not usually prescribed for conditions listed and document the conditions in condition history. Also confirm at assessment what medications are prescribed for to reduce ambiguity, i.e. duloxetine for pain or for depression - how effective are these in the management of their condition? If there has been a change in dose, why was this and has it helped?

• Always list medications which have not been previously identified and what they are for.

‘Ask about Fluoxetine increase, why? efficacy? Any side effects?’

A step by step guide to prep…(Taken from Java PA4 e-learning)

You will remember from your Java PA4 training that the updated prep functions were explained in full - here is a refresher of the step-by-step process to ensure you can do the best possible prep!

PreparationWhen you select the ‘Preparation’ tab at the left hand side it opens up the screen below. You will see all 12 PIP activities listed across the top. First of all, indicate whether there is a problem stated in the PIP2 or AR1.

TIP: This will not currently give you the option to select so you will need to free text whether the claimant has reported that it is harder/easier/no change, then put in your notes as shown below.

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Work your way along each of the activity tabs at the top completing your prep for each activity.This information will then be available for you to view on the screen beside the relevant Functional History area as you complete it with the claimant. It will help prompt you for relevant areas of the evidence to explore and address.

TIP: Remember that claimants may not always write their issues in the relevant activity section of the PIP2. For example, they may write about difficulties with walking in the section about planning and following a journey, or they may write about difficulties with engaging in the section about verbal communication. If this is the case, it is necessary to ensure your prep notes are made in the relevant section on the PA4.

You will then complete your prep for the history of conditions and examinations as shown on the next couple of slides. Include any areas you want to remind yourself to talk about or examine.

Select whether problem stated on PIP2 or not for each area

Insert your Prep notes for each area here

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Impact on AssessmentAs you move on to the consultation you will see from the slide below that your prep notes for each activity are available on screen whilst you are taking your functional history for that activity to remind you of all the areas that you need to probe and to discuss any inconsistencies within the evidence. The system will also remind you whether the activity has been claimed as a problem within the PIP2/AR1 or not, to help you focus your discussions in the most relevant areas.

Completing your reportWhen you move on to complete your report and choose your descriptors there are a couple of things to note.

Firstly, as you can see from below, your prep notes and full functional history for that activity are available for you to see at the bottom of the screen.

Secondly if, as in the example shown, you select an ‘A’ descriptor and you have indicated in your prep that the PIP2 or AR1 has shown a problem, then this is highlighted with a warning sign. This doesn’t mean your descriptor choice is wrong – it just draws your attention to the fact you are disagreeing with the claimed level of disability and will need to provide a strong justification.

Reminder that PIP2 has indicated a problem

Prep notes available at the bottom of each activity area

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Reminder that PIP2 has indicated a problem

Prep and Functional History shown on screen

Summary sheetFinally in this section your prep notes, and whether or not you have indicated that there was a problem on the PIP2 or AR1, is visible on the summary sheet as a final reminder to you that you have agreed or disagreed with what was said within the questionnaire. Again, the yellow warning arrow does not mean your advice is wrong – it’s just to highlight there has been a different opinion offered.