1. health and fitness

Qualifying criteria survey for MROs
In the Ministry of Justice (MoJ) response of 4 December 2014 to the Government’s
consultation on independence in medical reporting and expert accreditation, the
Government stated (at paragraph 22) that both medical experts and Medical
Reporting Organisations (MROs) would be:
‘…subject to an objective and transparent accreditation process which will
assure both the quality of medical reports and, more generally, the service
levels to be provided. In order to remain on the MedCo system all experts will
have to meet the minimum standards set by the accreditation process. The
scheme for MROs will be based on objective criteria related to service levels
and other operational information…’.
Subsequently the MoJ has worked closely with its core group of key stakeholders to
develop robust service level criteria for MROs wishing to register with the MedCo IT
portal. The MoJ is seeking views on these draft criteria. These criteria relate solely to
MROs and not experts. Experts will be subject to a separate accreditation scheme,
which is currently under development by MedCo. Details of this scheme will be
published in due course on the MedCo Registration Solutions (MedCo) website, and
medical experts will have until 1 January 2016 to gain their accreditation.
The Government is committed to minimising - where possible - the impact on the
market from the whiplash reform programme whilst also seeking to deliver the key
public policy objectives. When using the MedCo website users will have the
opportunity to search for either a MRO or an independent expert. If a user decides to
search for a MRO the user will be provided with a choice of MROs. This choice would
include both larger MROs with the capacity to service high numbers of clients with
reports to agreed minimum standards and timeframes, along with smaller regionally
based MROs who service a local market. MROs will therefore be split into two
groups. The aim is for the mechanism to maintain consumer choice but with sufficient
flexibility so as not to prevent smaller MROs from developing their practice with a
view to increasing their market share.
Users of the MedCo portal will have an upfront choice between engaging an expert
willing to accept direct instructions and engaging a MRO. When the choice is made
for a MRO, a search will be carried out with a number of MROs chosen randomly
from each group. The final number to be drawn is still to be decided, but the intention
is for a mix of MROs from both groups to be presented on every search. There is no
intention for there to be a barrier between groups and it is envisaged that MROs who
meet the additional criteria can apply for reclassification following an appropriate
audit of their capabilities. The operation of this system is intended to strike a balance
between avoiding a disproportionate adverse effect on organisations which have
established their business over time and avoiding entrenching their position, creating
barriers to entry or protecting current organisations from competition.
Draft criteria have been developed for MROs and are set out in the two tables found
attached at annex B of this document. As a minimum, all MROs wishing to register
with MedCo will be required to comply with the criteria in table one of the criteria
document. In addition, larger organisations with high claims capacity and broad
national coverage will also need to meet the criteria set out in table two if they are to
be included in the higher capacity group.
The MoJ is seeking views on the criteria for deciding which group an MRO should be
allocated to. In order to finalise the criteria as soon as possible the survey on this will
close on 20 February 2015. Respondents may either complete the online survey on
the MedCo website or alternatively complete the questionnaire attached at annex B
and email their response to: [email protected]
Responses received after the 20 February will not be included in the final analysis of
the draft criteria. However, it is important to note that these responses will be
retained and will be considered as part of the MoJ’s future review process.
Annex A
Qualifying Criteria for all Medical Reporting Organisations (MROs)
All MRO’s applying for inclusion on the MedCo system must meet these criteria. The criteria
listed in table 2 cover the extra requirements for high volume, national MROs.
1. Qualifying Criteria for all MROs
1.1 Obligation to declare all
“direct financial links”
1.2 Commitment to pay medical
experts on set credit terms
irrespective of the outcome of the
case
1.3 A bond or other financial
instrument demonstrating that the
MRO has sufficient funds available
to remunerate medical experts
from whom it has commissioned
medical reports in the case of
failure of the MRO. We suggest that
this should be in the region of
£20,000.
1.4 Evidence of a specified
minimum level of professional
indemnity and public liability
insurance.
We suggest that this should be in
the region of £1m for professional
indemnity and £3m for public
liability.
Revised Rationale for criteria
The Government is committed to tackling the
issue of ‘direct financial links’ between those who
commission reports and those who produce them.
In order to ensure this public policy objective is
delivered, the MRO will be required to declare all
those individuals and organisations to whom it is
“linked”, as defined in the MedCo user agreement
for MROs, and keep that declaration up to date.
The user agreement for MROs is not yet
available, but it will be similar to the agreement for
Claimant representative, such as a firm of
solicitors, claims management company or a
compensator such as an insurance company. This
agreement is available to view on the MedCo
website.
MROs must commit to, and demonstrate the
ability to pay medical experts within payment
terms agreed. These payment terms must not
include any element of contingency based on a
particular outcome of the case in order to remove
any suggestion that the medical expert has an
interest in the outcome of the case. This is
consistent with paragraph 88 of the “Guidance for
instruction of experts in civil claims” produced by
the Civil Justice Council and which came into
force on 01/12/14.
The availability of sufficient financial resources will
ensure that medical experts are protected in the
event of a failure of an MRO. It will also provide a
disincentive for the establishment of “shell” MROs
designed to undermine the random allocation
model.
If an MRO mismanages a case (e.g. misses a
limitation date or court deadline) then the claimant
and the claimant’s representative might suffer
significant financial loss. Therefore, we believe
that a minimum level of Public Liability cover is
required for MROs.
On the same basis, if a claimant sustains any loss
or injury during the course of the medico-legal
process, the MRO should have appropriate
Insurance cover to mitigate any losses arising
from a claim. We believe the level of Insurance
stated in the criteria is a reflection of the
premiums that the industry currently pays.
1. Qualifying Criteria for all MROs
1.5 Compliance with all relevant
regulatory requirements in relation
to information security.
1.6 Commitment to, and
compliance with, anti-bribery
legislation.
1.7 Commitment to, and
compliance with, a business ethics
policy.
1.8 Documented complaints
handling process.
1.9 Appointment of a Responsible
Officer/Compliance officer.
1.10 Restriction on providing
medical evidence in any case
where a Related Party is involved.
1.11 MROs should not have
Shareholders, Directors and
Officers who has been declared
bankrupt or convicted of fraud in
last 5 years
1.12 Direct management of an
MROs panel of medical experts.
1.13 Payment of the requisite fees
for registration with MedCo.
Revised Rationale for criteria
MROs, irrespective of their size, handle sensitive
information often medical in nature. Therefore,
this requirement is intended to ensure that all
MROs can demonstrate that they have all
necessary systems, controls and checks in place
in relation to information security.
This will give confidence to instructing parties that
MROs registered with MedCo all adhere to a
consistent minimum standard and, if necessary
that they can demonstrate compliance if audited.
MROs, irrespective of their size, may be
susceptible to bribery. Therefore this requirement
is intended to ensure that all MROs can
demonstrate that they have all necessary
systems, controls and checks in place from to
comply with anti-bribery legislation.
This will give confidence to instructing parties that
MROs that are accredited through MedCo all
adhere to consistent minimum standard and, if
necessary that they can demonstrate compliance
if audited. .
In order to give all users the comfort that this and
other legislation is being taken seriously, the
MedCo user agreement contains a business
ethics policy with which all MROs must comply.
It is a consequence of the operation of the MedCo
Portal that instructing parties will have to utilise
MROs that they previously may not have chosen.
As such, and in order to retain MedCo credibility,
any MRO should be able to demonstrate that it
handles all complaints seriously and in a
professional manner. A documented process
should be in place and be auditable.
All MROs should have a single point of contact
responsible for demonstrating compliance with
MedCo requirements.
No MRO should provide a medical report in
support of a case in which a related party is
involved in order to avoid conflicts of interest.
This will ensure that MROs are owned and
operated by people of appropriate character.
The MRO is responsible for the recruitment,
validation and management of the medical
experts on it’s panel, so should be able to
demonstrate that it’s medical experts comply with
all legal and regulatory requirements as well as
any additional requirements specified by MedCo
(such as accreditation).
MROs will only be able to become registered with
MedCo upon receipt of the requisite fee as
determined by the MedCo Board and published at
www.medco.org.uk.
1. Qualifying Criteria for all MROs
1.14 Collection of management
information
Revised Rationale for criteria
In order to underpin effective management of the
MedCo Portal and to monitor its effectiveness,
MROs must provide to MedCo the management
information set out at www.medco.org.uk
All MRO’s applying for inclusion on the MedCo system must meet the criteria shown in table 1
above. The criteria listed in table 2 below cover the extra requirements needed to be
reclassified as a high volume, national MRO.
2. Additional Qualifying Criteria
Rationale for criteria
2.1 Minimum two years of trading
history.
This will give the instructing party confidence in
the sustainability of the chosen MRO and provide
reassurance in the market that the random
allocation model will only produce MROs that
have a demonstrable record of delivery.
2.2 Operational Capability: MRO
will be able to demonstrate:
It is important that MROs will be able to provide
confidence to users of the MedCo system that
they are able to achieve the required minimum
standards, even with high instruction volumes.
This will be auditable as part of the MedCo
accreditation process.
•
capacity to process a
minimum number of
independent medical reports
each year (where instructions
are received from an unlinked
source). As an illustrative
example, this could be in the
region of 50,000 reports a
year;
•
that it has contractual
arrangements with a minimum
number of individual medical
experts who are able to
provide medical reports. As
an illustrative example, this
could be 250 individual
experts;
•
that it has contracted medical
experts in each of the
postcodes listed at
www.medco.org.uk
•
it has a minimum of five
distinct clients, which are not
associated organisations with
it and no client represents
more than 40% of the total
instruction volume (to prevent
an in-house MRO serving its
own commercial ambitions);
•
The MROs must be able to
comply with minimum
standards and service levels
as defined by MedCo.
The requirements as to the number of experts and
availability within each region are intended to
ensure that there is a sufficiently large number of
medical experts available in any particular region.
A larger number of experts with whom an MRO
has a contractual relationship will mean that there
is likely to be a much greater ability for those
MROs to offer appointments that are
geographically and temporally convenient for
those members of the public who require a
medical report to be produced. A small number of
experts in any region could restrict choice in this
respect.
A distinction is made between instructions
received from a linked source and an independent
source, as an independent source will require a
more demanding and challenging service
accessed from a free and open market.
We suggest that no client represents more than
40% of the total instruction volume.
2. Additional Qualifying Criteria
2.3 A bond or other financial
instrument demonstrating that the
MRO has sufficient funds available
to remunerate medical experts
from whom it has commissioned
medical reports in the case of
failure of the MRO.
We suggest that this should be in
the region of £100,000.
2.4 Evidence of a specified
minimum level of professional
indemnity insurance and public
liability insurance.
We suggest that this should be in
the region of £2m for professional
indemnity and £5m for public
liability.
2.5 A documented Disaster
Recovery Plan (DRP) and Business
Continuity Plan (BCP), including
testing schedule, which
demonstrates that the MRO can
return to normal operation within a
maximum of 72 hours
2.6 Appointment of Chief Medical
Officer
2.7 Appointment of nominated
Caldicott Guardian
Rationale for criteria
The availability of financial resources will ensure
that medical experts are protected in the event of
a failure of a larger MRO with more contracted
medical experts on their panel.
Given the number of reports produced, higher
levels of cover for both professional indemnity and
public liability are required for MROs operating a
high volume model.
It is good industry practice for an MRO handling
significant volumes of cases to have a
documented disaster recovery plan and business
continuity plan.
Clients currently and typically, expect that plans of
this nature are in place. Lawyers are likely to
require such plans so that, in the event of any
significant problems, they can be assured that this
will not have a prolonged detrimental impact on
their own business and their clients.
A retained General Medical Council of Health
Care Professionals Council registered CMO would
ensure clinical governance and dispute resolution.
Whilst not mandatory for all MROs, it is clearly
preferable for those providing high volumes of
medical reports and this requirement
demonstrates commitment to clinical governance.
To ensure claimant data is protected and used for
the correct purpose only.
Organisations that have access to patient records
are required to have a Caldicott guardian, a senior
person responsible for protecting the
confidentiality of a patient and enabling
appropriate information sharing. This is required
by the NHS and is an example of “best practice”
and demonstrates further commitment to the
protection of sensitive information.
2.8 Payment of the requisite fees
MROs will be required to undergo an onsite
for registration with MedCo
and of their adherence to the criteria set out in this paper.
inspection
onsite inspection
Payment will be made to an external inspector and the report
resulting from the inspection must be provided to MedCo
2.9 Demonstration of the ability to A2A functionality streamlines the claims process
offer A2A functionality to solicitors for all stakeholders, including the claimant,
making the system more efficient and timely and
also removing unnecessary costs for both MROs
and solicitors.
Annex B
Survey Questions
1.
For criteria 1.3 in table one we suggest that a bond or financial instrument
that would demonstrate the MRO has sufficient funds available to remunerate
medical experts from whom it has commissioned medical reports in the case
of failure of the MRO should be in the region of £20,000. Do you agree? If
not, what would you suggest and why?
Yes
No
Comments:
 
2.
For criteria 2.3 in table two we suggest that a bond or financial instrument that
would demonstrate that a larger MRO has sufficient funds available to
remunerate medical experts from whom it has commissioned medical reports
in the case of failure of the MRO should be in the region of £100,000. Do you
agree? If not, what would you suggest and why?
Yes
No
Comments:
 
3.
For criteria 1.4 in table one, we suggest a professional indemnity insurance of
£1m and a public liability insurance of £3m. We believe these to be in line
with the sums that the industry currently has to pay. Do you agree? If not,
what would you suggest and why?
Professional Comments:
Indemnity
Yes
No


Public
Liability
Yes
No


4.
For criteria 2.4 in table two we suggest a professional indemnity insurance of
£2m and a public liability insurance of £5m. We believe these to be in line
with the sums that larger MROs in the industry currently has to pay. Do you
agree? If not, what would you suggest and why?
Professional Comments:
Indemnity
Yes
No


Public
Liability
Yes
No


There are a number of questions under criteria 2.2 in table 2 regarding the
operational capacity for larger MROs.
5.
Yes
Such MROs will be expected to have the capability to carry out large volumes
of independent medical reports a year. As an illustrative example, this could
be in the region of 50,000 reports a year. Do you agree? If not, what would
you suggest and why?
No
Comments:
 
6.
Yes
We suggest that the MRO should be able to have contractual arrangements
with a sufficient number of individual experts to be able to carry out these
reports. As an illustrative example, this could be 250 individual experts. Do
you agree? If not, what would you suggest and why?
No
Comments:
 
7. We suggest that the MRO should have contracted medical experts in each of
the regions in England and Wales. Do you agree? If not, what would you
suggest and why?
Yes
No
Comments:
 
8.
Yes
For the initial accreditation exercise, we suggest the MRO should have a
minimum of five distinct clients, which are not associated organisations and
no client represents more than 40% of the total instruction volume for the
MRO. Do you agree? If not, what would you suggest and why?
No
Comments:
 
9.
Yes
It is proposed that larger MROs would have a sizeable number of experts
registered in all regions of England and Wales. Do you agree? What should
the minimum number of experts be in a region to qualify as sizeable?
No
Comments:
 
10.
The MoJ is specifically seeking views on the draft criteria for the different
groups of MROs, but please use the box below for any other general comments.
Comments:
Thank you for completing this survey.
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