The bundle usually arrives before the person does. A refusal letter, several years of GP records, a handful of hospital letters and an instruction asking what would happen to this person's health if they were removed from the UK. By the time we meet, the papers have been read and my questions written down. What is left is the part no document can do, which is sitting with the person and finding out how the illness actually behaves.
The question underneath an Article 3 medical report is a practical one. Solicitors and applicants want to know what a doctor must cover for the evidence on health grounds against removal to be complete and honest, and what the doctor should leave to the lawyers.
Chest pain, signs of a stroke, severe breathlessness, heavy bleeding, a severe allergic reaction or symptoms of sepsis need 999 or A&E immediately. For urgent advice that cannot wait, call NHS 111.
What should an Article 3 medical report actually cover?
I start with the instruction, because the questions asked decide the shape of the report. A good instruction names the issues: the diagnosis, the current treatment, the likely effect of that treatment stopping, and sometimes fitness and wellbeing in relation to detention, removal or the proceedings themselves. If a question sits outside medicine, the report says so rather than stretching to answer it.
The history, taken slowly
Then the person. I take the history in the order the illness happened, not the order the records were filed. When it started, who diagnosed it, what was tried, what helped and what did not. I ask about a typical day: sleep, eating, washing, getting dressed, getting to appointments, and who helps with which of those. The detail of an ordinary Tuesday tells me more about severity than any label on a hospital letter.
The examination and the records, side by side
The examination is targeted to the condition, and I record what I find, including what is normal. Then I set the history against the records. Where they agree, the report says so. Where they differ, the report says that too and gives the likeliest clinical explanation, because an unexplained gap is the first thing a careful reader will notice.
Good days, bad days and what sits underneath
The day of the assessment is one day. Where a condition fluctuates, the bad weeks need describing as well, from the records and from the person, and the report makes clear which observations are mine and which are reported to me. I also look for the second layer. Someone with a serious physical illness who is facing removal is often sleeping badly and eating less, and that can change the clinical picture as much as the main diagnosis does.
Treatment now, and what follows without it
In a health case this is often the centre of the medical evidence. I describe the current treatment in plain terms, how long the person has been on it and how they respond. If the records show an earlier break in treatment, what happened during that break is often the most reliable guide there is. The prognosis is then stated with honest uncertainty: what is likely and what is merely possible, with a rough timescale for each.
Where the opinion stops
A doctor cannot say whether removal would breach Article 3 of the European Convention on Human Rights. That decision belongs to the Home Office and, on appeal, to the tribunal. Nor will the report guess at what a health system in another country provides; that question needs its own evidence. A report that writes down its own boundaries is easier to rely on, not harder.
What should be sent before the assessment?
The turnaround starts once the records and instructions are in, so a missing document is the simplest way for a report to run late. It helps to gather these first:
- The letter of instruction, with the specific questions and the date the report is needed by.
- Full GP records rather than a summary printout, covering several years where possible.
- Hospital letters, discharge summaries and any earlier medical or psychiatric reports.
- The current medicines list, with doses.
- The Home Office decision or refusal letter, if there is one.
- Whether an interpreter is needed, and for which language and dialect.
If someone's health is getting worse quickly while the papers are being gathered, that needs a doctor now, separately from the report. For urgent mental health help, call NHS 111 and choose the mental health option, or call Samaritans free on 116 123, any hour. If anyone is at immediate risk, call 999.
Can a GP give this evidence, or is a specialist needed?
For many physical conditions, and for the overall picture of how several conditions interact, a GP with a medico legal practice is a sensible author. General practice is the specialty that follows the whole person over time. Where the case turns on serious mental illness, or on detailed psychiatric diagnosis and risk, a consultant psychiatrist report may be the better instruction. Consultant psychiatrists lead our psychiatric report work, and I say early if I think a question belongs with them. There is more on that choice in mental health evidence in an asylum or human rights claim, and where private or family life is also argued, in Article 8 and your health.
How does instruction work at Clinique Alpa?
Solicitors can instruct directly, and individuals can contact us themselves. Scope, fixed fee and timescale are agreed first. The assessment is in person at 466 Green Lanes in Palmers Green, and if travel is not realistic, a home visit examination can be arranged. Any letter or report is written where clinically appropriate after assessment.
The fee follows the depth of evidence needed. A short immigration medical letter is £550 (2 to 4 pages), a standard immigration medical report £1,000 (5 to 8 pages), a comprehensive immigration medico legal report £1,250 (8 to 15 pages) and a complex asylum or immigration expert report £1,500 (up to about 20 pages). Legal aid work is done at the authorised rate only, with prior authority. The full list sits on our medical report fees page, and there is a wider account of the process in immigration medical reports for the Home Office.
Reports are usually ready 48 to 72 hours after the assessment, once all records and instructions are in. A priority 24 hour service is available for 25 per cent more, subject to the diary. Complex reports may need a longer window, and that is stated at quotation.
This is an independent clinical opinion. It cannot be written to a required conclusion and does not guarantee the outcome of any claim, application, exemption or hearing.
All medico-legal assessments and expert reports are independent professional opinions. No particular diagnosis, conclusion, causation opinion, prognosis, consistency assessment, recommendation or outcome can be promised or guaranteed.
Written by Dr Mitesh Parmar, MBBS MRCGP, Principal GP and Clinical Director at Clinique Alpa, 466 Green Lanes, Palmers Green, London N13 5PA. This article is general information, not personal medical advice. In an emergency call 999. For NHS advice call 111 or visit nhs.uk.