The weakest letters of instruction I receive are often the longest. They enclose everything and ask me to comment on the appellant's health in general. The strongest are shorter and ask 4 or 5 numbered questions, each tied to something the judge has to decide. The reports that follow differ more than the doctors who write them.
For a solicitor, the decision is who to instruct and how to instruct them, so that the immigration tribunal medical report answers the issue actually in dispute. The short version: choose a doctor whose expertise fits the question, ask specific questions, and send the records with the instruction rather than after it.
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What do I look at when an instruction arrives?
I read an instruction in a fixed order: the questions first, then the issue in dispute, then the material I am being asked to rely on. Only after that do I decide whether to accept it.
The questions
Good questions are numbered and anchored to the case. A request to comment on someone's health invites a report that describes everything and answers nothing. Asking for the current diagnosis, the treatment being received, and the likely effect on health if that treatment stopped gives me something to reason towards, and gives the tribunal something to weigh.
Immigration instructions usually fall within a handful of areas: a medical condition and its treatment, Article 3 or Article 8 ECHR health grounds, scarring and injury documentation, fitness and wellbeing relevant to detention, removal or proceedings, the Knowledge of Language and Life in the UK exemption, and records review. I have written separately about what an Article 3 medical report must cover and about the scarring examination.
Whether the question is mine to answer
This is the check that protects everyone, including the person being assessed. I am a GP with a special interest in psychological medicine and a parallel medico legal practice. Where the central question is a psychiatric diagnosis, particularly a disputed one, a consultant psychiatrist is usually the right expert, and at Clinique Alpa consultant psychiatrists lead that work. I would rather say so at the scoping stage than write outside my expertise. The post on mental health evidence in asylum and human rights claims sets out where that line sits.
The records
I read the GP records, hospital and specialist letters, any previous medical reports and the decision being challenged, so I know which parts of the medical picture are accepted and which are not. Gaps matter as much as entries. If the records go quiet for 2 years, the report says so and considers why, rather than filling the silence with assumption. If the questions are mine to answer but the records are thin, I say what difference fuller records would make before you decide how to proceed.
The person
The assessment is in person at Palmers Green, and a home visit examination can be arranged where travel is not realistic. I need to know the language and dialect the person is most comfortable in, and anything that makes a long appointment hard. At the start I explain who the report is for and that it is independent. People often assume the doctor is on their side, or on the Home Office side. The honest answer is neither.
What I observed, and what I was told
A tribunal needs to know which parts of a report rest on my own observation and which rest on the person's account or the records. I keep them apart on the page. Where I say a finding fits an account, I also say what else could explain it, because an opinion that ignores the alternatives is not much of an opinion.
What the report will contain
The structure follows the instruction. What I was asked, what I read, what I was told, what I found on examination, my opinion on each question with the reasoning behind it, and where my opinion stops. Where something falls outside my expertise, or the evidence does not allow a view, the report says so in plain words. A tribunal can work with a clear limit. It can do very little with a vague answer.
What slows an immigration tribunal medical report down?
Reports are usually ready 48 to 72 hours after the assessment and after all records and instructions are in. That last condition is where most delay lives, and the causes are predictable:
- records sent after the assessment instead of with the instruction
- questions added or reworded once the work has started
- no date given for when the evidence has to be served
- nothing said about language or interpreter needs
- the person arriving without knowing why they are being seen, or by whom
Instruct as soon as the medical issue is identified, not when the directions arrive. If a date is close, tell me on the first call. If some records cannot arrive in time, I can work from what is there, and the report lists what I did not see. A priority 24 hour service is available for 25 per cent more, subject to the diary, and complex reports may need a longer window, which I state at quotation. The post on deadlines and what is realistic goes further into timing.
How does Clinique Alpa handle a direct instruction?
Solicitors can instruct directly, and individuals can contact us themselves. Scope, a fixed fee and a timescale are agreed before the assessment is booked. If further records or questions arrive later, any extra work is agreed with you before it is done.
The fixed fees are £550 for a short immigration medical letter of 2 to 4 pages, £1,000 for a standard immigration medical report of 5 to 8 pages, £1,250 for a comprehensive immigration medico legal report of 8 to 15 pages, and £1,500 for a complex asylum or immigration expert report of up to about 20 pages. Legal aid work is done at the authorised rate only, with prior authority. Any letter or report is written where clinically appropriate after assessment. The full list is on the medical report fees page.
My duty in writing the report is to give an honest opinion, whoever pays for it.
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.