1. Referees comments

2. Age Profile 2 peaks: 20 - 29y – recruiting age (asthma, 20 - 29y – recruiting age (asthma, eyesight eyesight 50 – 59y – older Age group (IHD, OA 50 – 59y – older Age group (IHD, OA etc) etc)

3. Medical categories Cardiovascular 30.8% Cardiovascular 30.8% Endocrine 14.2% Endocrine 14.2% Sensory 12.9% Sensory 12.9%

4. Significance! ADs decision vs. MRs decision ADs decision Number Percentage MRs decision Number Percentage Fit 0 0.0 Fit 66 14.2 Fit with restrictions 111 23.9 Fit with restrictions 252 54.2 Temporarily unfit 86 18.5 Temporarily unfit 62 13.3 Permanently unfit 268 57.6 Permanently unfit 85 18.3 Total 465 100.0 Total 465 100.0

5. ADs decision vs. MRs decision Most common AD decision – Category 4 Most common AD decision – Category 4 Most common MR decision – Category 2 Most common MR decision – Category 2 Most common reasons for grading change- cardiovascular, endocrine, sensory Most common reasons for grading change- cardiovascular, endocrine, sensory

6. Referees workload Large variation in MR workload. Large variation in MR workload. 4 referees saw 58% of the referrals. 4 referees saw 58% of the referrals. 1 referee saw more then 20% of the referrals. 1 referee saw more then 20% of the referrals.

7. Reassurance No significant association between MRs decision and Referee code. No significant association between MRs decision and Referee code.

8. Interesting points The 3 MRs with most dove-like trait were the top 3 in terms of workload! The 3 MRs with most dove-like trait were the top 3 in terms of workload! Most appellants benefited from appeal – only 2% were downgraded. Most appellants benefited from appeal – only 2% were downgraded.

9. Conclusions Most findings were as expected. Most findings were as expected. The commonest reasons for appeal have been addressed in the new guidelines. The commonest reasons for appeal have been addressed in the new guidelines. High variance between ADs and MRs by medical category may indicate a need for revision of the standards. High variance between ADs and MRs by medical category may indicate a need for revision of the standards.

10. Recommendations Consider MR workload review. Consider MR workload review. Monitor variance between ADs and MRs by medical category to determine effectiveness of standards. Monitor variance between ADs and MRs by medical category to determine effectiveness of standards.