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Independents' Day

Sickness certification

Dr Nerys Williams passes on insights gained from working as a consultant occupational physician

Dr Nerys Williams passes on insights gained from working as a consultant occupational physician

1 GPs are required to provide some medical statements for free.
This requirement extends to recording on a medical statement ('sick note') the advice given to the patient regarding their ability to perform their usual occupation.

GPs may also be asked for a factual report by a Department for Work and Pensions medical officer. The most common use of the information in the report is to claim for incapacity benefit.

2 There is one exception to the rule that a doctor is not required to issue a certificate for the first seven days of absence.
When claiming incapacity benefit, if a person has had one or more spells of incapacity in an eight-week period, the doctor will be required to issue a certificate for any further spell of incapacity within that period.

In such circumstances Jobcentre Plus or DWP will notify the doctor.

3 Be aware of protocols for the primary/secondary care interface.
Recent DWP guidance states that a Med should be issued to patients on discharge from hospital where a doctor advises a patient not to work.

Further certificates must be issued by the doctor who assumes clinical responsibility for treating the condition causing the incapacity, which may not be the GP – for instance where a patient has advanced cancer and is attending oncology outpatients regularly, in which case the treating clinician will issue further certificates.

This is also in the best interests of the patient as they avoid unnecessary visits to the GP purely for a sick note. If GPs find that hospital specialists are not issuing statements, they should inform the trust chief executive.

4 Remember the rules for how sick notes must be issued.
Medical statements must be completed in ink and issued only once.

They must be signed by a registered medical practitioner (other than the claimant) and used for social security purposes only.

Current legislation does not permit other healthcare professionals to sign sick notes but other professionals such as osteopaths may issue recommendations to patients in the form of a certificate that employers can consider on its own merits. But these do not necessarily replace the statement signed by the GP.

5 Notes must have a specific diagnosis but it is possible to protect patient confidentiality in some cases.
Medical statements should contain an accurate diagnosis of the patient's condition which has led to the advice to refrain from work or has caused the patient's absence from work.

DWP guidance states that terms such as 'bereavement' or 'pregnancy' which do not relate to a specific disease or disablement should not be used.

But if the doctor feels that disclosing the diagnosis may be prejudicial to the patient's well-being and that the employer should not know the diagnosis, it is appropriate to use a non-specific diagnosis and send form Med to the DWP medical officer, who will write to the GP requesting a brief report on the patient's condition.

6 Don't forget RM7 forms if in doubt about a patient.
If the GP feels an independent assessment of the patient is needed, for example where there are doubts about their continuing incapacity for work but the GP is issuing statements, a request can be made to DWP on form RM7.

The form does not ask for any clinical information and can be found in the pad of statements. Some advice on repeated requests for Med 4 statements If a GP is asked for a Med 4 statement soon after they have already completed one, the most likely reason is that the patient's claim for incapacity benefit has been disallowed and they have decided to make a further claim.

From the GP perspective, only one Med 4 is required per claim.

There are schemes to help people back to work. These include Work Trials, where disabled and non-disabled people can try a job for 15 days while the employer assesses whether they can be engaged on a permanent basis. Workstep is another scheme that provides support and a development plan to employer and employee.

The Access to Work scheme can help disabled people Access to Work assists employers in defraying the costs of a range of interventions that help people with disabilities gain and retain work.

This could be a signer for a deaf person, a ramp for someone in a wheelchair or specialised software for someone with visual impairment. This scheme and Work Trials and Workstep are accessed through the disability employment adviser (DEA) who is based at local Jobcentre Plus offices.

Pilots are under way to provide employment advice in GP surgeries DWP is currently undertaking a pilot study in which Jobcentre Plus staff provide employment advice via a base in GP surgeries.

The two-year pilot takes referrals from GPs and other primary healthcare staff and assesses the individual before referral into a range of schemes to support the person back into work. These include condition management programmes (delivered by healthcare professionals such as occupational therapists, physiotherapists and psychologists) and training in new skills.

Nerys Williams is a consultant occupational physician and principal occupational physician for the Department for Work and Pensions – she is a former GP.

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