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Spotlight on GP dilemma of sicknotes

A court case in London has highlighted the dilemma in writing sicknotes – Dr Nicholas Norwell of the MDU looks at a highly complex issue that faces all GPs

A recent court case involved a City trader who claimed damages from her employers reportedly for the stress caused by her job.

The Times reported that the woman's GP stated on a medical certificate she was suffering from a viral illness, not depression and work-related stress. The woman told her GP she feared her job would be in jeopardy if the truth about her stress emerged1.

Mr Justice Creswell in the High Court called for the GMC to investigate the issues brought up in the case, although he made no criticism of the GP in question.

The concerns raised by the court case were echoed by a Norwich Union Healthcare survey that revealed an average GP gets 577 requests for sicknotes each year and believes a quarter are questionable2.

GPs are contractually required to issue various certificates including sick certificates for illnesses of more than seven days. The GMC is clear about a doctor's duty with regard to sicknotes.

Paragraph 51 of the booklet Good Medical Practice states doctors must be 'honest and trustworthy when writing reports, completing or signing forms and providing evidence in litigation or other formal inquiries'.

It continues: 'You must take reasonable steps to verify any statement before you sign a document. You must not write or sign documents which are false or misleading because they omit relevant information.'

There are four common sickness certificates – Med3, Med4, Med5 and Med6. GPs are probably most familiar with Med3 – which states the doctor examined the patient 'today/yesterday' – and Med5 which allows backdating.

Where a doctor feels it would be harmful to the patient to write the exact illness, they can write a 'vague diagnosis' on a Med3 and the actual diagnosis on a Med6 which goes to the Benefits Agency.

It must be emphasised that this is for the protection of the patient and not to mask the true nature of the illness from the employer. Entering false details on sicknotes could be construed as fraud.

GPs should be aware of, and guided by, the booklet 'Medical evidence for statutory sick pay, statutory maternity pay and social security incapacity benefit purposes: a guide for registered medical practitioners (IB204)' available from the Benefits Agency.

Doctors often raise queries with the MDU about signing sickness certificates. Here are a couple of examples.

Example 1

A GP treated a man for bronchitis. Three weeks afterwards the patient's wife rang the GP to ask for a note saying they had had to cancel a holiday because of the illness. The GP declined, partly because he had not seen the course of the illness and partly because he did not know exactly why the couple had cancelled the holiday.

He offered to write a factual 'To whom it may concern' document saying he had seen the man on that date, had diagnosed bronchitis and had treated him. That document achieved its purpose and the

couple received partial reimbursement of their holiday costs.

Example 2

A man asked his GP for a sicknote because he wanted to stay at home and look after his sick wife.

The GP explained he could not issue a sick certificate to someone who was not ill. With the wife's consent, however, the GP wrote to the man's employer and the man was given a period of non-holiday leave.

Nicholas Norwell is an MDU medicolegal adviser

The cases mentioned in examples one and two are fictitious, but based on cases from the MDU's files. Doctors with specific concerns are advised to contact their medical defence organisation for advice.


1 'Suicide' City trader agrees to settle with bank. Times April 29, 2004

2 Norwich Union press release: April 28, 2004

Case history 'I couldn't sign because I hadn't been asked at the time'

Dr Grant Winstock, a GP in south London, told Pulse he had once treated a child for a discharging ear.

Two weeks later the mother had phoned to say she had cancelled her holiday – could Dr Winstock sign a form to say it was because of the child's ear. Dr Winstock said No.

'I told the woman I couldn't sign because I hadn't been asked at the time – it would be fraudulent to sign now. I would have signed had I been asked when I'd seen the child, but felt I couldn't do so now.

'Sometimes patients get awkward when I use this argument. I reassure them I'm not accusing them of fraud.

'It would be me who would have to take the consequences. They usually understand when I put it to them like this.'

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