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What do I do if a patient forges a sick note?

Three experts advise a GP whose patient has faked a sick note with their name on

I have discovered that one of my patients has forged my signature on a sick note. What do I do?

Dr Grant Ingrams

Dr Grant Ingrams: Warn the patient in writing

Patients falsifying documents is sadly not an uncommon event. And it is becoming easier. On one website you can get two fake Med3 forms for £9.90. Although the small print on this site mentions that these notes should only be used for entertainment purposes, the main wording explains how and why employers need a Med3 and how to complete them.

I still feel betrayed and angry each time it happens, but as usual the first step is to find out what has actually occurred.

Most commonly the first you hear is a communication from the Department of Work and Pensions (DWP) or an employer. You must reply with clear facts, but still respect the patient’s confidentiality. For example, confirm that you did not write the note, or that it has been altered – but do not give any clinical details.

Be careful if you are contacted by phone that you ensure the validity of the caller before giving out any information.

The fraud undermines the doctor-patient relationship, but by itself, it would not usually be grounds to remove a patient from your list.

Practices cannot usually remove patients unless they have given a written warning within the previous year according to GMS Regulations (Schedule 3, Paragraph 24).

It would be reasonable to write to the patient expressing your views, warning that if this or anything similar happens over the next year they will be removed.

If you think your patient is deliberately defrauding the benefits system you can report them online (gov.uk/report-benefit-fraud) or via the national helpline 0800 854 440.

Dr Grant Ingrams is a GP in Glenfield, Leicester and ex-chair of the IT subcommittee of the GPC

Dr Natasha Usher

Dr Natasha Usher: Find out how this happened

First, it is important to consider the source of this information, and to determine whether this has definitely occurred. If you learn about it through official channels such as an employer or the DWP, then it is likely to be valid. I would want more information about what has been written on the sick note, including the duration, and even better, a copy. Is it an official Med3 or is it simply a letter, which is much easier to fake?

If this is confirmed, I would discuss it with the other partners to find out if this has happened before or if anyone else has any concerns about this patient. Then I would contact the patient and bring them in to discuss it, both to let them know I am aware of the situation and to find out the reasons. It would be important to let them know this is unacceptable and could result in removal, or legal action for fraud.

It is also important to review practice procedures – where are sick note pads kept? Are they in lockable drawers and did the patient get access? Is it usual practice to do them electronically, with a much better audit trail, and could this be notified to local employers or the DWP? Was the sick note forged from a template found on the web? It is important to look at how this occurred, and what could be done to prevent it happening again.

Dr Natasha Usher is a GP in Montifieth, near Dundee, Scotland

Dr sarah jarvis

Dr Sarah Jarvis: Beware of breaching confidentiality

If you have been asked by a third party to confirm whether a sick note is legitimate, you can confirm you did not produce it without breaching confidentiality, but you should not disclose any further information about the patient. As always, it’s vital to have clear and thorough records so that you can check what has been issued from your practice.

Doctors often feel a situation like this is a breach of trust and you may want to remove the patient from your list or even involve the police. But the first step should be to ask the patient in to discuss the note. Then make your decision.

The GMS contract suggests that doctors can remove a patient if they have reasonable grounds, but must usually issue a warning in the preceding 12 months. A warning could emphasise that it is a serious matter and allow you to take further steps if there is a recurrence.

If you are thinking of notifying the police, bear in mind the patient is unlikely to give permission for the information to be disclosed, so you should aim to balance the benefits to an individual or society versus the harms of disclosure. Disclosure in the public interest without consent, or after refusal, may be justified if failure to make the disclosure could expose others to a risk of serious harm or death – unlikely in this case. However, this may be relevant to other scenarios where a patient misleads an employer and it is helpful to be familiar with paragraphs 51-56 of the GMC’s confidentiality guidance (2009).

Dr Sarah Jarvis is a medicolegal adviser at the Medical Defence Union

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Readers' comments (12)

  • A great example of how far the inequality in the Doctor patient relationship has gone. Imagine if we forged their signature on something allowing us some pecuniary benefit? Next stop GMC, or jail, or both.

    If I had incontrovertible evidence, I'd strike to so-and-so off for permanent breakdown of relationship, do it noisily by writing and let your colleagues know, and then ring a Constable. Fraud is Fraud. Let's stop pussyfooting about.

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  • Amazing how an act of clear intentional fraud can occur and yet we're ( or you working GPs) are forced to collude with the crime!

    My suggestion if you're going to collude just ring up the patient and give them a real med cert - will save you paperwork and hassle!

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  • After seeing the film, I Daniel, it makes no difference having a sick note because the Department of Social Security will have you interviewed by an official with no medical qualifications who decides that you are fit for work even if you are recovering from a traffic accident or have a severe cardiac condition, so don't bother to give sick notes and just tell the patients to write their own. The alternative is to sack Her Majesty's Government which destroyed the Social Security Scheme and reinstate the Scheme we used to have which was staffed by doctors. These and employers are the only people qualified to judge whether an applicant is fit for work. If you turn up for manual labour with one leg, you place the poor employer in a difficult position. You should have previously been signed off sick and suitable for any work other than manual labour. The current Government scheme is as irrelevant as the social security parts of 1832 Reform Act were. It was all started by Queen Elizabeth 1st who required the propertied to pay a small amount each week for the upkeep of the destitute who were asking for alms after being dismissed from the care of the Monasteries which Cardinal Wolseley and King Henry 8th had destroyed in the efforts to deal with the King's Excommunication and the declining contents of the King's Exchequer. Elizabeth was of course a devout Christian knowing her duty but the 1832 capital class were not terribly Christian and no longer wanted to pay. I am an atheist but I can see straight though this terrible Government's agenda and it is neither charitable nor Christian. If the prime minister declares she is a Christian, tell her to do her duty like Elizabeth 1st did, and pay up.

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  • It's the era we live in. Anyone can be an 'expert'

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  • These three so called experts are nothing more than hand wringing cardigans who contribute to the mess we find ourselves in.

    1. Confirm its really a fake
    2. Write and remove from list and inform the police.
    End of story.

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  • GP: Dead patient it turns out you have been fraudulently taking my name in vain. Would you mind stopping it and if I informed the police
    Patient: No thanks I think I'll continue and if you dob me in I'll complain to the GMC
    GP: oh alright then
    Patient: oh and whilst I'm here can I have some diazepam
    GP: Why?
    Patient: erm.. shall we say back pain or stress??
    GP: No
    Patient: what's your GMC number Doc?
    GP: here's some diazepam just calm down

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  • GP: it turns out you have been fraudulently taking my name in vain. Would you mind stopping it and if I informed the police
    Patient: No thanks I think I'll continue and if you dob me in I'll complain to the GMC
    GP: oh alright then
    Patient: oh and whilst I'm here can I have some diazepam
    GP: Why?
    Patient: erm.. shall we say back pain or stress??
    GP: No
    Patient: what's your GMC number Doc?
    GP: here's some diazepam just calm down

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  • Fraud is fraud.

    And worse, its directly involving you, your signature and your GMC number.

    This for me is an instant removal from list due to crime being perpetrated, fraudulent behaviour and breakdown in relationship.

    Any other response is not acceptable.

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  • Forging a doctors signature is technically impersonating a doctor which is not permitted under the Medical Act. And punishable in law. I wouldn't create a fuss about it though but I would remove them from my list due to a break down in doctor patient relationship that us irreconcilable.I wouldn't be able to reconcile this behaviour nor do Ifeel inclined to try to do so.

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  • @anonymousPrivate GP 2:27 pm.
    The punishment under law for impersonating a doctor which the GMC can impose is........ ...to be struck off the medical Register : which is not much of a problem to a patient who was not Registered to start with.
    I tend to agree with everything else you said!

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