How should we deal with fit note fraud?
The Department of Work and Pensions (DWP) has contacted us to say a patient is suspected of changing the number of weeks specified on a Med 3 form issued by one of our GPs. How should we respond?
Dr Rob Hampton: Encourage the patient to deal directly with the DWP
It’s worth remembering that the only statutory purpose of the fit note is to help a patient get sick pay. In all other regards, it serves only as advice to the patient. However, the reality is the Med 3 has become a de facto standard that carries much weight in the employment and welfare sector.
GPs have been able to generate e-fit notes since October 2014, but I estimate only 30-40% of the profession is doing this. And whether computer generated or not, fit notes are susceptible to modification. When dealing with this, first consider patient confidentiality. Act in an objective manner that includes the patient in the dialogue and places responsibility on them to address the issue directly with the DWP, first checking that there has been no misinterpretation by the department.
Write to the patient, with a copy to the DWP, outlining the reported discrepancy. Tell them you have a clear record of the note and re-issue a ‘copy’ to them. Try to arrange a telephone consultation with the patient to discuss the matter and tell them that you are seeking advice about direct disclosure to the DWP from your medical defence body.
A patient forging documents constitutes a clear breach of trust between patient and the practice, but rather than remove them from the list, appoint a member of staff to discuss the issue with the patient once the immediate concern has been clarified.
Dr Rob Hampton is a GP in Wigston and clinical director of the Leicestershire Fit For Work service
Dr Helen Cotton: Try to gain patient consent before proceeding
The GMC views confidentiality as ‘important but not absolute’ and accepts it can be breached in three situations: if information is required by law; if the patient has consented to disclosure; and if disclosure is in the public interest.1 Therefore, if possible, try to gain consent from the patient before discussing the issue with the DWP.
Removing the patient is more complex. GMC guidance states this should be an exceptional action taken as a last resort when the doctor-patient relationship has broken down irretrievably.2
This course of action could become appropriate if the practice had issued a warning to the patient in the 12 months preceding the current discrepancy.
It will also be necessary, then, to review the existing relationship with the patient. Consider whether this is typical behaviour or something out of character that could be discussed with them. Even if the doctor concerned feels unable to continue providing care, the patient could start seeing another GP.
If the practice has an existing policy about removing patients this should be followed. As removal is an exceptional event, have a practice discussion before the decision is made.
Dr Helen Cotton is a GP in Yeovil
Dr Rachel Birch: Get a copy of the fit note
Remember that you have a duty of confidentiality to your patient; don’t provide any clinical details about the patient or even confirm whether they attended that day.
However, you should ask the DWP to provide you with a copy of the fit note. Either confirm that this is a copy of the original or state that the note, in its current form, was not issued by the practice.
If the latter is the case, contact the patient to explain you are aware of alterations to a fit note issued to them and that you are obliged to confirm this with the DWP.1 Explore why the patient felt the need to take this action as there may be mental health or social issues that you are unaware of.
The GMC states ‘you should end a professional relationship with a patient only when the breakdown of trust between you and the patient means you cannot provide good clinical care to the patient’.2 If you are considering removing the patient from your practice list, you should first provide them with a warning, outlining the reasons for doing so.
You do not have grounds for immediate removal, unless the patient has previously been warned for similar behaviour.
Dr Rachel Birch is a medicolegal consultant at the Medical Protection Society
When contacted by Pulse, the DWP said that it investigates all allegations of fraudulent claims to benefits, which can include instances where Med 3 forms have been altered, but could not offer more specific advice on the case.
1 General Medical Council. Good Medical Practice (2013).
2 General Medical Council. Ending your professional relationship with a patient (2013).