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