Sickness certification in Primary Care

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Introduction.. A full and detailed guide to the provision of certificates by medical practitioners is provided by the Department of Works and Pensions (DWP).www.dwp.gov.ukwww.direct.gov.uk www.citizensadvice.org.uk . Certification for less than one week's sickness absence . An employer may requir

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Sickness certification in Primary Care

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1. Sickness certification in Primary Care Dr S Thomas GPR CHC.

2. Introduction. A full and detailed guide to the provision of certificates by medical practitioners is provided by the Department of Works and Pensions (DWP). www.dwp.gov.uk www.direct.gov.uk www.citizensadvice.org.uk

3. Certification for less than one week's sickness absence An employer may require an employee to provide a doctor's certificate after more than seven days' sickness. An SC2 self-certification form (SC1 for unemployed or self-employed) is used by an employee to provide their employer with details of sick absences of 4 or more days in a row. The completed SC2 form is then used to help decide whether or not the employee is entitled to receive Statutory Sick Pay (SSP). GPs are not been obliged to issue NHS medical certificates for periods of sickness of less than seven days duration. However if a patient requires a short-term certificate, the GP is entitled to charge a fee.

4. Completion of medical statements The appropriate forms should be: Completed in ink Signed by a registered medical practitioner (other than the claimant) Issued only once Provided for Social Security purposes only Kept secure to prevent misuse and fraud The form should contain details of: The patient's name An accurate diagnosis The date the statement is issued The address of the doctor The doctor's signature Duplicate statements: Can only be issued when the original statement has been lost and should be clearly marked 'duplicate'. People with more than one employer should be advised to submit the certificate to their main employer, who can note the details of the advice you have given, and then present the certificate to their second employer.

5. Med 3

6. Med 3 (White) A Med 3 is generally required after 7 days of incapacity. Less than seven days-short spells of incapacity totalling more than seven days within an eight week period, a Med 3 may be required for periods of incapacity Can only be issued within 24 hours of examination by the doctor who signs the certificate. However a comment in the remarks section such as 'patient tells me he/she has been unfit since...' may be appropriate if the patient has already been unable work for longer than seven days.

7. Med 3 (Contd) Periods of incapacity can be indicated in two ways: Open certificates: Unable or do not want to specify a date for return to work. Complete the 'for' section. Can only initially issue a Med 3 certificate for one month. Cannot issue a Med 3 certificate for more than 6 months within the first 6 months of incapacity. After the first 6 months of incapacity, can issue a Med 3 certificate for any clinically appropriate period up to indefinite. Closed certificates: When able to give a specific date for a return to work, complete the 'until' section. The specific date may be up to 14 days after the date that the statement is issued. The 'remarks' section can be used to advise the patient if they are able to work but with restrictions ('light duties') or whether a workplace assessment by their employer might be appropriate.

8. Med 5

9. Med 5 (Pink) The Med 5 certificate is used for-Covering an earlier period (Can be back dated) Based on examination by another doctor. Where you have a report or records from another doctor to support an opinion that the patient is incapable of work, providing the report was made/issued less than one month previously. If the opinion is based on evidence other than your own examination, the certificate must not cover a forward period of more than one (month. Based on your examination: This may be required if the patient is off work for longer than initially anticipated, e.g. told to use self-certification form but genuinely unable to return to work for 2 weeks. The advice must be based on your examination of the patient on a previous occasion. The doctor must be sure that they would have advised the patient to refrain from work from the date of examination for the entire period of the certificate.

11. Med 4

12. Med 4 GP may be requested by the patient to provide a Med 4 statement prior to the first application of the PCA. A fully completed Med 4 can: Identify those people with a severe condition who may be 'exempt' from the Personal Capability Assessment (PCA), which is: The procedure used by Job centre Plus to determine whether a patient should continue to receive a state incapacity benefit or equivalent benefit. The PCA applies from the start of a period of incapacity if your patient has not worked for at least eight weeks in the preceding 20 weeks. In all other cases the PCA is applicable from the 29th week of incapacity. The medical advice is provided by a doctor approved by the Secretary of State. Avoid the need for the patient to be called to a medical examination when their own doctor's medical evidence provides sufficient information for the approved doctor. Reduce the need for medical evidence in the event of an appeal against disallowance of benefit. Disabling effects: including details of the physical or mental effects of the relevant medical conditions listed under diagnosis/other diagnosis. Additional information: including details about the effects of any treatment and the likely prognosis, including confirmed dates for surgery, chemotherapy etc.

13. Med 4 Contd. The patient's GP is not required to read or comment on the questionnaire that your patient has been asked to complete by the Department. The patient must be examined on the same day or the day before the issue of a Med4 statement. The completed form should include details of an accurate diagnosis of the main incapacitating condition and other relevant medical conditions. In the final section of the Med 4 advice about return to work should be recorded in the same way as with the completion of a Med 3. Even though the PCA process has commenced, the GP can still advise the patient that they are fit to return to work to end the current spell of incapacity. The advice provided on a Med 4 about incapacity for work overrides the advice provided on any earlier statement, Med 3 or Med 5. Using the 'remarks' section: The completed form should indicate if the patient is unable to travel to a Department for Work and Pensions/Job centre Plus examination centre as a result of their medical condition. Otherwise it will be assumed that the patient is able to travel to an examination centre up to 90 minutes travelling time from their own home or normal place of residence.

14. Med 6

15. Med 6 If it is not possible to enter a diagnosis on form Med 3, Med 4 or Med 5 as precisely as the rules require, the local DWP office should be notified at the same time as the statement is issued, by sending a completed form Med 6. A copy of the Med 6 certificate can be found included in each pad of Med 3 and Med 4 forms. The address of the nearest DWP office can be found in the telephone directory under ‘Department for Work and Pensions’. On receipt of form Med 6, if the patient is claiming a state incapacity benefit, a DWP Medical Officer will write to the patient's GP requesting a brief report. This report provides an opportunity to provide a full diagnosis to the Medical Officer.

16. Form RM 7

17. Form RM 7 A General Practitioner may suggest an independent assessment of a patient by the Department for Work and Pensions earlier than would be required under normal control procedures, e.g. if there are any doubts about the patient's ongoing incapacity for work. A form RM 7 should then be sent to the local Department for Work and Pensions office who will take appropriate action. A copy of form RM 7 is included in each pad of Med 3 and Med 4 statements. The current form RM 7 does not ask for any clinical information

18. Form DS 1500

19. Form DS 1500 A form DS 1500 should be issued if requested by a patient (or their representative) if the patient may be suffering from a potentially terminal illness. The relevant definition of terminal illness is a progressive disease where death as a consequence of that disease can reasonably be expected within 6 months. The DS 1500 should be handed to the patient (or their representative) and not sent directly to the DWP. A fee is payable by the DWP for the completion of the form. DS 1500 forms are supplied in booklets by the Department on written application (DWP, DCS Unit 12, Manchester Road, Heywood, OL12 2PZ). The DS 1500 asks for factual information and does not require a prognosis. The report should contain details of: The diagnosis Whether the patient is aware of their condition and if unaware, the name and address of the patient’s representative requesting the DS1500 Relevant current and proposed treatment Brief clinical findings

21. PREGNANCY Maternity Certificate – form MAT B1 Maternity certificates (form MAT B1) are for completion by a doctor (or a registered midwife). You should enter the date of birth at Part B and it is important that the Expected Week of Confinement (EWC) should also be shown in all cases. SMP or MA is paid for a maximum of 26 weeks, starting, at the earliest, 11 weeks before the Expected Week of Confinement (EWC) and, at the latest, the baby's birth SMP is payable to those women who, at the 15th week before the EWC, have completed 26 weeks continuous service with their employer. MA is payable to employees who cannot get SMP, the self-employed and recently employed.

22. QUIZ(AKT) Choose the current sick note for following situations. Med 3 Med 4 Med 5 Med 6 Rm7 Mat B1 Sc1 Sc2   Form for those who can claim statutory sick pay         Completed after 28 weeks off work                             Should not cover more than a month                           Can be used if putting a diagnosis would be harmful  Can be written on the basis of a report from another doctor   

23. From the News By Daily Mail Reporter 26th August 2008 “Fake sick notes being sold online for £25 each” The Times October 19, 2004 GPs told to end ‘sick note culture’ Minister says patients should get back to work quicker DOCTORS were urged yesterday to encourage patients to follow the example of Tony Blair and return to work quickly after illness rather than adopting a “sick note culture”.

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