Certification - Notes for School Children

Schools Requesting Certificates for Children's Absences

Schools are under pressure to reduce non-attendance and will make contact with parents/guardians if there is a concern that the missed schooling is not justified. The parents/guardians turning up and asking for a letter may be to avoid the dialogue which may be in your patient's best interest about how the school can accommodate your patient in spite of their on going health needs or problems.

Occasionally GPs are asked by school staff for certificates to confirm illness in children. This is not usually necessary, and is not part of core services. We have therefore produced a letter which you may download to send to the school requesting such information.

You should, however, consider the following:

is this a safeguarding issue (is the parent keeping the child home to act as a carer or other role, for example)?
do you consider that your patient has an enduring health problem that would be best helped by involvement of the education authorities (every child has a right to an education)?

If so, then sharing information with the school should be done without charge (although you don't necessarily have to provide a written report). If you are reasonably sure that these two important considerations don't apply, and the parents/guardians would like a letter and you are willing to do so then you may charge a fee.

Certificates for Missing Exams

As above, GPs are not contractually obliged to provide a sick note for pupils who are off sick from school, nor are they obliged to provide sickness certification for students that miss an exam or believe their performance was affected due to illness. Unfortunately, many GPs still receive requests for the latter.

The BMA's General Practitioners Committee (GPC) therefore wrote to the Office of the Qualifications and Examinations Regulator (Ofqual) about this, and has received this response which highlights that medical proof should not be required. If you receive a request for this, you may wish to draw the requester's attention to the letter.

Reasonable Adjustments and Special Consideration for Examinations

Special consideration is when the candidate would like retrospective adjustments made to the marks of the candidate.

Reasonable adjustments are those made when the candidate is taking the examination e.g extra time or rest breaks, help reading or use of a computer. These are considered under access arrangements. The use of computers does not need to go through a formal process and should be decided within the centre of examination.

In the guidance released by the Joint Council of Qualifications, who review these applications, then a detailed specialist view is required by the SENCO, not a GP view, this is for both physical and mental health problems for reasonable adjustments.
For special consideration then the view of a GP may be helpful. This is not funded by the NHS and is not included in the GMS contract.

The access arrangements and reasonable adjustments policy can be found here:

Access Arrangements, Reasonable Adjustments and Special Consideration - JCQ Joint Council for Qualifications

Arnewood Pyramid Partnership - addressing poor school attendance levels

The follow information advised by Nigel Watson may also be of interest...

I am always impressed when I visit practices at the variety of ways that have been found to solve common problems that we all face. Sometimes the idea is to address the rising demands but often it is to provide a better service to patients and is addressing an issue that is not required of the practice but one they want to address because they care about their patients.

If you have a good idea, don’t be shy, please share it with us and we can share it far more widely.

Below is some work I have been involved in locally which relates to schools.

I work in a small town of 25,000 people, which has 3 practices, 7 primary schools and one large secondary school. We suffered from the usual barrage of requests:

· Johnny needs a letter to be off games.

· Lucy has ADHD and the teacher wants you to refer her because it is quicker.

· Fred had a cold and did badly in his exams, can we have a letter?

· Sarah is missing too much school so the teacher wants you to see her every time she is ill and report this to the Head Teacher.

Does this sound familiar?

As an LMC we have written to many schools pointing out the GP is not required to do this unfunded work.

Locally we decided to take a different approach, and arranged a meeting with all the local Head Teachers to discuss our “grievances”. To our surprise the Head Teachers were fair and reasonable people who were actually quite nice and easy to talk to. None came with a cane and no punishments were dealt out.

We addressed all the issues above and the Heads broadly accepted and agreed with our concerns. So almost immediately the unnecessary requests stopped.

The Heads were concerned about the label of ADHD as they believed that some children were well behaved at school but still were diagnosed by CAMHS as having ADHD, when the real issue was parenting. They were frustrated that the CAMHS service would not listen to them.

We spent some time talking about the pupil who was off school for recurrent minor illness and the impact that might have for their future. This led to The Arnewood Pyramid – Health, Wellbeing and Attendance Partnership

The practices and Arnewood Pyramid of schools formed a partnership to address poor school attendance levels. Whilst this is not part of core work and the practices are under no contractual obligation to participate, we have found it useful to work with local schools on health and wellbeing issues, particularly with regard to attendance where it is felt that particular children may be vulnerable.

To that end, the partnership was established so that local schools could ‘refer’ children to their local practice who will confirm whether a child’s absence is appropriate following telephone triage or a face to face appointment. However, the onus is on the parent to cooperate and to actively participate in the programme. It is only intended for those children and families where there are long term ongoing concerns, where there have been previous efforts to engage with the family and the family is already aware of the initiative.

The Head Teacher identifies the child and family and meets with them to discuss the situation – so we are only talking about the extreme cases.

Procedural Agreement

Before referring a child onto this scheme Head Teachers will:

· Have had long term ongoing concerns about pupils whose attendance has dropped below 85%, with the significant majority of absences being reported as ill health.

· Be able to demonstrate that they have tried to work with the family to improve attendance.

· Have engaged the services of Education Welfare Officer, as appropriate.

· Have referred the case to the School Nurse.

· Have met with the family to explain the HWBAP scheme before referring them.

Upon receiving a referral from the school the participating GPs surgery will:

· Aim to see the pupil on the first day of illness.

· Recommend a return to school in the afternoon, if it is felt appropriate.

· Recommend a return date to school, if it is possible to do so.

· Complete the HWBAP pro forma for return to the school.

· Liaise with the school, as appropriate, to support the child and family.

I have just had a second child see me on the scheme and I have to say I have quite enjoyed working with the child, parents and the school.

If you would like to consider a similar scheme in your area, we have re-produced the Arnewood Pyramid’s documentation (attached).

Following our initial meeting we planned to meet every 3-4 months, which has been useful. We worked with the schools who planned a “healthy schools week” and got several GPs to go into schools to talk to the children on a range of subjects. I have been involved in one schools programme for the last 3 years. I think I have got more out of it than the schools have! The children are interested, knowledgeable, attentive, enthusiastic and appreciate what you do for them.

Although, talking to a group of 100 pupils aged 8 and 9 is far more frightening than talking to 100 GPs!

We did this because we wanted to rather than because we had to.

Attached file: Arnewood-pyramid-partnership.docx