Guidance

Bus Pass

In England, individuals can apply for a bus pass for free travel when they reach their state pension age (60 in London and Wales). The “eligible disabled” (as described in the list below) may also apply for a pass, and patients may attend with forms for the doctor to sign to prove eligibility. This is a poor use of NHS resources when there are many other ways of proving eligibility without using GP time and resources.

  • There is no obligation to sign these forms
  • If you do so, you may charge a reasonable fee

We have provided the following templates which we hope you find useful:

(Our thanks to Dr Terry and partners in Southampton for letting us use their letters to design these templates.)

The Government Department of Transport recommendation to Local Authorities is that GPs should not be used to verify claims and ideally the Local Authority should set up assessment centres for people seeking concessionary passes who do not have other methods of proving disability (such as receipt of invalidity benefit, ownership of a blue badge, etc)

(see Guidance to Local Authorities on assessing eligibility of disabled people in England for concessionary bus travel)

Eligible Disabled Criteria listed on the government website is as follows:

  • if you are blind or partially sighted
  • if you are profoundly or severely deaf
  • if you are without speech
  • if you have a disability, or have suffered an injury, which has a substantial and long-term adverse effect on your ability to walk
  • if you do not have arms or have long-term loss of the use of both arms
  • if you have a learning disability – a state of arrested development since birth
  • If you would be refused a driving licence due to physical fitness (Section 92 of the Road Traffic Act 1988)
  • If you are a member or veteran of the Armed Services who has been seriously injured in service

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Chargeable

In 2001 the Government recognised that GPs were spending too much time doing unnecessary paperwork. After much consideration it produced a consultation document called Making A Difference: Reducing General Practitioner Paperwork

However, GPs still receive many requests for reports from government organisations or other third parties. Remember you do not have a contractual obligation to fill in these reports and they attract a fee. The fee needs to take into account your professional time and expertise along with an administration charge. Bear in mind there are a considerable number of administrative, financial and legal duties which go along with the professional processing of any request for a report. These are often referred to as collaborative fees/arrangements and we have a dedicated webpage here.

For information on certificates which no charge may be made go to: Non-Chargeable

The BMA fee finder guidance can be found   here:

https://www.bma.org.uk/advice/employment/fees/fee-finder

In addition, we have guidance on the following:

Domestic Abuse Letters

The BMA believes that there is no need for medical involvement in the process for gaining access to legal aid for domestic abuse victims. We feel that such requests can compromise the relationship between doctor and patient, and that legal aid agencies should take the word of victims without needing to consult a GP – who themselves may not be best placed to confirm whether domestic abuse has occurred. This is a position we continue to make clear through our input into the Government’s ongoing review into bureaucracy in General Practice.

While these letters are not funded by the NHS contract and practices are able to charge patients a fee for their completion, the BMA recommends that they do not. Ultimately, however, this is at the practice’s discretion.

Private Referrals

You cannot charge for referring a patient privately, however you can refer privately on a standard referral letter. Some companies have standard forms that you can use, but you don’t have to use these.

If, following an initial referral, you are then asked for further detail by the insurance, or relevant company, you can charge for supplying this.

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Child Performers

Most children taking part in non-commercial performances do not require a licence to perform and, even if a licence is required for commercial work, the Local Education Authority may have discretion as to whether a medical certificate is required.  In this instance, a child is considered to be:

any person who has not yet reached compulsory school leaving age.

There is no statutory or contractual requirement for a GP to provide any medical certificate in association with a licence to perform. If a GP chooses to provide such a certificate, this may be provided as a private service in return for a professional fee. 

Legislation does require a licence for children:

  • working in paid/professional sport
  • working as models
  • performing on stage or in television, film, commercials etc

This applies in particular to any performance:

  • in connection with which a charge is made
  • at a licensed premises or a registered club
  • any broadcast or any performance, recorded by whatever means, with a view to its use in a broadcast, or film intended for public exhibition.

The Local Education Authority usually has discretion as to whether a medical certificate is required before issuing a licence to perform.

Medical clearance by the Senior Medical Officer (or any other practitioner approved by the Authority) covering the area in which the child lives is compulsory for:

  • film or television work
  • performances lasting more than a week in which the child is to perform on six days during that week (five days for sound broadcasting)
  • every month for runs lasting more than four weeks.

There is no legal requirement for a licence:

  • if a child does not perform on more than four school days in any period of six months (providing that there is no absence from school)
  • for school performances
  • for performances put on by a body of persons approved by the Secretary of State (Home Office) or in the Local Education Authority in connection with which no payments has been made to the child or any other person. (This could include amateur productions, drama societies, churches, scouts and other youth organisations.)

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Jury Service

Medical certificates are not normally required when someone feels they have grounds to be excused from Jury Service. However, the summoning officer will occasionally request one, and we would recommend that you produce a letter stating only the facts for the summoning officer to consider and weigh up e.g.. “the patient tells me that their anxiety makes traveling to the court impossible”.

Her Majesty’s Court – Guidance for Summoning Officers states thus:

“  21/. Applications for excusal on the grounds of a physical disability which would make jury service difficult to undertake should be considered sympathetically. Such applications should normally be considered without the necessity for a medical certificate to be produced. However, a certificate should be requested if the summoning officer feels that one is necessary to support an application for excusal on the grounds of physical disability (for example, where there is uncertainty as to the illness/ disability), or where one is required for an appeal against non-excusal. 

Under schedule 4 of the NHS (GMS Contracts Regulations) no charge may be levied for issuing a certificate to establish unfitness for jury service.

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Low Calorie Diets

Patients often approach GPs with forms to fill out before they can embark on some low calorie diets.  You may find this information useful:

  • You do not have to fill out these forms
  • You can charge a reasonable fee for filling out the form
  • Much of the data, weight and BP is part of normal GMS care
  • You can sign the form but still make it clear and document that you are not endorsing the diet plan

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Non Chargeable

The following is a list of obligations relating to Certification by GPs:

  • GPs are obliged to provide data essential for a clinical referral free of charge.
  • A GP has a statutory duty to supply a registered patient, free of charge, with any of the prescribed certificates set out in Schedule 4 of the NHS Regulations.
  • A doctor has a professional and legal obligation to act in the patient’s best interests at all times and must any provide information that is essential to prevent death or serious harm to an individual.
  • A GP has a legal obligation to provide any certificate required under a Court order or by order of a Coroner.
  • There is specific legislation and government and professional policy that imposes an obligation to provide information that is essential for the protection of children and vulnerable adults.
  • There are other occasions where a GP may be obliged to provide information, for example where it is overwhelmingly in the public interest to do so, or where it is essential for the pursuit of due legal process. Specific legal advice may be required before providing such information.
Statutory Obligations

GPs have a statutory obligation to issue the following certificates to patients without charge:

  • Fit Notes (formally Med 3, Med 4, Med 5)
  • Death and Stillbirth certification
  • Mat B1
  • Others covered in Table 1 below

Table 1: List of Prescribed Medical Certificates For NHS GPs (England And Wales) for Which Fees May Not Be Charged

Description of Medical Certificate Enactment under, or for the purpose of which certificate required:
To support a claim or to obtain payment either personally or by proxy; to prove incapacity to work or for self-support for the purposes of an award by the Secretary of State; or to enable proxy to draw pensions etc
  • Naval and Marine Pay and Pensions Act 1865[59]
  • Air Force (Constitution) Act 1917[60]
  • Pensions (Navy, Army, Air Force and Mercantile Marine) Act 1939[61]
  • Personal Injuries (Emergency Provisions) Act 1939[62]
  • Pensions (Mercantile Marine) Act 1942[63]
  • Polish Resettlement Act 1947[64]
  • Social Security Administration Act 1992[65]
  • Social Security Contributions and Benefits Act 1992[66]
  • Social Security Act 1998[ 67 ]
To establish pregnancy for the purpose of obtaining welfare foods Section 13 of the Social Security Act 1988 (schemes for distribution etc of welfare foods)      [ 68 ]
To secure registration of still-birth Section 11 of the Births and Deaths Registration Act 1953 (special provision as to registration of still-birth) [69]
To enable payment to be made to an institution or other person in case of mental disorder of persons entitled to payment from public funds Section 142 of the Mental Health Act 1983 (pay, pensions etc of mentally disordered persons)[70]
To establish unfitness for jury service Juries Act 1974[71]
To support late application for reinstatement in civil employment or notification of non-availability to take up employment owing to sickness Reserve Forces (Safeguarding of Employment) Act 1985[72]
 To enable a person to be registered as an absent voter on grounds of physical incapacity Representation of the People Act 1983[73]
To support applications for certificates conferring exemption from charges in respect of drugs, medicines and appliances National Health Service Act 1977[74]
To support a claim by or on behalf of a severely mentally impaired person for exemption from liability to pay the Council Tax or eligibility for a discount in respect of the amount of Council Tax payable Local Government Finance Act 1992[75]
Certificates for which GPs May Not Charge Fee
Bankruptcy

Any individual who is able to give information about a bankrupt may be required to give evidence, for which no charge can be levied. The Court may also require such individuals to produce any documents in their possession or under their control relating to the bankrupt (S366, Insolvency Act, 1986).

Coroners’ Post-Mortem

Although rarely used, the coroner has power under section 19 of the Coroners Act, 1988 to direct that a post-mortem shall be conducted by the deceased’s general practitioner.

Death Certificates

Including death within 28 days of birth: the registered medical practitioner in attendance during the deceased’s last illness must by law provide a certificate of cause of death (S22, Births and Deaths Registration Act, 1953).

Also see our page Death Certification

Dentists

Dentists sometimes discover that their patient suffers from a medical condition which may influence the treatment they are proposing to give. In this event they would generally require medical advice from the GP in order to treat the patient safely. It is not generally necessary for the GP to provide a full medical report, but he or she should provide relevant information by telephone or in a brief written report. It is clearly in the patient’s best interests that this clinical information is shared with another health professional, provided of course that the patient has consented to the release of limited medical data for this purpose.

Notification of Infectious Diseases

There is no fee for issuing certificates about infectious diseases.

Paternity Tests

Services which doctors are not obliged to provide, but when they do, the fee payable is governed by statute: for example, fees for taking samples of blood required in cases of disputed paternity under the Blood Tests (Evidence of Paternity) Regulations.

Prescription Charge Exemptions (England)
  • Patients “battling cancer” (See the Department of Health Guidance cancer patient prescription exemptions)
  • Children under 16 and full time students 16-18
  • People 60 years and above
  • War pensioners with certificate
  • Recipients of Jobseekers Allowance of Income Support
  • Any partner of recipient of Pension Credit Guarantee
  • Those holding exemption certificates
Exemption Certificates
  • Pregnant women until 1 year after the birth
  • Permanent fistulae (NB this includes renal dialysis patients)
  • Hypoparathyroidism
  • Myasthenia gravis
  • Myxoedema
  • Epilepsy if continuous anticonvulsant therapy is necessary
  • Physical disabilities affecting mobility *
  • Diabetes (unless treatment is by diet alone)
  • Hypopituitary disorders including diabetes insipidus

For further guidance please see: https://www.nhsbsa.nhs.uk/exemption-certificates/medical-exemption-certificates

Professional Evidence in Court

Under the Supreme Court Act 1981, any registered medical practitioner may be directed to give professional evidence.

In almost all other situations there is no legal, contractual, or professional obligation for the GP to provide a certificate or report. However, he or she may choose to do so as a private service for which they may charge the patient, or third party, that requests the information. See our Certifications – Chargeable section on this page for more information on which reports/certificates are chargeable.

Stillbirth Certificates

At the request of the ‘qualified informant’, ie the next of kin, or the person eligible to report the stillbirth to the registrar, a registered medical practitioner present at the birth must give a certificate stating that the child was not born alive and giving, to the best of their knowledge and belief, the cause of death and estimated duration of pregnancy (S11, Births and Deaths Registration Act, 1953).

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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 Template letter to Schools requesting confirmation of illness 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

Further Reading:

Statutory_guidance_on_supporting_pupils_at_school_with_medical_conditions

Healthier Together – should your child go to school today Final

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Parachute Jumps

The profession is divided. Some GPs say “don’t touch them with a barge pole” and others do them and charge appropriately.

Considerations:
  • you are not obliged to provide this service
  • if you feel competent to sign these forms you may and you may charge (even if “it’s for charity”)
  • a small study showed that the money raised for charity jumps was less than the money spent in health and social costs treating the minority of jumpers who were injured
  • it would be better to provide the information as “Mrs X is my patient. She is fit and well (or insert medical conditions). She is on no medication (or insert medication). I hope you find this medical information useful as your jump instructor considers the suitability of my patient to undertake training and make a jump”

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Road Traffic Accidents

Under the Road Traffic Act 1988, the first doctor providing emergency treatment to the victim of a road traffic accident is generally entitled to charge a fee. A fee may be levied in respect of each person treated (Section 158(2) of the Road Traffic Act 1988). Mileage is also payable in excess of two miles.

Since 1999 the ability to levy a fee under S158 of the Road Traffic Act has been limited to claims by doctors not working in NHS hospitals, as the cost of hospital treatment is recovered from insurers directly by the NHS. The fee can be levied even if the person driving the vehicle at the time of the accident is on the GP’s NHS list.

There has been some debate as to whether ’emergency treatment’ only applies to treatment provided at the scene of the accident. S158(1) of the Act defines ’emergency treatment’ as ‘medical or surgical treatment or examination that is immediately required as a result of bodily injury (including fatal injury) caused by, or arising out of, the use of a motor vehicle on a road’.

The Road Traffic Act is silent as to what is immediately required. It is a common understanding that some injuries may not manifest until several hours after the accident and do not warrant a visit to a hospital accident and emergency department but do warrant the attention of the local primary health care team. Under such circumstances where a claim is to be made the BMA professional fees committee believes that the patient should be seen within one working day.

The BMA ‘s legal advice is that, while treatment provided at the scene of the accident will be most common, treatment provided at the GP’s surgery can be included in the definition of ’emergency treatment’ and therefore attract a fee under the Road Traffic Act.

The person driving the vehicle at the time of the accident is responsible for meeting the doctor’s professional fee for themselves, their passengers or anyone injured by their vehicle. All UK motor insurance policies cover such fees and payment of such fees does not constitute any admission of liability. Medical practitioners should take the following steps to recover their fees:

  • an oral request should be made to the person who was using the vehicle at the time of the occurrence which led to the emergency treatment

or, if a verbal request is not made:

  • a written request should be made to the person who was using the vehicle at the time of the occurrence which led to the emergency treatment. This request must be served upon that person within seven days from when emergency treatment was given. It must be signed by the claimant, stating his/her name and address, the circumstances in which emergency treatment was effected, and confirm that the claimant was the first person to render emergency assistance. The request may be served by delivering it to the person using the vehicle or by recorded delivery to the usual or last known address.

Doctor’s experiencing difficulty in ascertaining the name and address of the person using the vehicle should contact the appropriate chief constable (in practice the ‘dealing police officer’, who is required by the Act (S156) to supply the doctor with any information identifying the vehicle involved in the accident and the name and address of the person using it.

The fees payable under the Act are recoverable by Court proceedings as if they were a simple contract of debt due from the person who was using the vehicle to the doctor rendering the service.

Effective date: 17 April 1995
Reference: Road Traffic Act 1988, Section 158; Road Traffic Accidents (Payments for Treatment) Order 1995
Allowances:

  • Treatment – for each person treated = £21.30
  • Mileage – rate per mile or part of a mile (over 2 miles) = £0.41
  • Where the purpose for attending a GP surgery following an accident is to record injuries for future medico-legal purposes this is not covered by the Road Traffic Act and the doctor may charge at their own rate for this work.

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SCUBA

What should you do if a patient wants you to confirm their suitability to do SCUBA diving?

This is not part of GMS so you do not have to provide this service to your patients. You may do so if you feel competent to make this assessment. If you do this work you must consider how you resource this non-NHS work in your already busy day and charge accordingly.

UK Diving Medical Committee information webpage

This website explains standards of fitness required for those of your patients who have conditions that might increase the risk of diving (including asthma, epilepsy, mental health)

It also includes a list of medical referees who can offer this service to your patients.

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Shared Lives

Shared Lives is a national idea rolled out to Local Authorities to encourage citizens to help share the lives of vulnerable adults. It is an excellent scheme that encourages people within communities to help vulnerable adults and get paid, while saving the state significant sums of money.

Your Local Authority may well request a Medical Referee report on a patient to assess their suitability to be a “shared lives carer”.

Our advice is that any Local Authority requesting an opinion should be clear about the information it is seeking (responsibilities of the role including physical, emotional, psychological and ethical) and should expect to pay for the report or better still, employ an appropriately qualified occupational health assessor to make this judgment.

If a detailed request is not made, you may wish to return the forms with “I know of no reason why this person should not be involved with the Shared Lives Scheme” if appropriate – charging the patient or not as you wish.

For more information about the scheme, click here.

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Sickness

GP Fit Certificates – Statement of Fitness to Work (Med 3)

The fit note was introduced to replace the old sick note in 2010.  Doctors issue fit notes to individuals to provide evidence of the advice the doctor has given about the individual’s fitness for work. The fit note allows doctors to advise that individuals “may be fit for work” taking into account the doctor’s advice, or that they are “not fit for work”.

Doctors use fit notes to record details of the functional effects of their patient’s condition so that individuals and employers can consider ways to help the individual return to work.  Fit notes can be hand-written or computer-generated and printed out. Fit notes should be issued by hospital doctors if someone is receiving treatment in hospital, or otherwise by GPs.

There is no need for a back to work certificate and there is the ability to make an assessment by telephone consultation, face to face encounter or report from another health professional.  The certificate has space to recommend whether or not you need to see the patient again at the end of the statement period. There is a reduction in the maximum duration of statement during the first 6 months of illness to 3 months and the form has space for comments and some tick boxes to indicate simple adjustments or adaptations that could aid the patients return to work.

This is not to suggest that we should suddenly become occupational health doctors, but that it may facilitate a discussion around returning to work, and we can use our clinical judgement on what we feel may be done to achieve this.  This advice is not binding for employers and if they cannot implement the advice then the certificate is valid for the patient to remain off work without need for a further consultation.

Here is some further information you may find useful:

Extending Fit Note Certification

From 1 July 2022, new legislation comes into force which allows nurses, occupational therapists, pharmacists, and physiotherapists to legally certify fit notes, in addition to doctors. To support this, the government has published guidance to help individuals and employers identify the knowledge, skills and experience required to certify fit notes. A new training package is also available and should be completed before taking up this task – this is freely accessible for all healthcare professionals. There is a rollout period from 1st July 2022 where GP IT systems will also be updated to reflect the change.

Sickness of Less Than 7 days

You are not obliged to provide a ‘sick certificate’ for your patients for periods of less than seven days.  In these circumstances patients should self certify as below.  We have produced a letter for your patient to take to his/her employer

Click here to access guidance from Acas on managing absence from work.

Employees Statement of Sickness Forms (Self certificate or SC2)

Individuals may make a statement of sickness for the first week of sick leave, and GPs are not required to issue certification for periods of less than 7 days.  You can download a copy of the HMRC SC2 Self Certificate Form from here

Sending Fit Notes Electronically

It is possible to send Fit Notes, electronically via email to patients to avoid them having to attend your practice to collect it. Ardens have produced an article and video of a step-by-step guide on how to do this.

TPP SystmOne  guide to sending Fit Notes electronically

EMIS Web  guide to sending Fit Notes electronically

Hospitals and Sick Certification

Hospital Doctors have also been issued with guidance on Fit Certificates which can be accessed here ​​​​​​.

Sick certification will be integrated into the hospital discharge process so that hospital doctors and consultants will not refer patients to a GP solely for the purpose of obtaining a sickness certificate.”

The target date for this was July 2001!  Hospital staff should therefore provide their patients with an adequate certificate to cover the expected period of disability.  If the patient has unexpected complications that necessitate a GP consultation, it is appropriate for the GP to provide any necessary treatment and/or specialist referral and to provide any additional certification that is required. Similarly if the patient’s recovery is delayed beyond the expected period then the GP is obliged to provide further certification.

Whenever a patient is discharged without adequate certification it is worth personalising the letter to the Chief Executive of the hospital to draw the matter to his or her attention.  Please let the office or your local Committee representative know if this is a frequent problem.

Fit To Return To Work Note – When A Fit Note Ends

You are not obliged to provide a fit to return to work note when a fit note has ended.  We have produced a Fit to return to work template letter to take to his/her employer to explain this.

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