Certification – Patients Claiming Benefits
Practices are not obliged, either by statute or contract, to complete reports requested by organizations assisting people with their claims for benefit. Practices may choose to do so and may charge a fee. Welfare Rights and CAB usually say that they are not in a position to pay a fee.
If a claimant is turned down for a benefit after making an application without a report from the GP, s/he can appeal the decision. If the appeal comes before a Tribunal and the Tribunal feels that it would be helped in its decision making by a report from the GP, the Tribunal is entitled to request such a report from the GP and will pay a fee.
(We are indebted to Derby and Derbyshire LMC for this advice from Dr John Grenville. )
|The Benefits System – A short guide for GPs is available here on the Gov.uk website. The guidance describes the main benefits that the DWP provides, and situations when you may be asked for information relating to a benefit claim on behalf of a patient.
Further to a meeting with the BMA (April 2021), the DWP have agreed to supply copies of all relevant GP forms prior to their publication on the Healthcare Professionals pages of Gov.UK .
There is also a useful table that lists the forms DWP may ask healthcare professionals to complete and whether there is a charge for doing so.
The BMA have provided the document below with all the forms currently available. Please click here to download a copy.
Personal Independence Payments (PIP) and Disability Living Allowance DLA
Personal Independence Payments (PIP) can help those patients with some of the extra costs if they have a long term physical or mental health condition or disability.
Patients do not need a GP report or letter to be able to make a PIP claim. However, if further medical information is required, a healthcare professional from IAS (previously known as ATOS) or Capita may occasionally phone you for more information. Patients give consent for this to happen as part of their claim and you do not need to seek additional consent.
General Medical Council confidentiality guidance (paragraph 115b) states ‘you may accept an assurance from an officer of a government department or agency, or a registered health professional acting on their behalf, that the patient or a person properly authorised to act on their behalf has consented’.
IAS or Capita may ask you to complete a medical report if they require further medical evidence to decide whether your patient needs a face-to-face assessment or to help inform the face-to-face assessment. You can complete this from your medical records without carrying out a separate examination of your patient. This is chargeable.
There is help for patients from Advicenow.org.uk on “How to win a PIP appeal”
Citizens Advice can also offer guidance to patients on challenging a PIP decision.
Disability Living Allowance (DLA) is being replaced by PIP for most adults.
Patients will keep getting DLA if:
- they’re under 16
they were born on or before 8 April 1948
If they were born after 8 April 1948, the Department for Work and Pensions (DWP) will invite them to apply for PIP. They do not need to do anything until DWP writes to them about their DLA unless their circumstances change.
|As the patient’s doctor
You may be asked to complete the statement at the end of the DLA claim form.
If the DWP decision maker (a specifically trained lay person) can’t decide about benefit entitlement without further evidence, they may ask you to complete a medical report based on your medical records and knowledge of the patient. A factual report is chargeable.
See information on completing medical reports for DWP
Employment Support Allowance (ESA) 113
Employment Support Allowance (ESA)113 forms replacing IB113
No fee is payable for an ESA113 and you are obliged to provide the information. For more information please see https://www.gov.uk/government/publications/dwp-factual-medical-reports-guidance-for-healthcare-professionals
There is now an interactive version of the ESA113 that healthcare professionals can use and can be accessed on Gov.uk
A healthcare professional from the Centre for Health and Disability Assessments (CHDA) may phone you for more information. Patients give consent for this to happen as part of their claim and you do not need to seek additional consent. General Medical Council confidentiality guidance (paragraph 115b) states ‘you may accept an assurance from an officer of a government department or agency, or a registered health professional acting on their behalf, that the patient or a person properly authorised to act on their behalf has consented’.
You may occasionally be asked by patients to contribute some information to the ESA50 form. If a claimant is claiming solely because of cancer, they only need to complete up to page five of the ESA50. After signing the necessary declaration, they should then ask their chosen healthcare professional/ cancer specialist to complete the section “Cancer treatment” at the end of the form.
CHDA may ask you to complete an ESA113 or FRR2 form if they require further medical evidence to decide whether your patient needs a face-to-face assessment or to help inform the face-to-face assessment. You can complete this from your medical records without carrying out a separate examination of your patient. This is not chargeable.
ESA Appeals and Medical Evidence
As the rules tighten more people are losing their ability to claim. Many are likely to appeal (now called mandatory reconsideration) and ask their GP to help in this appeal. This puts GPs into a difficult position as this work is not part of NHS work and these patients often are in a difficult financial position making it hard for some GPs to feel they can charge the patient for this work.
This was information received from an LMC secretary in England who provides useful information.
“I sit on Employment and Support Allowance appeals.
The criteria for ESA are VERY much stricter than for Incapacity Benefit, which it replaces. Although the Department for Work and Pensions talks about the test defining the claimant’s ability to work, it does no such thing. You have to pass the test (score 15 points) to claim the benefit. If you don’t you have to claim Job Seekers Allowance. This does not necessarily mean that you are fit for work or employable.
It is likely that nearly all applicants will appeal as you continue to get ESA until your appeal is determined.
If the appeal panel hears a case and thinks it would be helped by further medical evidence, it can adjourn the case and ask for a GP report or for a copy of the records. The Tribunals Service will pay for these, not a very high rate but better than nothing. The practice does not, therefore, disadvantage a patient if it declines to do a report for at the patient’s request before the appeal.”
Digital SR1 Form
The Gov.uk website has information regarding the new SR1 form, (which has replaced the DS1500 form). The SR1 supports terminally ill patients, who are likely to have less than 12 months to live, to access a fast track route for a number of key benefits.
DWP have launched a digital SR1 Form in addition to an electronic version, for return via email and a paper form, for return by post.
The Digital SR1 Service enables healthcare professionals to complete and submit SR1s online. You’ll need an NHS smartcard to access the service on https://portal.national.ncrs.nhs.uk, select ‘Launch Digital SR1 Service’ and complete the SR1 form online. Once submitted, the form reaches the DWP securely and immediately which can help reduce waiting time for the patient and you can download a copy of the form and save it to your patient’s medical record. You can also download a fee form, if required.
To get a copy of the electronic version of the SR1 form (with or without a fee form), send an email from your secure email address to form.e-SR1@dwp.gov.uk with the following information:
- surgery / hospital / office postal address, telephone number, request for SR1 form, request for fee form, if necessary.
When required, complete the electronic SR1 form (with or without fee form) and email it to form.e-SR1@dwp.gov.uk using your secure email address. Do not print the electronic version of the SR1 Form to return by post.
Requests for a book of paper copies must be made using the order form .
If you complete a paper copy of the SR1 form or fee form, remember to sign it. Only original signed copies of these forms will be accepted by post. There are 2 options for returning the forms :
- give the SR1 form to the person who requested it and return the fee form separately, or
- post the completed SR1 form and fee form directly to:
Personal Independence Payment (10)
Mail Handling Site A
When returning SR1 forms, use a separate envelope for each patient. Do not staple documents together.
Further details can be found The Gov.uk website