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Incapacity Benefit Appeals

A patient has asked for a report to support his appeal after having his Incapacity Benefit withdrawn. Does the GP have to provide a report?

No. Under their NHS contract there is no requirement for GPs to provide reports or offer an opinion on incapacity for work to anyone else unless requested to do so by Jobcentre Plus.  However, GPs, as certifying medical practitioners, have a statutory obligation to provide statements of incapacity and certain other information for patients on their list, when requested by a healthcare professional working for Atos Healthcare on behalf of DWP.  

Claimants should contact Jobcentre Plus or the Appeals Service, where appropriate, if they think that further medical evidence is necessary to support their claim or appeal. They should state clearly their reasons for believing that further evidence is necessary. If Jobcentre Plus or the Appeals Service consider that further medical evidence is necessary, they will seek it. They will be responsible for paying any fee to the doctor providing the report.

GPs are under no obligation to provide such evidence to their patients, nor to provide it free of charge. However, if a GP does not agree to provide additional evidence for their patient, then it is a matter to be resolved between the GP and their patient.

This has been taken from the Department of Work and Pensions webpage for Health Professionals.  It is worth a visit for answers to other questions around incapacity benefits and Fit Notes. There is also a guide to Personal Independance Payments for healthcare professionals at:  https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/303676/pip-quick-guide-health-professions.pdf

We have a template letter for practices to adapt, if they wish, explaining that they are not obliged to provide medical reports in support of benefits appeals.

Confidentiality Guidance: Disclosing Information with Consent

Some GPs are insisting on sight of the written consent for reports for the DWP and their agents. The GMS / PMS Regulation requires GPs to accept the assurance of the DWP and its agents that there is consent. The relevant extract from the GMS Regulations (the PMS Regs are the same, with different numbers) is as follows:

80           (1) The contractor must, if satisfied that the patient consents--

(a) supply in writing to any person specified in sub-paragraph (3), within such reasonable period as that person may specify, such clinical information as any of the persons mentioned in sub-paragraph (3)(a) to (d) considers relevant about a patient to whom the contractor or a person acting on behalf of the contractor has issued or has refused to issue a medical certificate; and

(b) answer any inquiries by any person mentioned in sub-paragraph (3) about--

(i) a prescription form or medical certificate issued or created by, or on behalf of, the contractor, or

(ii) any statement which the contractor or a person acting on behalf of the contractor has made in a report.

 

(2) For the purposes of being satisfied that a patient consents, a contractor may rely on an assurance in writing from any person mentioned in sub-paragraph (3) that the consent of the patient has been obtained, unless the contractor has reason to believe that the patient does not consent.

 

(3) For the purposes of sub-paragraph (1) and (2), the persons are--

(a) a medical officer;

(b) a nursing officer;

(c) an occupational therapist;

(d) a physiotherapist; or

(e) an officer of the Department for Work and Pensions who is acting on behalf of, and at the direction of, any person specified in paragraphs (a) to (d).

 

(4) In this paragraph--

(a) "medical officer" means a medical practitioner who is--

(i) employed or engaged by the Department for Work and Pensions, or

(ii) provided by an organisation under a contract entered into with the Secretary of State for Work and Pensions;

 

(b) "nursing officer" means a health care professional who is registered on the Nursing and Midwifery Register and--

(i) employed or engaged by the Department for Work and Pensions, or

(ii) provided by an organisation under a contract entered into with the Secretary of State for Work and Pensions;

 

(c) "occupational therapist" means a health care professional who is registered in the part of the register maintained by the Health Professions Council under article 5 of the [Health and Social Work Professions Order 2001] relating to occupational therapists and--

(i) employed or engaged by the Department for Work and Pensions, or

(ii) provided by an organisation under a contract entered into with the Secretary of State for Work and Pensions; and

 

(d) "physiotherapist" means a health care professional who is registered in the part of the register maintained by the Health Professions Council under article 5 of the [Health and Social Work Professions Order 2001] relating to physiotherapists and--

(i) employed or engaged by the Department for Work and Pensions, or

(ii) provided by an organisation under a contract entered into with the Secretary of State for Work and Pensions.]

 

The GMC guidance is also clear that doctors may rely on an officer’s consent: http://www.gmc-uk.org/guidance/ethical_guidance/confidentiality_24_35_disclosing_information_with_consent.asp 

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Updated on 10 April 2017 1457 views