The Sick Note “Buzz”

- Nidhi Agrawal, GPVTS ST2

Sick notes are legal documents - a doctor may be

accused of fraud if they 'bend the rules'

Options: a. Cannot issue statement d. Med 4 and Med 5 g. SC2b. Med 3 e. Med 5 h. RM7c. Med 4 f. Med 6 and Med 5 i. SC1

Mrs Ward is going through a relationship break-up

and has financial problems. She is low and tearful and not coping at work. You decide that she would benefit from 2 weeks off work.

Med 3

• The ‘standard’ sick note.• Doctor must examine the patient on the day, or the

day before they issue the statement

Options: a. Cannot issue statement d. Med 4 and Med 5 g. SC2b. Med 3 e. Med 5 h. RM7c. Med 4 f. Med 6 and Med 5 i. SC1

Mr West has not been to work today (Monday). He has been unwell since Friday evening and you diagnose viral gastroenteritis and recommend that he does not return to work until 48 hours after he is better. In the past his boss has not been happy with absences for sickness so Mr West requests a certificate.

SC2

• The ‘standard’ self certification form for patients eligible to claim statutory sick pay.

• Issued for the first 7 days of illness

Options: a. Cannot issue statement d. Med 4 and Med 5 g. SC2b. Med 3 e. Med 5 h. RM7c. Med 4 f. Med 6 and Med 5 i. SC1

Mrs Reeves is a flight attendant. She broke her leg skiing 3 weeks

ago. Yesterday you saw a letter from the orthopaedic consultant , dictated 3 weeks ago , saying that her leg has been pinned and she was to be in plaster for next 6 weeks. Mrs Reeves phones to request a certificate to cover this 6 week period.

Med 5

Used for backdating if the patient requests a note

greater than one day of being seen or is seen by a different doctor

Options: a. Cannot issue statement d. Med 4 and Med 5 g. SC2b. Med 3 e. Med 5 h. RM7c. Med 4 f. Med 6 and Med 5 i. SC1

A 36 yr old banker who is known to be HIV positive has recently had a 2 week stay in hospital for treatment related to his HIV. He does not want his employer to know he is HIV positive.

Med 6 and Med 5

Med 6 Used when it is felt harmful to use the exact

diagnosis on the sick note

Options: a. Cannot issue statement d. Med 4 and Med 5 g. SC2b. Med 3 e. Med 5 h. RM7c. Med 4 f. Med 6 and Med 5 i. SC1

Mr Smith requests you to issue a certificate as he is planning to apply for a Personal Capacity Assessment inorder to receive State Incapacity Benefit

Med 4

Statements used for patients undergoing the

Personal Capability Assessment

Options: a. Cannot issue statement d. Med 4 and Med 5 g. SC2

b. Med 3 e. Med 5 h. RM7c. Med 4 f. Med 6 and Med 5 i. SC1

Lisa is a 21 year old self employed architect working

on a contract with Bailey Constructions. She has been off work due to an ankle sprain since 4 days. She now wants a sick note to certify her time of absence.

SC 1

Self certificate used by patients within first 7 days of

illness who are unemployed, self employed or employees who are not entitled to SSP

Self Certification

Form SC2: • Standard form for self- certification. • Can be used for first 7 days of illness• Its use is optional since many employers use their

own forms for their employees to notify sickness.

Self Certification...

Form SC1: Available for specific categories. It's use has been

restricted since 1990 to:-• the self-employed • the unemployed • employees who are not entitled to Statutory Sick Pay • patients who have specific medical treatment eg

radiotherapy, dialysis

Med 3

- Required after 7 days of incapacity

- Can only be issued within 24 hours of examination by the doctor who signs the certificate.

Med 3 ...

- Can only initially issue a Med 3 certificate for up to 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.

Med 4

- Form Med 4 should be issued to a patient on request prior to the first application of the PCA in a spell of incapacity.

(PCA , Personal Capability Assessment: The procedure used by Jobcentre Plus to determine whether a patient should continue to receive a state incapacity benefit or equivalent benefit. )

- Usually a Med 4 will be after 28 weeks of incapacity

Med 4

- The completed form should include details of an accurate diagnosis of the main incapacitating condition and other relevant medical conditions.

- Med 4 certificates relate only to state benefits and the patient is required to send this form to the Department for Work and Pensions office with the appropriate incapacity questionnaire

Med 5

Med 5 can be used to backdate sick certificates

If 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

Med 5...

If based on doctor’s own 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

Med 6

• Used when it is inappropriate to use the exact diagnosis on the forms Med 3, 4 or 5.

• The local DWP office should be notified at the same time as the statement is issued, by sending a completed form Med 6.

• 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.

RM 7

• Used in a situation where GP may have some doubts about patient's ongoing incapacity for work but is continuing to issue statements.

• Hence, the GP may suggest an independent assessment of the patient by the Department for Work and Pensions earlier than it might have occurred under normal control procedures.

• A request should be made on a form RM 7 to the local Department for Work and Pensions Office who will take appropriate action

Article from Mail Online on 9/2/10 saying:“GPs: Write your own sick notes”

• GPs in this week will demand an end to the system in which people need a certificate to prove their illness

• Instead parents of school children can sign them off sick and responsible adults can certify themselves

• This proposal will be debated at BMA’s annual conference in London

• 2.4 million GP appointments a year are wasted on needless bureaucracy

Article continues..

• The Chairman of BMA Scottish GP Comittee said “ It is just daft bureaucracy, and we haven’t got time for it.”

• If in doubt, universities or companies can set up Occupational Health Services to confirm if the patient is fit to work.

Sick notes are legal documents - a doctor may be accused of fraud if they 'bend the rules'

Thank You..