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Question

Can I issue a duplicate medical certificate [statement] to a patient who has two part-time jobs and will probably need two weeks off work to recover from an operation?

GP Manchester

Response

No.
Duplicate statements [Med 3/4/5] can only be issued when the original statement has been lost and should be clearly marked ‘duplicate’ – IB204 p7.

However, people with more than one employer should be advised to submit the certificate you provide to their ‘main’ employer, who can note the details of the advice you have given, and then present the certificate to their second employer.

Question

I am a dentist who treats National Health Service patients – can I give Social Security sick notes to these patients when I feel it is appropriate?

Dentist Sheffield

Response

No.
Social Security Regulations* state that only a ‘registered medical practitioner’ can issue statements of a person’s incapacity for work.

However, the opinion of a dental practitioner would clearly be persuasive to an employer or benefit Decision Maker but would need to be provided on a certificate other than a Med 3 or Med 5 statement. The certificate should clearly identify the name, address and speciality of the practitioner

*The Social Security [Medical Evidence] Regulations 1976.

Question

In this area we have developed a single point of access for patients with back pain – a ‘single spine pain pathway’. It is possible for patients to go through this pathway with very little input from medical practitioners because physiotherapists and other health care professionals often refer them.
The patient’s GP is clearly not able to issue a certificate – what systems does the Department for Work and Pensions have in place to deal with these types of initiative?

LMC Secretary Merseyside

Response

Normally the duty to provide a statement rests with the doctor who has clinical responsibility for the patient and therefore when a patient has been referred for treatment of short duration this responsibility will normally rest with the patient’s own doctor – IB204 p6.

However, an employer will normally consider all available evidence in deciding to accept and employee’s incapacity to work.
Where a patient is receiving treatment through a National Health Service pathway with little involvement from doctors, an employer is able to consider evidence of incapacity for work from someone who is not a registered medical practitioner – physiotherapist, psychologist etc – on their merits.
The certificate from a health care professional should clearly identify the name, address and speciality of the practitioner. However this medical certificate cannot be a Med 3, 4 or 5 which can only be issued by a doctor.

Question

Where can I find out more about certification issues and queries? Is it possible to speak to a medical officer about a difficult situation?

GP Gwent

Response

Written information is available in the IB204 ‘A guide for Registered Medical Practitioners’.

Medical Services have dedicated helplines for use by medically qualified practitioners and these numbers are available in the IB204. If a Medical Services’ doctor is unable to help they may refer you to the Office of The Chief Medical Officer.

Question

I have been asked by the family of a16 year old lad, with 'learning difficulties' and who attends a special school, to provide a certificate so that he can claim Incapacity Benefit. I have not seen him for 3 years and so have refused to provide a certificate but have been told by the local Social Security office that I should comply with the family's request. I presume the local office is mistaken. Should I provide a 'private' certificate in such circumstances?

GP Nottingham

Response

The local Social Security office is correct. Although this is a slightly unusual request General Practitioners NHS 'terms of service' state that medical certificates should be issued free to patients or their personal representatives. Schedule 9 of these regulations further explains that such certificates can be used to support a claim to prove inability to work or incapacity for self-support for the purposes of an award by the Secretary of State - IB204 p5.

While statements Med 3 and Med 5 normally provide advice regarding a patient's fitness for work, you may, from time to time, be asked to provide them for people who have never worked. In these circumstances you should base your advice on work for which their education or training might have fitted them.

The following information may help you complete the appropriate statement in these circumstances:
If you wish to issue statement Med 5 to cover an earlier period you must either:

• base your advice on examination of your patient on a previous occasion providing you are sure that you would have advised your patient to refrain from work from the date of that earlier examination for the entire period of the certificate or,
• base your advice on a report from another doctor issued less than one month previously and issue form Med 5 for a forward period up to one month.

In any other circumstances it will be necessary for you to examine the patient and if you wish to supply evidence of incapacity for an earlier period you can:

• Issue form Med 3 for an appropriate forward period in keeping with your clinical findings from the date of your current examination with a note in the remarks section stating, for example,

'Has been unfit since..[date]...'.

'The above diagnosis has been present since birth'

'The above condition has been present since...[date]..'

IB204 p8-9.

Question

The local Jobcentre Plus keeps sending my patients away telling them I should issue them with a sick note. If I refuse my patient is caught in a 'no man's land' but if I accede to the request I am not helping my patient get back into work. What should I do?

GP Suffolk

Response

National Health Service GPs are under a statutory obligation to issue or refuse to issue statements [medical certificates].

If you refuse to issue a statement because your patient is able to perform their own job or usual occupation Jobcentre Plus must accept your patient as a legitimate claimant to jobseekers allowance.

You might issue a statement Med 3 verifying that there is no reason for your patient to refrain from work but [in the notes section] certain adjustment or accommodations would be reasonable in the light of the medical condition or disability present.
In difficult cases you can issue a statement Med 3 and refer to Jobcentre Plus on form RM7 for early application of the Personal Capability Assessment - IB204 p13.

Question

When a patient is discharged from our hospital we currently provide a Med 10 to cover the period of their inpatient stay.

A local General Practitioner has contacted us because he understood that when a hospital consultant tells a patient that they should not return to work following a procedure the Trust should provide a certificate to cover this period.

London Hospital

Response

When a patient is discharged from hospital and a hospital doctor with clinical responsibility for the patient advises them to refrain from work then it is appropriate for a member of the medical team to issue a Med 3 statement for this forward period. The hospital doctor must follow the rules for issuing a Med 3 - IB204 p7

The duty to provide a medical statement rests with the doctor who has clinical responsibility for the patient at the time. Hospitals are required to provide all certificates for Social Security and Statutory Sick Pay purposes and doctors’ statements for both inpatients and outpatients who are incapable of work - IB204 p5.

This guidance was reinforced in a letter, from the Chief Operating Officer at the Department of Health in July 2001 to Chief Executives of NHS Trusts and Primary Care Groups etc, which discussed the integration of sickness certification into hospital discharge and outpatient processes at the Department of Health.