DWP health and work

No. You can only issue a duplicate statement (Med 3/5) if the original statement has been lost. You should clearly mark it “Duplicate”.

Advise people with more than one employer to submit the certificate to their main employer, who can note the details of the advice you have given. They can then present the certificate to their second employer.

No. The Social Security (Medical Evidence) Regulations 1976 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. They would need to provide it on a certificate other than a Med 3 or Med 5. The certificate should clearly identify the name, address and speciality of the practitioner.

Normally, the duty to provide a statement rests with the doctor who has clinical responsibility for the patient. When a patient has been referred for treatment of short duration this responsibility will normally rest with the patient’s own doctor.

However, an employer will normally consider all available evidence in deciding to accept and employee’s incapacity to work.

If a patient is receiving treatment through an NHS pathway with little involvement from doctors, an employer can consider evidence of incapacity for work from a physiotherapist or psychologist, for example – on its merits.

The certificate should clearly identify the name, address and speciality of the practitioner. The certificate cannot be a Med 3 or 5 which only a doctor can issue.

Jobcentre Plus is correct. Although this is a slightly unusual request, your terms of service state that you must issue medical certificates free to patients or their personal representatives. Schedule 9 of these regulations explains that people can use such certificates 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.

While a Med 3 or Med 5 normally provides advice about a patient's fitness for work, you may sometimes need to provide them for people who have never worked. In these circumstances, base your advice on work for which their education or training might have fitted them.

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 if 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,
• 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 you must examine the patient. 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).”

NHS 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 allow your patient to claim Jobseeker’s Allowance.

You could issue a Med 3 verifying that there is no reason for your patient to refrain from work but say (in the notes section) that certain adjustments might be reasonable in the light of the medical condition or disability present.

If a hospital doctor with clinical responsibility for the patient advises them to refrain from work 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.

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 statements for both inpatients and outpatients who are incapable of work.

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

You can only issue a Med 5 to cover an earlier period in these circumstances if you can base your advice on a report from the hospital doctor issued less then one month previously.

If you have a hospital discharge summary – and the provision of a Med 5 is the appropriate clinical management of this patient – you should bear in mind that you can only issue it for a forward period of up to one month.

If you have a report from a hospital doctor you can use this to support the provision of a Med 5 statement with your advice on a date return to work.

However, in these circumstances, the certificate you provide cannot cover a forward period of more than one month.

Alternatively, you can arrange to see your patient and issue a closed form Med 3, specifying a date of return to work and include a note in the remarks section stating, for example, “He has been unfit since…..(date)..”.

No. Only a registered medical practitioner can legally issue a Med 3 or Med 5. A fundamental principle of sickness certification in the United Kingdom is that GPs provide advice on fitness for work as an integral part of the clinical management of a patient’s condition.

The assessment applied by a benefit Decision Maker is different to your original opinion regarding your patient’s ability to perform their own job or usual occupation.

The tests that Jobcentre Plus applies are the Personal Capability Assessment (PCA) or Work Capability Assessment (WCA). These are tests look at capacity to undertake a range of different work and your patient may be fit to undertake some work other than their own occupation.

There are several issues that you should consider in these circumstances.

• Have you, as the certifying medical practitioner, provided all the relevant facts when requested on form IB113 (or ESA113)?
• Did the PCA or WCA consider all the clinical facts?
• Has your patient’s condition altered or deteriorated since the assessment?
• What is your patient’s view of the situation?
• Is there any possible alternative clinical management that might help your patient return to some form of work?

Atos Healthcare Medical Services have dedicated help lines for use by medically qualified practitioners.

• Atos Healthcare

Yes. NHS GPs are under a statutory obligation to provide certain information to a Medical Officer, in respect of patients that they have issued or refused to issue a certificate. This includes a requirement to complete IB/ESA 113 reports when requested by Jobcentre Plus.

People suffering from certain specified severely disabling conditions (“exempt” category in Incapacity Benefit or “support group” in Employment and Support Allowance) may be treated as incapable of work without being tested.

Jobcentre Plus therefore takes steps to identify such people before applying the Personal Capability Assessment (Incapacity Benefit) or Work Capability Assessment (Employment and Support Allowance). GPs (acting as certifying medical practitioners) play a crucial role in providing a precise diagnosis and factual clinical details in cases where a person may have a severe condition that, under Regulations, allows them to be treated as incapable of work.

A fully completed IB113/ESA 113 report may thus avoid the need for a person to undergo a benefit related examination and help Jobcentre Plus to give a prompt decision on entitlement.

No. NHS GPs are under a statutory obligation to provide certain information to a Medical Officer, in respect of patients that they have issued or refused to issue a certificate. This includes a requirement to complete IB113 reports when requested by Jobcentre Plus.

Reports to the DWP are not subject to the Access to Medical Reports Act 1998. DWP obtain consent for the release of clinical information when someone makes a claim to benefit, and DWP gives claimants access to reports on request. Therefore it is not necessary for you to obtain consent from your patient for the release of clinical information or to check if the patient wishes to see a copy of your report.

This is enshrined in the General Medical Services Contract Regulations 2004.

• General Medical Services Contract Regulations 2004 (OPSI website)

GMC guidance (Confidentiality: protecting and providing information, FAQs, footnote 6) states:
In some cases other bodies give patients access to reports, for example, the Department of Social Security gives all claimants access to reports made in connection with state benefits. In such cases it is not necessary for you to check patients’ wish to see the report.

• General Medical Council – Confidentiality FAQs (GMC website)

No. GPs, as certifying medical practitioners, have a statutory obligation to provide statements of incapacity to patients on their list and certain information to a Medical Officer when requested. However, 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.

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.

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