Certification

1. Certification Dr. Mary M.Cuthbert

2. Illness certification • Legally a doctor is required to issue a statement of incapacity for work due to illness ONLY if it lasts more than seven days(including Sunday) • This is known,in layman’s terms,as a “sick note”

3. Self-certification of Illness • Patients should self-certify for the first 7 days of illness • Form SC2 is the standard form used,but some employers use their own unique forms to notify sickness • Form SC1 is used by the self-employed and unemployed

4. Doctor’s sick note when patient off work less than one week • Med 3 can only be issued if patient has been off work more than 7 days • A private sick note can be given if a patient is off work less than 7 days.This can be charged for. • Sick notes are legal documents –a doctor may be accused of fraud if he “bends the rules”

5. Westcliffe Medical Centre, Westcliffe Rd. Shipley West Yorkshire BD18 3EE Dear Employer, You have requested a doctor’s statement for the first seven days of an employee’s sickness. I wish to refer you to the Statutory Sick Pay Manual for Employers –National Insurance Contributions Series CA30, Paragraph 28, which states: “……you (the employer) cannot ask for a doctor’s statement for the first seven days of a spell of sickness”. The purpose of this regulation is to avoid the necessity for employees with minor, self-limiting illness or injury to use surgery appointments for the sole purpose of obtaining a medical certificate. We do not, therefore, issue certificates in these circumstances. If employers have reason to enquire about a spell of sickness, they are advisedto write to the doctor, including written permission from the employee concerned, when a report may be issued. A charge will be made to you, the employer, for provision of such a report, The Doctors, Westcliffe Medical Centre

6. Issuing a sick note without seeing the patient • A Med 3 CANNOT be given without seeing the patient • A Med 5 can be given in certain circumstances - If patient has been seen previously but no sick note was issued at that consultation - If patient has an open note and now requires a return to work note - If there is a report from another doctor,issued less than a month ago,stating patient is not fit to work. In this situation Med5 should be for 1 month or less

7. General Rules about Sick Notes • Should be completed in ink and signed by a medical practitioner (other than the patient) ie doctor cannot certify self • Should be issued once only; replacements should be marked “Duplicate” • Should be used for Social Security purposes only

8. The statement must contain: • The patient’s name • Date of examination on which statement is based • Diagnosis of condition(see also Med6) • Date statement issued • Address of doctor • Signature of doctor

9. Which Sick notes are used most commonly? • Med 3 • Med 5 • Med 4

10. Med 3 • The doctor must examine the patient on the day,or day before,the statement is issued • Med 3 can be for a “closed” or “open”period of incapacity • Note the “remarks” section

11. “Closed” Med 3 • In this situation doctor completes the “until” section,giving a specific date to return to work • The date specified may be up to 14 days from date of issue

12. “Open” Med 3 • A specific date is not entered but a time period eg “2 weeks” • This implies that patient will be reviewed after that period has elapsed • If patient’s condition and prognosis are uncertain and an open Med 3 has been issued,patient needs to be reviewed and a closed Med 3 issued before resuming work

13. “0pen” Med 3- rules re length of sick leave • Med 3 can be issued for up to one month initially • A doctor cannot issue a Med 3 for more than 6 months within the first 6 months of incapacity • After the first 6 months of incapacity a Med 3 can be issued “for any clinically appropriate period up to indefinite”

14. Med 3 – “Remarks” section • Can be used if patient fit to return to work in limited capacity eg “should avoid heavy lifting” • Can be used to recommend a workplace assessment eg “ergonomic assessment recommended” • Can be used to recommend phased return to work

15. Med 5 • Med 5 should be used in exceptional circumstances • It is better for same doctor to see a patient throughout period of incapacity so that Med 3s can be issued

16. Med 5 • Med 3 can only be issued if patient is seen on day,or day before,issue • There may be times when doctor needs to supply evidence of incapacity for an earlier period.Med 5 may be used if conditions below are fulfilled

17. Med 5 – criteria for issue • Med 5 can be based on your examination of patient on a previous occasion(if Med3 not issued at the time) • Doctor must be sure that s/he would have advised patient to refrain from work for the whole period in question • Only exception is when report from another doctor is basis of evidence

18. Med 5-using another doctor’s report as basis of evidence • The other doctor’s report must have been issued less than a month before • The Med 5 issued cannot cover a forward period more than 1 month • Therefore if you(the issuing doctor) did not examine the patient at the start of the backdated period, you cannot issue a Med 5 unless patient was seen by another doctor and his report was issued less than a month ago

19. Definition of “report” from another doctor • A reasonably completed hospital discharge summary • A hospital letter • Your partner’s contemporaneous records from a previous consultation

20. What if patient hasn’t been seen in last month? • Patient needs to be seen and examined • Med 3 can be issued for an appropriate forward period • Comments can be made eg “the patient tells me he has been unfit since…”

21. Med 4-when is it used and why? • When patient has been off work for 26 weeks • Requested by Dept for Work and Pensions • Patient receives letter from DWP advising that Personal Capability Assessment is to be applied • Patient has to complete a long questionnaire and obtain Med 4 from GP,then submit them together

22. Med 4- what it should include • Diagnosis of main incapacitating condition • Other relevant conditions • In the “doctor’s remarks” section details of disabling effects,treatment,prognosis and ability to travel to an assessment medical examination • Advice regarding patient’s ability to carry out his usual occupation

23. What is the point of Med 4? • Helps provide evidence to DWP for patients with severe conditions who may be exempted from need to send in further sick notes • If Med 4 corresponds with patient’s account of their disability,may not need an examination • If completed thoroughly Med 4 helps to reduce need for “appeals” if benefit disallowed

24. Med 6 • There may be exceptional circumstances where a full,accurate “diagnosis” could be prejudicial to patient’s wellbeing eg AIDS • Don’t forget Med 3 and Med 5 certificates are passed by patients to their employers,who may not treat information as confidential • Med 6 is not passed to employer but goes straight to DWP

25. Med 6 • To be used if doctor has been unable to enter a precise diagnosis on Med 3,Med 4 or Med 5 • Med 6 should be sent direct to DWP office • A Med 6 is included in each pad of sick notes • DWP will request a short report from GP • An accurate diagnosis must be entered on Med 6 so the DWP medical officer has a realistic idea of patient’s true condition

26. And now……. A few cases to test your understanding! In the following situations,which certificate should you issue?

27. Case 1: • 35 year old man, seen in surgery having developed acute low back pain when lifting a crate at work today • Usually fit and healthy • Heavy job

28. Case 2: • 45 year old woman,underwent hysterectomy 10 weeks ago • Sick note given by hospital for 8 weeks • Saw consultant in OPD 3 weeks ago and forgot to get a sick note • Wants to return to work in 6 weeks from now

29. Case 3: • 21 year old man,phones to speak to you • He wants a sick note for 2 weeks for his “bad back” • He has not consulted a doctor during this period

30. Case 5: • 52 year old patient with depression • Patient has been seeing your partner for 6 months with this condition and is still unfit to work.She needs another sick note • Your partner has just gone on holiday but did see the patient 3 weeks ago • What if your partner had seen the patient 6 weeks ago?

31. Case 6: • 40 year old woman for whom you have previously issued a Med 3 when she had a breast biopsy • Med 3 now due to expire • She is about to embark on chemotherapy and radiotherapy which will take at least 9 months to complete

32. Case 7: • 45 year old man who has been off work for 3 days with D&V • Asking for a sick note as employer insists he has to produce a sick note after 3 days’ sick leave

33. Case 8: • A young offender attends surgery requesting a sick note as he had D&V last week and was unable to complete his community service • He has not been seen by a doctor during the period in question

34. Case 9 • A 38 year old patient has recently been diagnosed with Hepatitis C following an admission with acute jaundice. • It is the first time you have seen the patient during this illness but you have received a letter from the consultant gastroenterologist

35. Case 10: • You have been seeing this patient regularly since he fractured his tibia and fibula in a RTA. • You saw him in surgery 2 weeks ago but did not issue a certificate • He phones you today to say that his sick note expired a week ago • What if he attended surgery instead?

36. Case 11: • Patient phones you to inform you that work has “lost” the Med 3 you issued her 2 weeks previously • She wants another sick note

37. Case 12: • Patient has been off work with sciatica and has an open Med 3 for 8 weeks • He attends surgery to inform you that he now feels ready to return to work (before the 8 week period has elapsed)