CertificationCertification

Dr. Mary M.CuthbertDr. Mary M.Cuthbert

Illness certificationIllness certification

Legally a doctor is required to Legally a doctor is required to issue a statement of incapacity for issue a statement of incapacity for work due to illness ONLY if it lasts work due to illness ONLY if it lasts more than seven days(including more than seven days(including Sunday)Sunday)

This is known,in layman’s terms,as This is known,in layman’s terms,as a “sick note”a “sick note”

Self-certification of IllnessSelf-certification of Illness

Patients should self-certify for the Patients should self-certify for the first 7 days of illnessfirst 7 days of illness

Form SC2 is the standard form Form SC2 is the standard form used,but some employers use their used,but some employers use their own unique forms to notify own unique forms to notify sicknesssickness

Form SC1 is used by the self-Form SC1 is used by the self-employed and unemployedemployed and unemployed

Doctor’s sick note when Doctor’s sick note when patient off work less than one patient off work less than one weekweek

Med 3 can only be issued if patient Med 3 can only be issued if patient has been off work more than 7 has been off work more than 7 daysdays

A private sick note can be given if A private sick note can be given if a patient is off work less than 7 a patient is off work less than 7 days.This can be charged for.days.This can be charged for.

Sick notes are legal documents –a Sick notes are legal documents –a doctor may be accused of fraud if doctor may be accused of fraud if he “bends the rules”he “bends the rules”

Westcliffe Medical Centre, Westcliffe Rd. Shipley West Yorkshire

 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 advised to 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

BD18 3EE

Issuing a sick note without Issuing a sick note without seeing the patientseeing the patient

A Med 3 CANNOT be given without seeing the patientA Med 3 CANNOT be given without seeing the patient A Med 5 can be given in certain circumstancesA Med 5 can be given in certain circumstances

- If patient has been seen previously but no sick note- If patient has been seen previously but no sick note

was issued at that consultation was issued at that consultation

- If patient has an open note and now requires a - If patient has an open note and now requires a

return to work notereturn to work note

- If there is a report from another doctor,issued less - If there is a report from another doctor,issued less

than a month ago,stating patient is not fit to work.than a month ago,stating patient is not fit to work.

In this situation Med5 should be for 1 month or less In this situation Med5 should be for 1 month or less

General Rules about Sick General Rules about Sick NotesNotes

Should be completed in ink and Should be completed in ink and signed by a medical practitioner signed by a medical practitioner (other than the patient) ie doctor (other than the patient) ie doctor cannot certify selfcannot certify self

Should be issued once only; Should be issued once only; replacements should be marked replacements should be marked “Duplicate”“Duplicate”

Should be used for Social Security Should be used for Social Security purposes onlypurposes only

The statement must The statement must contain:contain:

The patient’s nameThe patient’s name Date of examination on which Date of examination on which

statement is basedstatement is based Diagnosis of condition(see also Diagnosis of condition(see also

Med6)Med6) Date statement issuedDate statement issued Address of doctorAddress of doctor Signature of doctorSignature of doctor

Which Sick notes are used Which Sick notes are used most commonly?most commonly?

Med 3Med 3 Med 5Med 5 Med 4Med 4

Med 3Med 3

The doctor must examine the The doctor must examine the patient on the day,or day patient on the day,or day before,the statement is issuedbefore,the statement is issued

Med 3 can be for a “closed” or Med 3 can be for a “closed” or “open”period of incapacity“open”period of incapacity

Note the “remarks” sectionNote the “remarks” section

““Closed” Med 3Closed” Med 3

In this situation doctor completes In this situation doctor completes the “until” section,giving a specific the “until” section,giving a specific date to return to workdate to return to work

The date specified may be up to The date specified may be up to 14 days from date of issue 14 days from date of issue

““Open” Med 3Open” Med 3

A specific date is not entered but a time A specific date is not entered but a time period eg “2 weeks”period eg “2 weeks”

This implies that patient will be This implies that patient will be reviewed after that period has elapsedreviewed after that period has elapsed

If patient’s condition and prognosis are If patient’s condition and prognosis are uncertain and an open Med 3 has been uncertain and an open Med 3 has been issued,patient needs to be reviewed and issued,patient needs to be reviewed and a closed Med 3 issued before resuming a closed Med 3 issued before resuming workwork

““0pen” Med 3- rules re 0pen” Med 3- rules re length of sick leavelength of sick leave

Med 3 can be issued for up to one Med 3 can be issued for up to one month initiallymonth initially

A doctor cannot issue a Med 3 for A doctor cannot issue a Med 3 for more than 6 months within the more than 6 months within the first 6 months of incapacityfirst 6 months of incapacity

After the first 6 months of After the first 6 months of incapacity a Med 3 can be issued incapacity a Med 3 can be issued “for any clinically appropriate “for any clinically appropriate period up to indefinite”period up to indefinite”

Med 3 – “Remarks” Med 3 – “Remarks” sectionsection

Can be used if patient fit to return Can be used if patient fit to return to work in limited capacity eg to work in limited capacity eg “should avoid heavy lifting”“should avoid heavy lifting”

Can be used to recommend a Can be used to recommend a workplace assessment eg workplace assessment eg “ergonomic assessment “ergonomic assessment recommended”recommended”

Can be used to recommend phased Can be used to recommend phased return to workreturn to work

Med 5Med 5

Med 5 should be used in Med 5 should be used in exceptional circumstancesexceptional circumstances

It is better for same doctor to see a It is better for same doctor to see a patient throughout period of patient throughout period of incapacity so that Med 3s can be incapacity so that Med 3s can be issuedissued

Med 5Med 5

Med 3 can only be issued if patient Med 3 can only be issued if patient is seen on day,or day before,issueis seen on day,or day before,issue

There may be times when doctor There may be times when doctor needs to supply evidence of needs to supply evidence of incapacity for an earlier incapacity for an earlier period.Med 5 may be used if period.Med 5 may be used if conditions below are fulfilledconditions below are fulfilled

Med 5 – criteria for issueMed 5 – criteria for issue

Med 5 can be based on your Med 5 can be based on your examination of patient on a previous examination of patient on a previous occasion(if Med3 not issued at the occasion(if Med3 not issued at the time)time)

Doctor must be sure that s/he would Doctor must be sure that s/he would have advised patient to refrain from have advised patient to refrain from work for the whole period in questionwork for the whole period in question

Only exception is when report from Only exception is when report from another doctor is basis of evidenceanother doctor is basis of evidence

Med 5-using another doctor’s Med 5-using another doctor’s report as basis of evidencereport as basis of evidence

The other doctor’s report must have The other doctor’s report must have been issued less than a month beforebeen issued less than a month before

The Med 5 issued cannot cover a The Med 5 issued cannot cover a forward period more than 1 monthforward period more than 1 month

Therefore if you(the issuing doctor) did Therefore if you(the issuing doctor) did not examine the patient at the start of not examine the patient at the start of the backdated period, you cannot issue the backdated period, you cannot issue a Med 5 unless patient was seen by a Med 5 unless patient was seen by another doctor and his report was another doctor and his report was issued less than a month agoissued less than a month ago

Definition of “report” from Definition of “report” from another doctoranother doctor

A reasonably completed hospital A reasonably completed hospital discharge summarydischarge summary

A hospital letterA hospital letter Your partner’s contemporaneous Your partner’s contemporaneous

records from a previous records from a previous consultationconsultation

What if patient hasn’t been What if patient hasn’t been seen in last month?seen in last month?

Patient needs to be seen and Patient needs to be seen and examinedexamined

Med 3 can be issued for an Med 3 can be issued for an appropriate forward periodappropriate forward period

Comments can be made eg “the Comments can be made eg “the patient tells me he has been unfit patient tells me he has been unfit since…”since…”

Med 4-when is it used and Med 4-when is it used and why?why?

When patient has been off work for 26 When patient has been off work for 26 weeksweeks

Requested by Dept for Work and PensionsRequested by Dept for Work and Pensions Patient receives letter from DWP advising Patient receives letter from DWP advising

that Personal Capability Assessment is to that Personal Capability Assessment is to be appliedbe applied

Patient has to complete a long Patient has to complete a long questionnaire and obtain Med 4 from questionnaire and obtain Med 4 from GP,then submit them togetherGP,then submit them together

Med 4- what it should Med 4- what it should includeinclude

Diagnosis of main incapacitating Diagnosis of main incapacitating conditioncondition

Other relevant conditionsOther relevant conditions In the “doctor’s remarks” section details In the “doctor’s remarks” section details

of disabling effects,treatment,prognosis of disabling effects,treatment,prognosis and ability to travel to an assessment and ability to travel to an assessment medical examinationmedical examination

Advice regarding patient’s ability to Advice regarding patient’s ability to carry out his usual occupationcarry out his usual occupation

What is the point of Med What is the point of Med 4?4?

Helps provide evidence to DWP for patients Helps provide evidence to DWP for patients with severe conditions who may be with severe conditions who may be exempted from need to send in further sick exempted from need to send in further sick notesnotes

If Med 4 corresponds with patient’s account If Med 4 corresponds with patient’s account of their disability,may not need an of their disability,may not need an examinationexamination

If completed thoroughly Med 4 helps to If completed thoroughly Med 4 helps to reduce need for “appeals” if benefit reduce need for “appeals” if benefit disalloweddisallowed

Med 6Med 6

There may be exceptional circumstances There may be exceptional circumstances where a full,accurate “diagnosis” could be where a full,accurate “diagnosis” could be prejudicial to patient’s wellbeing eg AIDSprejudicial to patient’s wellbeing eg AIDS

Don’t forget Med 3 and Med 5 certificates Don’t forget Med 3 and Med 5 certificates are passed by patients to their are passed by patients to their employers,who may not treat information employers,who may not treat information as confidentialas confidential

Med 6 is not passed to employer but goes Med 6 is not passed to employer but goes straight to DWPstraight to DWP

Med 6Med 6

To be used if doctor has been unable to To be used if doctor has been unable to enter a precise diagnosis on Med 3,Med 4 or enter a precise diagnosis on Med 3,Med 4 or Med 5Med 5

Med 6 should be sent direct to DWP officeMed 6 should be sent direct to DWP office A Med 6 is included in each pad of sick notesA Med 6 is included in each pad of sick notes DWP will request a short report from GPDWP will request a short report from GP An accurate diagnosis must be entered on An accurate diagnosis must be entered on

Med 6 so the DWP medical officer has a Med 6 so the DWP medical officer has a realistic idea of patient’s true conditionrealistic idea of patient’s true condition

And now…….And now…….

A few cases to test your A few cases to test your understanding!understanding!

In the following situations,which In the following situations,which certificate should you issue?certificate should you issue?

Case 1:Case 1:

35 year old man, seen in surgery 35 year old man, seen in surgery having developed acute low back having developed acute low back pain when lifting a crate at work pain when lifting a crate at work todaytoday

Usually fit and healthyUsually fit and healthy Heavy jobHeavy job

Case 2:Case 2:

45 year old woman,underwent 45 year old woman,underwent hysterectomy 10 weeks agohysterectomy 10 weeks ago

Sick note given by hospital for 8 Sick note given by hospital for 8 weeksweeks

Saw consultant in OPD 3 weeks ago Saw consultant in OPD 3 weeks ago and forgot to get a sick noteand forgot to get a sick note

Wants to return to work in 6 weeks Wants to return to work in 6 weeks from nowfrom now

Case 3:Case 3:

21 year old man,phones to speak 21 year old man,phones to speak to youto you

He wants a sick note for 2 weeks He wants a sick note for 2 weeks for his “bad back”for his “bad back”

He has not consulted a doctor He has not consulted a doctor during this periodduring this period

Case 5:Case 5:

52 year old patient with depression52 year old patient with depression Patient has been seeing your partner for Patient has been seeing your partner for

6 months with this condition and is still 6 months with this condition and is still unfit to work.She needs another sick unfit to work.She needs another sick notenote

Your partner has just gone on holiday Your partner has just gone on holiday but did see the patient 3 weeks agobut did see the patient 3 weeks ago

What if your partner had seen the What if your partner had seen the patient 6 weeks ago?patient 6 weeks ago?

Case 6:Case 6:

40 year old woman for whom you 40 year old woman for whom you have previously issued a Med 3 have previously issued a Med 3 when she had a breast biopsywhen she had a breast biopsy

Med 3 now due to expireMed 3 now due to expire She is about to embark on She is about to embark on

chemotherapy and radiotherapy chemotherapy and radiotherapy which will take at least 9 months which will take at least 9 months to completeto complete

Case 7:Case 7:

45 year old man who has been off 45 year old man who has been off work for 3 days with D&Vwork for 3 days with D&V

Asking for a sick note as employer Asking for a sick note as employer insists he has to produce a sick insists he has to produce a sick note after 3 days’ sick leavenote after 3 days’ sick leave

Case 8:Case 8:

A young offender attends surgery A young offender attends surgery requesting a sick note as he had requesting a sick note as he had D&V last week and was unable to D&V last week and was unable to complete his community servicecomplete his community service

He has not been seen by a doctor He has not been seen by a doctor during the period in questionduring the period in question

Case 9Case 9

A 38 year old patient has recently A 38 year old patient has recently been diagnosed with Hepatitis C been diagnosed with Hepatitis C following an admission with acute following an admission with acute jaundice.jaundice.

It is the first time you have seen It is the first time you have seen the patient during this illness but the patient during this illness but you have received a letter from you have received a letter from the consultant gastroenterologistthe consultant gastroenterologist

Case 10:Case 10:

You have been seeing this patient You have been seeing this patient regularly since he fractured his tibia regularly since he fractured his tibia and fibula in a RTA.and fibula in a RTA.

You saw him in surgery 2 weeks ago You saw him in surgery 2 weeks ago but did not issue a certificatebut did not issue a certificate

He phones you today to say that his He phones you today to say that his sick note expired a week agosick note expired a week ago

What if he attended surgery What if he attended surgery instead?instead?

Case 11:Case 11:

Patient phones you to inform you Patient phones you to inform you that work has “lost” the Med 3 that work has “lost” the Med 3 you issued her 2 weeks previouslyyou issued her 2 weeks previously

She wants another sick noteShe wants another sick note

Case 12:Case 12:

Patient has been off work with Patient has been off work with sciatica and has an open Med 3 for sciatica and has an open Med 3 for 8 weeks8 weeks

He attends surgery to inform you He attends surgery to inform you that he now feels ready to return that he now feels ready to return to work (before the 8 week period to work (before the 8 week period has elapsed)has elapsed)