People, forms and benefits

1
People, forms and benefits

• A look at the different forms, sources of
  confusion and help. The influence of outside
  factors/societal issues.

2
Learning outcomes

• By the end of this session you should be
• Familiar with the different types of medical
  certificates
• Be aware of the circumstances in which different
  certificates should be used
• Know where to find help and advice
• Have considered the ethical implications of
  issuing sick notes from the perspective of
  patients, society and the doctor

3
Med 3,4,5

• Med 3 statement of incapacity from work greater
  than 7 days for SSP (Statutory Sick Pay) purposes
  only.
• Med 4 statement used for patients undergoing
  the Personal Capability Assessment (all-work
  test, decision makers, Incapacity Benefit usually
  after SSP ends at 28 weeks).
• Med 5 statement used for back-dating a sick
  note or where you are issuing a sick note without
  having seen the patient, but have written
  evidence from another medical practitioner.

4
Case 1

• A 33-years old staff nurse at Selly Oak hospital
  comes to see you. She has been off work for 3
  days with a sore throat. She believes it is a
  virus and wants to RTW tomorrow. Her nurse
  manager has told her to get a sick note from her
  GP.
• How might you respond?

5
Case 2

• John is a 14 years-old schoolboy who has been off
  school for 5 days with a cold. It is Friday and
  he plans to go back to school on Monday next. His
  school website indicates that he is expected to
  provide a doctors certificate in these
  circumstances.
• How might you respond?

6
Case 3

• Gloria is a 27 year old typist with a fractured r
  wrist. Her plaster is due to be removed in 2
  weeks time and she would like a note to RTW a
  week after this.
• How could you deal with this request?

7
Case 4

• Hilary is a 55 year old nursing auxiliary with a
  mild alcohol problem and degenerative disease of
  the spine. She is awaiting an MRI scan and saw
  you 2 weeks ago when she hobbled in using a stick
  to help her walk. She has now been off work for 6
  months and comes to see you again. She reports
  her back is a lot better and that she would like
  to give work a try next week.
• What do you think might underpin her request?
• How might you deal with her request?

8
Case 5

• Peter is a 44 year old with possible angina. He
  is still having hospital tests and is not due to
  see the consultant for review for another 6
  weeks. He asks for three Med 3 certificates for 6
  weeks one for his employer, the other two for
  loan/mortgage protection schemes.
• How would you deal with this?

9
Case 5 continued

• Peter becomes depressed and continues to have
  undiagnosed chest pain. He has been off work for
  6 months and the Department of social security
  have told him to get a med 4 certificate.
• What is the purpose of a med 4?
• Would you fill one in in Peters case?

10
Case 6

• Michael is a 24 years-old motor cyclist with a
  fractured left femur. He was discharged from
  hospital 2 weeks ago and you have a hospital
  letter to this effect in his records. He phones
  up requesting a home visit, because his sick note
  runs out today and he doesnt go back to hospital
  for 2 weeks. He went to fracture clinic
  yesterday, but the doctor said he was too busy to
  give him a note and to call his GP.
• How might you deal with this request?

11
Case 7

• George is a 33 year-old man who is registering
  with your practice today. He has manic depression
  and has repeatedly self-harmed. He has moved to
  Birmingham after being released from prison in
  London four weeks ago. He comes to see you
  wanting a back-dated sick note from 4 weeks ago.
  Social security say he cannot get any money till
  he gets one. He has medication from the prison
  doctor, but he hasnt seen a GP for over a year.
• How should you deal with his request?
• How would you deal with his request?

12
Case 8

• Reginald is a 50 year-old man who has developed
  AIDS, but he does not want his employer to find
  out because he is sure he will be sacked. He asks
  if you could write a vague diagnosis such as
  lethargy on his sick-note.
• What extra form could you fill in to facilitate
  his request?
• Would you do this?

13
Case 9

• You pop round one weekend to see one of your
  non-medical friends who lives over the other side
  of town. He is having a large garage built. You
  are sitting having a cup of tea, when you realise
  that one of the builders who is climbing some
  ladders and carrying a large pile of bricks, is
  in fact Peter from case 5.
• How would you deal with this at the time?
• What medical certificate form could you complete
  where you feel someone is more capable of work
  than they make out?

14
Med 6

• I have been issuing medical statements to this
  patient who is under my care. I have been
  recording a Vague diagnosis on the statements.
  This is because, in my opinion, to record the
  actual diagnosis may be harmful to my
  patient..Please send me a medical report form so
  that I can give you additional information,
  including the actual diagnosis of the disorder
  suffered by this patient.
• Send the form to the patients Social Security
  Office.

15
RM7

• I have been issuing medical statements (Form Med
  3) to this patient who is under my care. Please
  could you arrange for a doctor from Medical
  Services to give an opinion on their ability to
  carry out their occupation.Please send me a
  medical report form so that I can give you
  additional information.
• Please send this form to your patients Social
  Security office.

16
Help?

• What are the possible sources of help?

17
Ethical issues

• Consider the consequences of saying no to some of
  these requests in general, what are the pros and
  cons?
• Any suggestions as to how we can avoid/minimise
  conflict?
• Dealing with sick notes is boring, do you agree?

18
Sources of help

• Trainer, other doctors
• Practice manager
• DWP Department of Work and Pensions
  http//www.dwp.gov.uk/advisers/techguides/
• Direct.gov.uk websites for DLA/Incapacity benefit
• Read the different medical certificates (most are
  self evident)
• Oxford Handbook of Benefits

19
Disability Living Allowance and Attendance
Allowance

• DLA age 65 years and under has two components
  mobility component (higher and lower rates), care
  component (lower, middle and higher rates).
• AA age over 65 years has two rates for care
  (lower and higher), but no mobility component