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 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

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)