GANFYD request • 59 year old female • PAF – on sotalol 80mg od • Attends GP surgery asking for a letter • She has booked a day at a spa with her daughter • She was looking forward to having an aromatherapy body massage • She has been told by staff at the spa that she needs a letter from her GP stating that it is safe for her to have the have the massage in view of her PMH and DH.
How do you feel about this? • Are you clear about what information is requested from you? • Are you obliged to write the letter? • What would you say in the letter? • Do you request payment?
What would you write? • Refuse completely to write a letter • State that you are in full support of an aromatherapy massage and that it is perfectly safe • A vague non-committal opinion stating you think it is unlikely to do any harm • A statement of fact regarding PMHx and DH followed by “I am unable to comment of the risks or benefits of a complimentary therapy” • In the circumstance an aromatherapy massage is far too risky
How would you handle the following common scenarios? • A request for sick note to cover absence < 7 days • A letter to explain absence from school/exam • A letter regarding fitness to undertake/or not undertake certain activities at work • A patient’s request for a letter explaining that his depression was responsible for recurrent defaults on loans – due in court next week
Statutory Certificates • We are paid to issue them as part of our basic contract • No specific fee for issuing them • We are duty-bound to issue them, where appropriate
“Sick notes” • Issued for the purposes of claiming statutory sick pay • Required after 7 days of sick leave • Prior to this patients can self certify • Do not issue sick notes earlier on request of employer; refer them to government guidance • Useful to have standard letter to give to pts • We are not required to issue sick note to confirm school absence or absence from examinations (confirmed by BMA)
Kilmeny Surgery 50, Ashbourne Road, Ingrow, Keighley BD21 1LA Partners: Drs JE Aldred, DT Gopal, JD Hodgson, R McGill, A Parsons, B Kennedy, Other GPs Dr L Thake, Dr R McEnery, Dr M Begum 11 May 2010 Re: Request for certification for absences less than 7 days Employers asking for a doctor’s statement for the first seven days of an employee’s sickness are referred 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 seven days or less 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. I do not therefore issue certificates in these circumstances. If employers have reason to inquire 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 for such a report for which you, the employer, will be responsible. Yours sincerely
KILMENY SURGERY 50 Ashbourne Road, Ingrow, Keighley BD21 1LA Partners: Drs JE Aldred, MA England, DT Gopal, JD Hodgson, R McGill, B Kennedy, A Parsons Other GPs Dr L Thake, Dr A Belton, Dr M Begum, Dr R McEnery Dear Sir/Madam, My patient has requested that I send you details of his/her medical history in so far as this is related to: I would be grateful if you would confirm your need for this information and complete the details below. Precise information required: I consent to the above information being given by my GP. Your organisation accepts responsibility for the fee payable for this service (up to £50) depending on the work involved. In the event that this information is not required, I will assume that the patient themselves can supply you with all necessary details. Yours faithfully
“Sick notes” • Duty to provide statement rests with the doctor who has clinical responsibility for the patient AT THE TIME • Hospital doctors are responsible for statements for both in-patients and out-patients who are incapable of work • Hospital doctors should issue the Med 3 to cover an appropriate forward period • Responsibility for further certificates rests with the doctor who assumes clinical responsibility for treating the incapacitating condition • May be the GP or the specialist
GANFYD • Some requests may be reasonable • Often unnecessary, inappropriate or absurd! • Administrative personnel not willing to believe information given by patient • Companies seeking to avoid/shift legal responsibility for potential adverse consequences • e.g. fitness to work/travel/undertake certain activities
GANFYD • Patients may come on their own initiative, often to gain your support/avoid something undesirable • e.g. justify absence off work/get off speeding fine/court appearance etc…
GANFYD • Countersigning applications for official documents • Government has made it clear that tax payers should not have to fund doctors time to do this • Should no longer happen • Some paid arrangements with patients who find it convenient still exist
Fees and Payment • Remember: Regardless of how valid the request – the letters are a form of medical report • Fall outside of normal NHS duties We can refuse to issue them as no contractual obligation (although their may be a moral one) • Classed as private and attract a fee
Fees and Payments • Make the need for a fee clear to patients • Often filters out unnecessary requests! • Request fee prior to issuing the letter • At discretion of practice some fees may be waived, but run risk of perpetuating demand
Fees and Payments • Remember ‘Community Orientation’ • Well patients book an appointment for what is essentially a non-medical problem to ask for letter • They are using valuable GP time paid for by NHS money • By providing a letter writing service for free you are compromising the GP partnership - it is entitled to make money AND you are using NHS money to subsidise private work • A ‘fair price’ must mean that the practice makes a profit from the letter
Medico-legal considerations • Certain areas should be left to doctors with appropriate expertise • Fitness to drive • Fitness to fly • Occupational health assessments • Recording injuries for police purposes • If asked to certify if a patient is fit to undertake a certain activity – careful wording: • “I do not know of any reason why they cannot participate in this particular activity”
“Sick notes” for court appearances etc.. • Not an uncommon request for patients, but…. • ALL REQUESTS MUST COME DIRECTLY FROM THE COURTS • Doctors have been reprimanded in the past for providing letters at the request of patients; you risk being found to be in contempt of the court! • Similar for patients who want to be excused from jury service/community service/probation.
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