Sickness Certification in Primary Care

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Although usually straightforward, the provision of certificates for patients may sometimes cause difficulty. On 6 April 2010, the forms Med 3 and Med 5 were replaced with a single revised Statement of Fitness for Work. Forms Med 4, Med 6 and RM 7 were also withdrawn. See also the separate Long-term Sickness and Incapacity article.

An employer may require an employee to provide a doctor's certificate after more than seven days' sickness. To claim Statutory Sick Pay (SSP) for illness of seven days or less, the patient may self-certify using the appropriate form.

  • An SC2 self-certification form (SC1 for unemployed or self-employed) is used by an employee to provide their employer with details of sick absences of four or more days in a row. The completed SC2 form is then used to help decide whether or not the employee is entitled to receive SSP.
  • GPs are not obliged to issue NHS medical certificates for periods of sickness of less than seven days in duration. However, if a patient requires a short-term certificate, the GP is entitled to charge a fee. It is clearly not an appropriate use of NHS time, however, to see patients for no other purpose than to provide a sick certificate.
  • Some employers continue to operate occupational sick pay schemes which offer employees more benefits than those laid down under SSP legislation but require certificates for short periods of sickness. Standard disciplinary procedures recommended by the Advisory, Conciliation and Arbitration Service (ACAS) provide employers with the means for dealing with employees suspected of abusing the privilege of self-certification, or who have a record of persistent short-term sickness absence.
  • There have been various guidelines provided to deal with these problems. Employers can be informed that if they require additional certification, they should make their own arrangements with a doctor on a private basis to assess and verify the the patient's illness and consequent sickness absence.

Since 6 April 2010, the Statement of Fitness for Work has replaced forms Med 3 and Med 5. NHS General Practitioners and, where appropriate, other doctors are required to issue, free of charge, a Statement of Fitness for Work to patients for whom they provide clinical care. A Statement is not required until the patient has been off work for more than seven calendar days. The Statement may be issued:

  • On the day that the patient was assessed; or
  • On a date after the assessment if it is considered that it would have been reasonable to issue a Statement on the day of the assessment; or
  • After consideration of a written report from another doctor or registered healthcare professional.

The changes associated with the Statement of Fitness for Work include:

  • Telephone consultations as an acceptable form of assessment.
  • Removing the option to say a patient is fit for work.
  • Introducing: 'May be fit for work taking account of the following advice'.
  • More space provided for comments on the functional effects of the patient's condition, with tick boxes to indicate issues (such as altered hours or avoiding certain activities) that could help their return to work.
  • Changed rules for issuing the Statement so that during the first six months of sickness, the new Statement can be issued for no longer than three months; also, simplification of the system by combining the forms Med 3 and Med 5 into one form.

However, the Statement can still only be completed by a doctor, the doctor can still advise patients that they are not fit for work, and the Statement remains advice from the doctor to the patient. Patients can use the Statement as evidence of fitness for work for sick pay and benefit purposes; however, the advice on the Statement is not binding on employers.

The new Statement of Fitness for Work allows the doctor to advise one of two options:

  • Not fit for work: where your assessment of your patient is that they should refrain from work for a stated period of time.
  • May be fit for work, taking account of the following advice: where your assessment is that your patient's health condition does not necessarily mean they cannot return to work; however, they may not be able to complete all of their normal duties or hours, or they may need some support to help them undertake their normal duties.

If it is not possible for the employer to provide the support for your patient to return to work, your patient and their employer can use the Statement as if you had advised 'not fit for work'. The patient does not need to return to see a doctor for a new Statement to confirm this.

Other reports required by the Department for Work and Pensions (DWP) from time to time include:

  • ESA113: factual report in connection with Employment and Support Allowance (ESA).
  • FRR2: factual report in connection with ESA requesting answers to one or more specific questions.
  • PIP factual report: report in connection with Personal Independence Payment (PIP).
  • DLA/AA claim form statement: statement at back of claim form in connection with Disability Living Allowance (DLA)/Attendance Allowance (AA).
  • DLA/AA factual report: factual report in connection with DLA/AA.
  • DS1500: factual report in connection with PIP/DLA/AA for people who may be terminally ill.
  • BI205: factual report in connection with Industrial Injuries Disability Benefit (IIDB).
  • Bl127: request for photocopies of case notes including X-ray reports in connection with IIDB.
  • FAS1500: factual report in connection with Finance Assistance Scheme (FAS).

Form DS1500

  • A form DS1500 should be issued if requested by a patient (or their representative) if the patient may have a potentially terminal illness. The relevant definition of terminal illness is a progressive disease where death as a consequence of that disease can reasonably be expected within six months.
  • The DS1500 should be handed to the patient (or their representative) and not sent directly to the DWP.
  • A fee is payable by the DWP for the completion of the form.
  • DS1500 forms are supplied in booklets by the Department. Blank DS1500 forms can be obtained by ringing the iON Contact Centre on 0845 850 0475 and either faxing your order on headed notepaper to 0845 850 0479 or emailing it to
  • The DS1500 asks for factual information and does not require a prognosis. The report should contain details of:
    • The diagnosis.
    • Whether the patient is aware of their condition and, if unaware, the name and address of the patient's representative requesting the DS1500.
    • Relevant current and proposed treatment.
    • Brief clinical findings.

Personal Independence Payment (PIP) factual report

  • Factual reports for patients claiming PIP may be requested where the Assessment Provider believes that further evidence will help inform their advice to the Department.
  • The assessment for PIP considers the claimant's ability to carry out a series of everyday activities - eg, dressing, mobility, communicating, managing their health needs and making simple budgeting decisions.

Employment and Support Allowance (ESA)[2]

  • In October 2008, ESA replaced the system of incapacity benefits for new applicants.
  • ESA provides financial support to disabled people or individuals with a health condition that affects their ability to work.
  • GPs are still asked to provide 'statements of incapacity for work' until the independent Work Capability Assessment is carried out.
  • GPs may also be asked to complete a form ESA113 for patients with a severe disability, who might be entitled to benefit.

Further reading and references

  1. Medical (factual) reports - a guide to completion; Dept for Work and Pensions, April 2014

  2. The benefits system. A short guide for GPs; Dept for Work and Pensions, August 2013