GANFYD request

1. 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.

2. 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?

3. 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

4. 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

5. GANFYD

6. 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

7. “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)

8. 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

9. 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

10. “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

11. 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

12. 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…

13. 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

14. 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

15. 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

16. 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

17. 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”

18. “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.

19. http://www.ganfyd.org/index.php?title=Get_a_note_from_your_doctorhttp://www.ganfyd.org/index.php?title=Get_a_note_from_your_doctor Or go to: www.ganfyd.org and search for ‘get a note from your doctor’