This is NOT a rant against my colleagues in secondary care. Hopefully some of my readers are secondary care docs. Some of them may learn something from this post. Or they may not. (grandmothers, eggs, natch...)
There are 2 main types of sick note patients will come across. The Med3 and, less frequently, the Med5.
The Med3 is the white certificate you might obtain from your GP if you need more than seven consecutive days off work. Its duration can be open (specified typically as "two weeks" for example) or closed (when a specific return to work date is recorded). It cannot be backdated. The patient must be physically seen, in the flesh. Telephone consultations, although they seem to be ignored by the DWP, actually fall outwith the regulations governing these certificates
A Med5 has two possible functions. One is for a doctor to backdate a certificate, but only if he or she has seen you in the recent past and for upto only a month from the date of signing. The other is to provide a certificate (without necessarily seeing a patient) on the basis of a recently received (within a month) letter from another doctor. In this instance, the certificate cannot be backdated (again the DWP seems to ignore breaches when this inevitably happens).
As a GP I do a lot of these.
Not infrequently, patients come to see me after operations or hospital stays to get one because they have not been furbished with one at the time of discharge or they have been given one for a shorter period of time than will obviously be necesary (for example 1-2 weeks after a hysterectomy rather than the 6 weeks virtually everybody needs).
This irritates me. Greatly.
I would imagine it occurs mostly because of ignorance of the regulations by hospital junior doctors. I would hope that it isn't just laziness.
Because you see the guidance is quite clear:
The duty to provide a statement rests with the doctor who has clinical responsibility for the patient at the time. Hospitals are required to provide all certificates for social security and Statutory Sick Pay purposes and doctors' statements for both in-patients and outpatients who are incapable of work. The Med 3 should be issued on discharge from hospital where a hospital doctor advises a patient to refrain from work, and the doctor was attending and had clinical responsibility for the patient at the time this advice was given. In such cases the Med 3 should be issued for an appropriate forward period. Responsibility for issuing further certificates rests with the doctor who assumes clinical responsibility for treating the incapacitating condition. In cases where the GP has not taken over responsibility for the incapacitating condition, responsibility for issuing further certificates will rest with the treating clinician.
I am sure that, at times, junior doctors are advised by others (perhaps administrators or nursing staff on the wards) that sick notes are not available, or that "we haven't got any". It certainly happened to me when I was training.
I have written twice this year to senior colleagues at my local hospital advising of these regulations. The second time I offered to go and do a session at their twice-yearly inductions for the junior doctors. I didn't receive a reply to my second letter, but there you are, some people are just rude. Such is life.
However, given all the problems around the accountability of the GMC (as well as to it) together with increasingly draconian messages regarding probity coming from it, I suspect that in future, I will be regretfully apologising to patients as I do now. But the focus will shift from an apology that my secondary colleagues have somehow abrogated themselves of responsibility for the sick note and provide it whilst steaming quietly in my chair, to apologising that I may not provide a note for them and directing them back to the hospital consultant. I will show them a copy of that paragraph, and will give them a copy to show the consultant.
Hopefully the message will sink in, bit by bit. I will repeat my offer to educate if the opportunity arises (which sadly, I suspect it will). Letters will be written, patients will be inconvenienced.
Does that make me stroppy? I don't think so.