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Occupational health - some common questions answered
Update June 2008
- Statutory Sicknotes
- Statutory Sick Pay
- Private Sicknotes
- Incapacity Benefit (IB) and Employment and Support Allowance (ESA)
- Occupational Health Reports
- Health and Well-being at Work
- Information for Employers
The BMA can not advise individual members of the public on sickness benefits or occupational health issues, nor can we provide lists of occupational health doctors. We hope, however, that the following information will answers the questions that we are most commonly asked by patients and employers.
Statutory Sicknotes
Under current rules, there is no statutory requirement on GPs to provide a sick certificate for the first seven days of an employee's absence. During this period workers can self-certificate. Self-certification is for employers' records and to ensure that absent employees receives Statutory Sick Pay (SSP). GPs can also sometimes provide private sick notes for a fee - see Private Sicknotes section below.
For short-term illness of less than seven days but lasting more than four days in a row, employers may supply employees with a form to complete, or employees can complete form SC2 which is available from Post Offices and GP surgeries, or on the HM Revenue & Customs website. Self-employed or unemployed people can use a SC1 form, available from Job Centres and Benefit Offices or from their GP surgery.
On day seven of illness and absence from work, the GP or the doctor looking after the patient becomes responsible for certification of the illness. The present rules require a GP’s signature on a medical certificate - a Med 3 - to be given to an employer.
- Open and Closed Certificates
If a hospital doctor believes a patient being discharged is not ready to return to work, he or she can issue a Med 3 form, which should also state if the patient is likely to have to visit hospital again for check-ups or follow-up treatment.
- Backdated Sicknotes
A Med 5 statement can be used, however, to supply evidence of incapacity for an earlier period, but BMA guidance states that in backdating incapacity doctors must either:
- base their advice on examination of the patient on a previous occasion, providing they are sure that they would have advised their patient to refrain from work from the date of that earlier examination for the entire period of the certificate or;
- base their advice on a report from another doctor issued less than one month previously and issue form Med 5 for a forward period up to one month.
The DWP has produced an illustrated guide (Ref 2) for doctors on what medical certificate is most appropriate for a patient, alongside detailed guidance for doctors on their obligations in completing these forms.
- Reform of the Sickness Certification System
Electronic sick notes have being piloted with the aim of tackling problems relating to handwriting, improving data collection and promoting better communication between GPs and employers.
Following Dame Carol's review a consensus statement, signed by more than 30 health professional bodies (including the BMA), pledged to help people enter, stay in, or return to work, where appropriate.
Statutory Sick Pay (SSP)
Almost all employees who earn £90 a week or more, and who are aged over 16 on the first day of illness, are entitled to Statutory Sick Pay for up to 28 weeks of sickness. Statutory Sick Pay (SSP) is not paid for specific illnesses or treatments, but to all employees who are incapable of work and who satisfy the conditions for payment.
SSP is paid from the fourth day of sickness onwards - for days that an employee would normally be at work. For those who qualify, SSP is paid by an employer in the same way that they usually pay an employee's wages.
The Patient UK website includes a guide to SSP. Other sources of advice on SSP include Jobcentre Plus and local Citizens Advice Bureaux (CAB). The CAB website also provides useful advice on SSP.
The Department of Work and Pensions (DWP) administers the scheme and its website contains comprehensive information on SSP.
HM Revenue and Customs also has a Disputes System to deal with disagreements between an employer and employee on payment of SSP. The Disputes team may need to arrange a medical examination.
Private Sicknotes
GPs are required to provide sick certificates for periods of absence lasting longer than 7 days; this work forms part of their NHS responsibilities.
For periods of absence of less than 7 days, however, some employers still insist that an employee should obtain a sick note from their GP. This is not a statutory requirement. It may also not be the best use of a GP's time to see a patient simply to provide a private sick certificate, although some GPs will provide this service.
Where a GP is willing to provide a private sick note, this will normally attract a fee that the person, or company commissioning this service, will be obliged to pay (usually the employer - either directly, or through reimbursing the employee who has paid for the private sick note). A GP can charge a fee as this is non-NHS work.
The BMA has published suggested fees that doctors can charge for providing private certificates and medical reports for their own patients, although these are only 'suggested' fees; GPs can charge what they feel is reasonable for providing a particular non-NHS service. The BMA does, however, advise doctors to discuss their proposed fees before carrying out any private report work.
BMA suggested fees for GPs providing private sick certificates fall within BMA Fees Guidance Schedule 11 - Where no agreement applies.
These suggested fees do not apply to local authority employees who are covered by Fees guidance schedule 2 and NHS employees who are covered by Fees guidance schedule 3.
Incapacity Benefit (IB) and Employment and Support Allowance (ESA)
After week 28 of absence from work due to ill health, patients no longer qualify for SSP and move into the Incapacity Benefit (IB) system (if they qualify).
GPs do not make decisions on eligibility for IB. An IB candidate who has been ill for 20 weeks will be asked to visit their GP for a Med 4 form which gives fuller details of the patient's condition than any Med 3 issued originally. Based on the information in the Med 4 certificate, the DWP may be able to decide that a patient is incapable of work and would therefore qualify for Incapacity Benefit.
If further details of a patient's illness are required by the DWP, a form IB113 needs to be completed by the patient's GP. The DWP will write to the patient's NHS GP requesting that they complete this IB113 form.
On the basis of the information provided in the IB113 form, the DWP decides if the patient gets called up for a medical assessment to determine whether they are entitled to IB, called a Personal Capability Assessment.
These assessments are carried out by the DWP’s own medical professionals and decisions about whether someone actually receives IB are then made by a DWP lay adjudication officer. The DWP also operates an appeals system in respect of these decisions.
The Jobcentre Plus website contains information about qualifying for IB and the procedures that need to be followed before a person can receive the benefit, such as having an independent medical assessment. Further details on the support available to people on incapacity benefits can be found on the DWP's Pathways to Work website.
A new benefit, the Employment and Support Allowance (ESA) will replace Incapacity Benefit and Income Support paid because of incapacity or disability for all new claims made from October 2008. Incapacity Benefit and Income Support will, however, continue to be paid to those already receiving it. You can find out more about the new ESA on the Jobcentre Plus website.
A new test, the Work Capability Assessment, will be introduced alongside the new Employment and Support Allowance and will be applied to all those people claiming the new allowance. The test will replace the Personal Capability Assessment and will assess what an individual can do. The new system aims to support individuals with health conditions and provide employment advice to enable them to return to work where possible.
Occupational Health Reports
Employers may request an occupational health report from an employee's GP for pre-employment purposes or as part of an assessment of a current employee's fitness to work. These reports are outside a GP's normal NHS responsibilities, but can be supplied at the GP's discretion, on a private basis.
Should a GP agree to do this work on behalf of one of their own patient's they can charge a fee. The BMA's suggested fees for such work can be found in Fees Guidance Schedule 11 - Where no agreement applies.
Medical reports produced by doctors for employment purposes are subject to the provisions of the Access to Medical Reports Act 1988 and Access to Personal Files and Medical Reports (Northern Ireland) Order 1991.
An employer must gain an employee's consent before applying to a GP for a medical report. Before any medical report can be written, a GP must be satisfied that the individual has consented to the release of the information.
A patient can request to see a report written about them by their doctor before it goes to an employer. The BMA's Ethics Department has published comprehensive guidance for doctors on their duties in respect of medical reports, written for employment or insurance purposes, entitled Guidelines on Access to Medical Reports (Ref 3)
Some companies may also seek specialist occupational health (OH) guidance from their own OH doctors, although here the rights of an employee to see the medical report written about them before it is sent to their employer are less clear.
Health and Well-being at Work
There are numerous pieces of UK and European legislation which govern health and safety at work and occupational health. The relevant law, and enforcing bodies, differ depending on the size of a company and its workforce, the nature of the work undertaken and whether the organisation is in the public or private sector.
The Health and Safety at Work Act is the primary piece of legislation covering occupational health and safety in the United Kingdom. The Health and Safety Executive (HSE) is responsible for enforcing the Act and other laws and regulations relevant to the working environment.
- Health and Safety authorities
Local authorities enforce health and safety law in offices, shops and other parts of the services sector and are answerable to the Commission. The HSE website contains guidance for businesses, industry-specific information and advice on reporting incidents at work. Their website also offers access to FAQs and an Ask an Expert service.
- Disability at Work
Further information can be found on the CEHR's website or via their Helpline for businesses: Tel 08457 622633. The Access Association is a charity whose aim is to improve access and facilities for all people with specific accessibility requirements, by advising workers and employers.
- Information for Employees
The Citizens Advice Bureau service helps people resolve their legal, money and other problems by providing free information and advice. Workers can also consult their trade union if they have one.
Information for Employers
We have listed below, details of organisations that can offer occupational health services to employers. Services offered by Occupational Health (OH) providers would include pre-employment screening; absence management; smoking cessation schemes for staff; travel medicine for employees working abroad and general health advice for workers.
- Government/NHS OH Services
NHS Plus charges private clients a fee for its services, with all profits re-invested into the NHS. The NHS Plus website has a search engine which allows employers to find their local NHS Plus service.
The Department of Health recently announced a roll-out of the NHS Plus service with six new demonstration projects located in Merseyside, East London, West Yorkshire, the North East, Devon and Worcestershire.
Health Work Well-being is a Government-led initiative to improve the health and well-being of working age people. It aims to bring together employers, unions and healthcare professionals in helping more people with health conditions to find and stay in employment The website contains advice on what employees can do to improve workplace health and there are extensive case studies on organisations who have improved the health and well-being of their employees.
In Scotland Safe and Healthy Working is part of the Scottish Centre For Healthy Working Lives initiative which provides a free and confidential occupational health and safety service for small and medium-sized enterprises in Scotland.
Scotland’s Health at Work (SHAW) is a National Award Programme which rewards employers who demonstrate commitment to improving the health of their workforce. SHAW has produced an SME Toolkit to help companies prioritise key action points for workplace health and safety.
Small and medium sized business in Wales can benefit from the new Workboost Wales pilot service, which offers specific advice and help on workplace health, safety and return-to-work issues. Workboost Wales is available to businesses in Wales with between 5 and 250 employees, and can provides workplace visits to help solve problems. Advice given and visits are confidential, impartial and free of charge.
The Employment Medical Advisory Service (EMAS) is a statutory advisory body within the Health and Safety Executive for Northern Ireland (HSENI) offering advice on health matters relating to work. EMAS is staffed by health professionals and gives advice on health matters relating to work, to organisations and individuals including employers, employees, trade unions, regulators, health care professionals and others.
- Other useful Occupational Health organisations
The Faculty of Occupational Medicine, based at the Royal College of Physicians, is a professional and academic body whose role is to develop and maintain high standards of training, competence and professional integrity in occupational medicine. The Faculty also produces publications and on-line resources that can advise companies about employing occupational physicians and health screening.
The British Association and College of Occupational Therapists is a trade union and professional association for occupational therapy professionals in the UK. The College operates a consultancy service providing expert advice on the delivery of multidisciplinary and occupational therapy services.
References
- BMA. Guidelines on Access to Medical Reports. London: BMA, 2007; http://www.bma.org.uk/ap.nsf/Content/accessmedreports07
- Department of Work and Pensions. Guide to Issuing Med 3 or Med 5. London; http://www.dwp.gov.uk/medical/hottopics/desk-aid1.pdf
- BMA. Medical certificates and reports; The new GMS and PMS contracts London. BMA, 2004; http://www.bma.org.uk/ap.nsf/content/MedCertRep0704