Fees England Scotland Wales

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Benefits certification

Under GMS and PMS regulations, GPs are obliged to provide medical officers with certain information relating to patients on whom a certificate is being considered. 

The Regulations also state, however, that doctors can rely on the written assurance from the medical officer, or other officer of the Department for Work and Pensions (DWP) who holds the patient's written consent, that consent has been given, unless the doctor has reason to believe otherwise. 

For consent to be valid the patient must be fully informed about the purpose of the examination and or disclosure and relevant information cannot be withheld.

 

What to do about appeals and patients who need additional information

GPs, as certifying medical practitioners, have a statutory obligation to provide statements of incapacity to patients on their list and certain information to a healthcare professional working for the Health Assessment Advisory Service , on behalf of DWP when requested. 

However, under their NHS contract there is no requirement for GPs to provide reports or offer an opinion on incapacity for work to anyone else, unless requested to do so by Jobcentre Plus.

You should tell patients who are claimants, that they should contact Jobcentre Plus or the Appeals Service, where appropriate, if they think that further medical evidence is necessary to support their claim or appeal. 

They should state clearly their reasons for believing that further evidence is necessary. If Jobcentre Plus or the Appeals Service considers that further medical evidence is necessary, they will seek it. 

Jobcentre Plus or the Appeals Service will be responsible for paying any fee to the doctor providing the report.

NHS GPs are under no obligation to provide such evidence to their patients or to provide it free of charge. If a GP does not agree to provide additional evidence for their patient then it is a private matter to be resolved between the GP and their patient.

 

DWP consultant factual report

There has been some confusion over whether consultants should be paid a fee for providing a report to the DWP regarding a patient seeking benefits.

The DWP's position is that hospital doctors are contractually obligated to provide these reports and therefore no fee can be charged.

When a hospital doctor refutes this, the DWP provide a copy of the Health Services Circular.

It is the BMA's view that if the provision for this report is listed in the doctors contract, then they are contractually obliged to provide this report free of charge. If however this is not included within their contract, a fee can be charged irrespective of the health services circular provided by the DWP.

Find out more about assessing capability for work

 

DS 1500 forms for terminally ill patients

Patients automatically qualify for the highest rate of disability living allowance if the doctor confirms in the DS 1500 form that death is reasonably expected during the following six months.

There is no need for bank details to be filled in each time a form is completed.

On the DS1500 Fee Forms, Section C will only need to be completed if it is the doctor's first fee claim or if they wish to change their existing details. This is to bring the DS1500 fee form in line with the GP Factual Report fee form.

Find out more in the DWP guidance

 

How to complete the DBD36 form to receive prompt payment

  • Tick the box to say you are registered for VAT.
  • Ensure that all details are completed when first claiming the fee from Pensions, Disability and Carers' Service. These will include checking that full bank details, including account number and sort code, are supplied.
  • Complete GP name to include initials, to ensure that the correct GP within a surgery is paid.
  • Complete all of the details relating to the patient's name and date of birth.
  • The full surgery address needs to be completed to ascertain that the correct surgery is used for payment.
  • If a GP is registered for VAT, and wishes to claim this amount back, then they must include their full VAT number on the DBD36. The number should only contain digits, and not letters.
  • Remember to tick the box to indicate being registered for VAT.

 

What to do about vexatious complaints

Work within the benefits assessment field attracts a high level of vexatious complaints. This is attributed to the professional opinion doctors are required to make and the financial implications for the individuals being assessed. 

Doctors may feel vulnerable and increasingly reluctant to undertake this essential area of work, due to a lack of support during the complaints procedure.

However, the changes in the GMC's complaints procedure, for example, mean that a majority of complaints are now handled at a local level and doctors are no longer removed from the GMC website whilst under investigation, have somewhat eased the concerns of medical services doctors.