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 DWP (Department for Work and Pensions) who holds the patient's 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.
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 an officer of the DWP or 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.
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.
If DWP or the Tribunal Service request further evidence from a GP in relation to an appeal, they will be responsible for paying any fee to the doctor providing the report.
NHS GPs are under no obligation to provide reports, letters of support or offer an opinion for benefit claims direct to patients or anyone else, or to provide it free of charge. This includes the Citizens Advice Bureau and the Tribunal Service.
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.
GPs are advised to explain to the patient how the organisations involved in providing benefits can get relevant information and that the refusal to provide the evidence will not affect the outcome of the case.
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 hospitals are contractually obligated to provide these reports and therefore no fee can be charged by the NHS.
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 doctor's 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.
This must be done under trust time, and under trust indemnity.
Find out more about DWP factual medical reports.
DS 1500 forms for terminally ill patients
At the time of this update, the DS1500 form is for a prognosis of <6 months, and the new SR1 form is for prognosis 6-12 months.
Patients usually automatically qualify for the highest rate of the relative benefit entitlement if the doctor confirms that they would not be surprised if death was to occur during the following 6 /12 months.
Find out more from the DWP special rules guide.
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.