Sickness Certificate

Certification for less than one week's sickness absence

An employer may require an employee to provide a doctor's certificate after more than seven days' sickness. To claim Statutory Sick Pay (SSP) for illness of seven days or less, the patient may self-certify using the appropriate form.

• An SC2 self-certification form (SC1 for unemployed or self-employed) is used by an employee to provide their employer with details of sick absences of four or more days in a row. The completed SC2 form is then used to help decide whether or not the employee is entitled to receive SSP.
• GPs are not obliged to issue NHS medical certificates for periods of sickness of less than seven days in duration. However, if a patient requires a short-term certificate, the GP is entitled to charge a fee. It is clearly not an appropriate use of NHS time, however, to see patients for no other purpose than to provide a sick certificate.
• Some employers continue to operate occupational sick pay schemes which offer employees more benefits than those laid down under SSP legislation but require certificates for short periods of sickness. Standard disciplinary procedures recommended by the Advisory, Conciliation and Arbitration Service (ACAS) provide employers with the means for dealing with employees suspected of abusing the privilege of self-certification, or who have a record of persistent short-term sickness absence.
• There have been various guidelines provided to deal with these problems. Employers can be informed that if they require additional certification, they should make their own arrangements with a doctor on a private basis to assess and verify the the patient's illness and consequent sickness absence.

Statement of Fitness for Work

Since 6 April 2010, the Statement of Fitness for Work has replaced forms Med 3 and Med 5. NHS General Practitioners and, where appropriate, other doctors are required to issue, free of charge, a Statement of Fitness for Work to patients for whom they provide clinical care. A Statement is not required until the patient has been off work for more than seven calendar days. The Statement may be issued:

• On the day that the patient was assessed; or
• On a date after the assessment if it is considered that it would have been reasonable to issue a Statement on the day of the assessment; or
• After consideration of a written report from another doctor or registered healthcare professional.

The changes associated with the Statement of Fitness for Work include:

• Telephone consultations as an acceptable form of assessment.
• Removing the option to say a patient is fit for work.
• Introducing: 'May be fit for work taking account of the following advice'.
• More space provided for comments on the functional effects of the patient's condition, with tick boxes to indicate issues (such as altered hours or avoiding certain activities) that could help their return to work.
• Changed rules for issuing the Statement so that during the first six months of sickness, the new Statement can be issued for no longer than three months; also, simplification of the system by combining the forms Med 3 and Med 5 into one form.

However, the Statement can still only be completed by a doctor, the doctor can still advise patients that they are not fit for work, and the Statement remains advice from the doctor to the patient. Patients can use the Statement as evidence of fitness for work for sick pay and benefit purposes; however, the advice on the Statement is not binding on employers.

The new Statement of Fitness for Work allows the doctor to advise one of two options:

• Not fit for work: where your assessment of your patient is that they should refrain from work for a stated period of time.
• May be fit for work, taking account of the following advice: where your assessment is that your patient's health condition does not necessarily mean they cannot return to work; however, they may not be able to complete all of their normal duties or hours, or they may need some support to help them undertake their normal duties.

If it is not possible for the employer to provide the support for your patient to return to work, your patient and their employer can use the Statement as if you had advised 'not fit for work'. The patient does not need to return to see a doctor for a new Statement to confirm this.