Physiotherapist Issuing of Medical Certificates August 2008 by hmn57734

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									                                                  Gloucestershire
                                                             Primary Care Trust

             Policies, Protocols, Guidelines and Procedures




                        GUIDELINES FOR THE
                        ISSUING OF MEDICAL
                          CERTIFICATES BY
                         PHYSIOTHERAPISTS

This document may be made available to the public and persons outside of the Trust as part of the
                Trust’s compliance with the Freedom of Information Act 2000.




In the case of hard copies of this policy the content can only be assured to be accurate on
the date of issue marked on the document. The most up to date policy will always be
available on the PCT intranet site.




POLICY DATE: 8/8/2008                                        REVIEW DATE: August 2010

VERSION: 1                     POLICY NO: GPCT/CP 40          AUTHOR: Joanna Griffin
                                       Page 1 of 8
                                     CONTENTS


  Section                           Section Heading                             Page
                                                                               Number

      1        INTRODUCTION                                                        3


      2        STATEMENT OF PROTOCOL                                               3


      3        DEFINITION                                                          3


      4        POLICY DETAILS                                                      3-4


      5        CONSULTATION                                                        4


      6        TARGET AUDIENCE                                                     4


      7        COMMUNICATION OF POLICY                                             4


      8        TRAINING                                                            5


      9        COST IMPLICATIONS                                                   5


     10        REFERENCES                                                          5

                           SUPPORTING DOCUMENTS

 Appendix 1    Clinical Policy Authorisation                                       6

 Appendix 2    Template letter for GP – signed off work

 Appendix 3    Template letter for GP – signed back to work




POLICY DATE: 8/8/2008                                     REVIEW DATE: August 2010

VERSION: 1                  POLICY NO: GPCT/CP 40         AUTHOR: Joanna Griffin
                                    Page 2 of 8
Guidelines for the Issuing of Medical Certificates by
Physiotherapists

1.0   INTRODUCTION
1.1   In 1996 following discussion with the Gloucestershire LMC (Local Medical Council),
      physiotherapists working within Gloucestershire were authorised to issue medical
      certificates to patients with musculoskeletal conditions where it was considered that
      the patient was unable to work, or that to attend work would be detrimental to their
      condition.
1.2   As a result of organisational changes within the NHS and DWP (Department of Work
      and Pensions), it is considered necessary to review the guidelines and update them
      where appropriate.

2.0   STATEMENT OF POLICY
2.2   The aim of these guidelines are to ensure that that patients who are undergoing
      physiotherapy management of a musculoskeletal condition are signed off and back to
      work in a timely manner by their physiotherapist thereby avoiding unnecessary visits
      to their GP solely for the purpose of medical certification.

3.0   DEFINITION
3.1   Guidelines give recommendations for care/clinical practice, which are evidence
      based/referenced. It is a set of principles/best practice, which underpins some
      procedures within which individuals can use their professional judgment based on risk
      and needs assessment. Guidelines enable professional judgment to be exercised where
      there is less evidence.

4.0   POLICY DETAILS
4.1   A medical certificate may only be issued by a qualified, HPC (Health Professions
      Council) registered physiotherapist who accepts this responsibility and has received
      appropriate instruction.
4.2   A medical certificate should only be issued to sign patients off work if the
      physiotherapist deems the patient unable to work because of their physical disorder
      or that undertaking work is likely to be detrimental to their musculoskeletal condition.
4.3   Physiotherapists must use a Med 3 certificate issued by the DWP to sign patients on
      and off work. This was previously agreed with the Gloucestershire LMC in 1996.
4.4   It is the responsibility of the staff member issuing the medical certificate to inform he
      patient’s GP regarding absence from work (using the form in Appendix 1), or return to
      work (using the form in Appendix 2).
4.5   The medical certificate must contain the following information in black ink:
           • Patient name
           • Date of examination
           • Diagnosis
           • Date of issue of medical certificate
           • Printed name and signature of the staff member issuing the certificate
           • Printed address of the hospital using the stamp provided
4.6   The following information should be documented in the physiotherapy records:
           • Total period of absence from work covered by the medical certificate
           • Period of absence from work before the certificate was issued (if appropriate)
           • Intended date of return to work
           • The injury and why this prevents work


POLICY DATE: 8/8/2008                                         REVIEW DATE: August 2010

VERSION: 1                     POLICY NO: GPCT/CP 40          AUTHOR: Joanna Griffin
                                       Page 3 of 8
            • Clinical reasoning supporting the medical certification
4.7    If a closed certificate is issued, the ‘until’ section is completed with a specified date of
       return to work. This may be up to 14 days after the certificate is issued. If an open
       certificate is issued, the ‘for’ section is completed with a period of expected
       incapacity. It is preferable to issue a closed certificate where possible.

4.8    A medical certificate must only be issued for short term musculoskeletal conditions. It
       must only certify absence from the patient’s usual occupation and physiotherapists
       cannot issue medical certificates for unemployed patients.

4.9    A patient may self- certify for the first 7 consecutive days of absence from usual
       employment. A medical certificate may be issued by the physiotherapist if the
       condition necessitates a longer period of absence from work.

4.10   If a patient has an unclear prognosis that may require an absence of work for longer
       than 14 days, the physiotherapist must enter discussion with the patient’s GP. A
       repeat certificate of a further 14 days may be issued following discussion and
       agreement with the GP. For simple musculoskeletal conditions, the physiotherapist
       may issue a repeat certificate if it is expected that the patient will return to work after
       a further 14 days of recovery, e.g. soft tissue sprain or post surgery.

4.11   The GP retains ultimate medical responsibility for the patient. Any concerns which the
       physiotherapist has regarding the presenting condition must be discussed with the
       GP.

4.12   A certificate may only be issued once. If the certificate is misplaced, a replacement
       certificate should be clearly marked ‘duplicate’ by the original issuing member of staff.
       The replacement certificate must be dated with the same date as the original.

4.13   A certificate may only be issued from the date which the patient attends the
       physiotherapy appointment. Certificates may not be back- dated. Patients should be
       reminded that they are able to self- certify for the first 7 days of a period of absence
       from work.

4.14   Supplies of Med 3 certificates must be stored in a secure environment and the
       hospital stamp must be kept separately from the supply of certificates to reduce the
       risk of fraudulent claims.

4.15   Med 3 certificates are available from the Post Room, Victoria Warehouse, Gloucester
       Docks (telephone 01452 318860). To place an order the staff member must state
       their name, location and the number of pads required.

5.0    CONSULTATION
5.1    LMC
5.2    PCT Heads of Service
5.3    Clinical Policies Group

6.0    TARGET AUDIENCE
6.1    Gloucestershire PCT Adult Physiotherapy Service

7.0    COMMUNICATION OF THE POLICY
7.1    The Policy will be communicated to staff in paper format via line managers following
       the approved process.

POLICY DATE: 8/8/2008                                            REVIEW DATE: August 2010

VERSION: 1                       POLICY NO: GPCT/CP 40           AUTHOR: Joanna Griffin
                                         Page 4 of 8
7.2    The policy will be made available on the Trust Intranet and Website and it will also be
       highlighted in the staff newsletter.

8.0    TRAINING
8.1    No formal training will be required for these guidelines as they are intended to be
       comprehensive and self explanatory.

9.0    COST IMPLICATIONS
9.1    No cost implications are anticipated.

10.0   REFERENCES

       Department for Work and Pensions (2004) Medical Evidence for Statutory
       Sick Pay, Statutory Maternity Pay and Social Security Incapacity benefit
       Purposes:       A     Guide       for    Registered       Practitioners,
       http://www.dwp.gov.uk/medical/medicalib204/ib204-june04

       Hussey S, Hoddincott P, Wilson P, Dowell J, Barbour R (2004) Medical
       Certification System in the UK: Qualitative Study of Views of General
       Practitioners                       in                      Scotland,
       http://www.bmj.com/cgi/content/short.328/7431/88


       Hiscock J, Ritchie J (2001) The Role of GPs in Sickness Certification,
       http://www.dwp.gov.uk/asd/asd5/rrep148.pdf




POLICY DATE: 8/8/2008                                         REVIEW DATE: August 2010

VERSION: 1                     POLICY NO: GPCT/CP 40           AUTHOR: Joanna Griffin
                                       Page 5 of 8
                                                                     APPENDIX 1
                 Gloucestershire Primary Care Trust

                  Clinical Policy Authorisation Form

NAME OF POLICY:           Guidelines for the Issuing of Medical Certificates
                          by Physiotherapists.

AUTHOR:                   Joanna Griffin – Team Lead Physiotherapist.


DIRECTOR SPONSOR:         Jill Crook – Director of Clinical Development


NAME OF GROUP:            Clinical Policy Group


                        EQUALITY and DIVERSITY

An Equality & Diversity impact assessment     Date completed: 8/8/2008
has been completed

                             CONSULTATION

NAME OF GROUP (S)       DATE CONSIDERED & Recorded in minutes
Clinical Policy Group   August 2008
PCT Heads of Service
LMC

EDUCATION & TRAINING:         As recorded in section 8
RESOURCE IMPLICATIONS:        As recorded in section 9
                          RATIFICATION
CLINICAL POLICY STEERING GROUP       DATE APPROVED 5/8/2008
APPROVED                             Sarah Warne – Chair
REVIEW DATE:                         August 2010

                        COMMUNICATION
HARD COPY ISSUED TO STAFF         DATE: August 2008
RECORDED ON CORPORATE             DATE: August 2008
SPREADSHEET
POSTED ON INTRANET                DATE: August 2008




POLICY DATE: 8/8/2008                                REVIEW DATE: August 2010

VERSION: 1               POLICY NO: GPCT/CP 40       AUTHOR: Joanna Griffin
                                 Page 6 of 8
                                   Appendix One

      Letter to be sent to GP when a patient has been signed off work by their
      physiotherapist.



                                            Individual Department Address to be added

                                                                         Date to be added

      Dear Dr. (Insert Name of GP)

      This patient attended a physiotherapy assessment on (insert date) and has
      been issued with a medical certificate.

      Name:

      Address:

      Diagnosis:

      It is anticipated that the patient will return to work on (insert date)

      This patient has a further appointment in physiotherapy on (insert date) and
      their progress will be monitored.

      If you have any further queries, please do not hesitate to contact the
      physiotherapy department.

      Yours sincerely

      (Sign and Print Name)

      Physiotherapist (Insert Name of Department)




POLICY DATE: 8/8/2008                                       REVIEW DATE: August 2010

VERSION: 1                    POLICY NO: GPCT/CP 40          AUTHOR: Joanna Griffin
                                      Page 7 of 8
                                 Appendix Two

      Letter to be sent to GP when a patient has been signed back to work by their
      physiotherapist.



                                          Individual Department Address to be added

                                                                     Date to be added

      Dear Dr. (Insert Name of GP)

      This patient attended a physiotherapy assessment on (insert date) and has
      been issued with a medical certificate.

      Name:

      Address:

      Diagnosis:

      This patient is now fit to work and has been signed back to work, to start on
      (insert date).

      If you have any further queries, please do not hesitate to contact the
      physiotherapy department.

      Yours sincerely

      (Sign and Print Name)

      Physiotherapist (Insert Name of Department)




POLICY DATE: 8/8/2008                                    REVIEW DATE: August 2010

VERSION: 1                  POLICY NO: GPCT/CP 40        AUTHOR: Joanna Griffin
                                    Page 8 of 8

								
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