Fit Note, its purpose and the GP's role.

The request was successful.

Dear Department for Work and Pensions,

In a response to recent Internal Review of an FoI request you said:

VTR IR127
Questions 1 and 2: We hold no recorded information on this. You have been informed on multiple occasions previously that GPs are trained to diagnose and treat medical conditions rather than make an assessment on a person's capability for work according to legislation; the healthcare professionals that provide advice to the Department however, are trained to make that assessment.

On government website https://www.gov.uk/government/organisati...
the following appears:

The fit note was introduced to replace the old sick note on 6 April 2010. Doctors issue fit notes to individuals to provide evidence of the advice the doctor has given about the individual’s fitness for work.
The fit note allows doctors to advise that individuals “may be fit for work” taking into account the doctor’s advice, or that they are “not fit for work”.
Doctors use fit notes to record details of the functional effects of their patient’s condition so that individuals and employers can consider ways to help the individual return to work.
(please pay particular attention to the middle paragraph)

Q1 Please provide information / documentation regarding what weight a DM must or can place on a "Fit Note" when making a FFW decision
Q2 Please can you confirm if the DWP takes the stance adopted in your IR response quoted above or if you are in agreement with the statement on www.gov quoted above - I ask this as from my standpoint it appears the two quotes above are mutually exclusive.

In regard to Q2 I understand that FoI is not generally to confirm or deny an individuals opinion but I am asking for confirmation of the DWP policy on this matter.

Q3 When an ESA claimant is in the assessment phase he must have a valid "Fit Note" - if it expires his benefit is suspended / cancelled (please correct me if I am wrong on this). Should a GP refuse to give a "Fit Note" or the "Fit Note" issued states the patient is FFW then do DWP accept this and cancel an ESA claim (this is while it is in assessment phase)?

Q4 If the answer to Q3 is yes can you provide documentation and / or legislation to show that DWP must accept a GP's opinion when they state a patient is FFW but that they do not have to accept the opinion of a (potentially the same) GP when they state a patient (claimant / customer whichever designation DWP currently use) is not FFW.

Please note that all of the above is in regard to a person being or not being Fit For Work - I am not talking about being entitled to or awarded ESA

Yours faithfully,

Paul Malpas

DWP freedom-of-information-requests, Department for Work and Pensions

This is an automated confirmation that your request for information has
been accepted by the DWP FoI mailbox.

By the next working day your request will be forwarded to the relevant
information owner within the Department who will respond to you direct. 

If your email is a Freedom of Information request you can normally
expect a response within 20 working days.

Should you have any further queries in connection with this request do
please contact us.

For further information on the Freedom of Information Act within DWP
please click on the link below.

[1]http://www.dwp.gov.uk/freedom-of-informa...

show quoted sections

References

Visible links
1. http://www.dwp.gov.uk/freedom-of-informa...

Paul Malpas left an annotation ()

The DWP regularly and emphatically claim that GPs can only diagnose and treat illness and they are somehow unable to assess the "functional effects" of illness, disease or conditions - odd how the governments own website describes one of the purposes of the "fit note" as allowing a GP to note the functional effects and indeed DWP insist on this fit note being up to date during the assessment phase of ESA in order to (and I quote) "show limited capability for work".
They have this wonderful scenario where while you are being assessed for work capability you have to produce a recognised document (fit note) to show that you ALREADY HAVE limited capability for work - and if this fit note lapses or becomes out-of-date they will consider you fit for work and cancel your claim / suspend payments, however if you "fail" your face to face medical then the DWP no longer accepts the validity of the "fit note" (which, if we remember, they have been relying upon for the last 13 weeks or more to SHOW that you have limited capability for work)

Paul Malpas left an annotation ()

DWP - ESA Stakeholder Information Pack (Nov 2012):

"While they are in the assessment phase, claimants are required to provide up-to-date medical evidence known as the ‘Statement of fitness for work’ (Fit note) showing that they have limited capability for work for any claim longer than seven days. For the first seven days claimants can self-certify."

Unless I'm missing something this seems to indicate that "fit note" is medical evidence showing limited capability for work.

J Newman left an annotation ()

Paul,

Sorry for the length of this but you may find it helpful.

DWP suggests that Decision Makers expertly apply (precise) weightings to each piece of evidence they have and scientifically calculate the result and a while ago I tried to find out quite how it operated, particularly as they also said that each case was considered individually – by any standards, a task that would require some considerable training and expertise and probably some kind of medical knowledge. Not so. What the DM does is “weigh up” the evidence, which is something far less scientific and therefore subjective (which in itself explains a lot).

As you have probably heard it is DWP’s intention to largely take on the ‘fit note’ job too, even for people in work not receiving ESA – they believe they can drive down the days employers loose through sickness using the same techniques as they are using now I assume.

It is in DWP’s interests to decouple FFW from ESA payments (at least for the time being) to provide demarcation between what a HCP does and what a DM does and a thus a clear line between private & public sector. It also cunningly allows the people who meet claimants (HCPs) and may incur their wrath to hide behind DWP. By the same token the DM never has to meet the people who are affected by the decision and can likewise hide - so much for accountability!!!

Fyi, existing legislation does allow DWP to outsource the ESA decision making process too, but they have chosen not to take this up at least so far. Before long it seems there will be no public sector at all.

This all comes from other FoI responses.

adrian todd (Account suspended) left an annotation ()

This used to be an amazing FREEDOM OF INFORMATION site...

GEOFF REYNOLDS was doing a marvellous job, exposing the Dwps policy against the disabled.......

Im sorry GANESH, BUT ITS TIME YOU PACKED YOUR BAGS AND LEFT!!!!

You must be a " BLESSING IN DISGUISE" to the DWP, all their christmas's came at once!!!!

Link to this

DWP LS FOI, Department for Work and Pensions

1 Attachment

Dear Mr Malpas

Please find attached response to your recent FOI request.

<<Response 2728.pdf>>

Regards

DWP Central FOI Team

show quoted sections

Dear DWP LS FOI,

Thank you for your response.

I find your response to Q2 confusing and would request some clarification.

You stated:

Our IR response is correct. GPs are not trained to make an assessment on a person's
capability for work according to legislation. However they are able to provide "simple fitness
for work advice to aid their patient’s recovery and help them return to work."

I note that you have used the words "according to legislation" in bold presumably to add some form of emphasis. I was under the impression that the legislation defined a person's capability for work in terms of set descriptors and that these were specifically related to the "functional effects" of an illness or disability - you clearly stated this in other FoI responses and simultaneously claimed that GPs are not qualified to determine "functional effects" but merely to diagnose and treat.

The quote from https://www.gov.uk/government/organisati...
clearly states that Doctors use the "fit note" to record FUNCTIONAL EFFECTS. This again leads me to the conclusion that the quote from the website is contrary to the FoI response quoted. Can you clarify what it is that is different from an Atos HCP recording the funstional effects as compared to a GP (who may have treated the claimant for years) recording the functional effects of the illness / disability. Can you also clarify why it is that an Atos HCP needs to know what is required "according to legislation" when their job is supposedly to produce a report on the functional effects of a person's illness / disability and for the DM to take that report and apply it to the legislation.

Yours sincerely,

Paul Malpas

Dear DWP LS FOI,

Can you please send an acknowledgement of receipt of my request for clarification on 2nd July 2013.

Thank you

Yours sincerely,

Paul Malpas

DWP LS FOI, Department for Work and Pensions

1 Attachment

Dear Mr Malpas

Please find attached acknowledgement for your recent request for an
Internal Review as requested.

<<Acknowledgement IR 552.pdf>>

Regards

DWP Central FOI Team

show quoted sections

DWP LS FOI, Department for Work and Pensions

1 Attachment

Dear Mr Malpas

Please find attached response to your recent internal Review request.

<<Response IR 552.pdf>>

Regards

DWP Central FOI Team

show quoted sections

Dear DWP LS FOI,

Please note that contrary to what your IR reply says I did not request an Internal Review - however I would now like to make a request for an internal in relation to the content of your reponse.

I am a little confused, this is the second time I have asked the DWP for some clarification on an answer received and have somehow triggered an Internal Review.
There was really no need for an IR in either instance - indeed a request for clarification would be best met by the person who made the original reponse.
I did note that in the reponse to IR552 I was also given a reminder that FoI is not about clarifying information supplied - I would beg to differ on this point - unless the informtion is completely unambigous e.g. a table of raw data showing actual facts and figures, then clarification may well be needed as in the case of the response to VTR2728/13 which contained statements authored for the response and clearly not the raw data actually held by the department e.g. the statement....
"GPs are not trained to make an assessment on a person's capability for work according to legislation. However they are able to provide "simple fitness for work advice to aid their patient’s recovery and help them return to work."
... is clearly not raw data held by the DWP (if it is then could you tell in what document(s) it is found) I asked for clarification because one government website says that GPs can make assessments on the functional effects of illness/disability in terms of a persons ability to work and DWP were saying in their reponse that GPs are able to provide simple fitness for work advice - at the risk of sounding facetious stating that a GP can provide a lollipop to a child after their injections does not mean they can't do other things. Basically if you provide unclear answers, some of which are far more subjective than objective then you can expect to be asked for clarification and should not be reminding people in a condescending manner of what the FoI is or is not for.

Yours sincerely,

Paul Malpas

DWP LS FOI, Department for Work and Pensions

1 Attachment

Dear Mr Malpas
 
Please find attached response to your recent request IR 586.
 
 
 
Regards
 
DWP Central FOI Team
 
 

show quoted sections