Health related Benefits,the GPs role

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Health related Benefits,the GPs role

• and the forms we have to fill in

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This subject relates to several non clinical areas

• Ethics
• Professional responsibility
• Practice organisation and policies
• Employment law
• Social policy
• How government bodies and agencies work

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Main Health Related Benefits which may need
evidence from GP

• Not fit to work - Statutory Sick Pay, Incapacity
  Benefit
• Need help with personal care or mobility -
  Disability Living Allowance, Attendance Allowance
• Maternity Benefits

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Where do Benefits come from?

• Managed by Department of Work and Pensions (DWP)
  (formerly Benefits Agency, formerly Department of
  Social Security (DSS), formerly Department of
  Health and Social Security (DHSS))
• Paid via JobCentre Plus offices

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Forms for short term sickness

• SC2 - patient completes, for 1st 7 days
• Med 3 - after 7 days, when youve just seen the
  patient
• Med 5 - when someone else has seen the patient,
  or you saw them but too long ago to do Med 3
• NB Employers dont always know or keep to the
  rules so may ask for certificate before 7 days

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Statutory Sick Pay

• Paid via employer to people who are in work, even
  if only just started work
• Rate (Oct 07) is 72.55 per week
• Paid from 4th day of sickness, lasts up to 28
  weeks
• Employer may have sick pay scheme to supplement
  SSP

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Incapacity Benefit

• Not eligible for SSP (unemployed, self employed,
  SSP expired)
• Paid adequate NI contributions
• Short-term (under 28w) if unable to do your
  normal job
• Long term if unable to do any kind of work
• Rates (Oct 07) 61.35 for 1st 28w, 72.55 betw
  28 and 52w 81.35 after than

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Forms for Incapacity Benefit

• Short term Med 3
• At change to long term - patient completes
  questionnaire and asks GP for Med 4
• To assess long term IB, at start and from time to
  time, the DWP
• Sends GP form IB 113 to complete (no fee payable)
• Asks patient to attend for medical examination
  (done by an outside agency) to assess incapacity
  for ALL WORK

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Disability Living Allowance

• For people under 65 with long term conditions
• Care component - for personal care
• Lower rate 17.10 (some help needed)
• Middle rate 43.25 (substantial help, either day
  or night)
• Higher rate 64.50 (substantial help, 24h)
• Mobility component -
• Lower rate 17.10 (supervision/guidance on
  unfamiliar routes)
• Higher rate 45 (virtually unable to walk)
• (All rates are from Oct 07)

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Attendance Allowance

• For people over 65
• Same criteria as care component of DLA
• 2 rates (Oct 07)
• Lower (lt24h) 43.25
• Higher (24h) 64.50
• No mobililty component - over 65s cant apply for
  mobility but if awarded mobility component of
  DLA, can go on receiving after 65 if they satisfy
  criteria

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Forms for DLA and Attendance Allowance

• Patient completes v long form which includes one
  page for person most involved with your care
• DWP may send GP form DBD 370 (different ones for
  diff conditions) - fee payable for completing
• Fast track DLA application - GP completes DS1500
  for patients with prognosis lt6m

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Patients appealing when Benefits disallowed

• Refer them to an advice agency (e g DIAL for
  physical disability, MIND for mental disability)
• You may be asked to provide support letter on
  goodwill basis
• Advice agency can tell you what information will
  tick the boxes

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Maternity benefits (Apr 07)

• Statutory Maternity Pay - paid for 39w from DWP
  via employer, 90 of wage for 6w, then 112.75 or
  90 wage, whichever is less, for 33w - start 11w
  before EDD or any time up to birth. 52w off work
  allowed, last 13w unpaid.
• Maternity Allowance - same rates as SMP for those
  who dont qualify for it
• Sure Start Maternity Grant - lump sum 500 for
  women on low incomes
• GP or midwife completes form Mat B1 from 20w
  before EDD

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Some other Benefits

• Income support - if people havent paid NI
  contributions so cant get other benefits but
  havent enough to live on
• Job Seekers Allowance
• Working Tax Credits - for people who earn very
  little
• Carers allowance - for people of working age who
  spend time caring for someone who gets DLA or
  Attendance Allowance

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Some other certificates we are asked for

• Private sick note - e g for school, Court,
  Probation, employer who wont accept SC2 for 1st
  7 days
• Evidence of unfitness to travel (on insurance
  form)
• Evidence of fitness for gym, sports, gap year
  travel etc
• Most practices have a scale of fees for these

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Sources of information

• DWP website
• Patient.co.uk
• Many Benefits advice sites for patients