Benefits
There is of course a multitude of benefits enjoyed by UK citizens, and these have got more generous, but more complex under the current government. It is impossible to keep up to date on all of these, and (unless you are interested in train spotting), it is unlikely to prove a stimulating exercise.
I have confined myself to:
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Incapacity for work:
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Statutory sick pay (SSP)
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Incapacity benefit.
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Disability living allowance
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Attendance allowance
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Carers' allowance.
If you are interested in other benefits that your patients may be entitled to I would recommend the Disability rights handbook 28th Ed. 2003-4, obtainable from the disability alliance at for £14.00 post free. Please note that my summary of the subject is much abbreviated and only skims across each. The rules for each run to many pages of dense impenetrable prose and I have left out a lot of detail.
Incapacity for work.
General practitioners play an important role in certifying patients as fit or not fit for work. Understanding the different forms used is tedious, but essential to your day-to-day work as a GP. It also makes a very good SA/MRCGP MCQ question!
Be familiar with self certification (SC1 and 2) – used for 7 days of sickness or less, the ubiquitous Med 3 and Med 5, and some of the less common forms such as the Med 4, Med 6 and RM7 (also known to us cynics as a “Dob 1”).
Question for group work.
What is an RM7 (ask your trainer if you aren’t sure) Have you ever used, or been tempted to use one? What were the issues? What are the ethical implications?
Guidance on the use of each of these can be found on the back pages of sick note pads and on the DSS website.
Statutory sick pay (SSP)
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If you are employed (and earning >£77pw) you can get this for up to 28 weeks.
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If you are self-employed (e.g. a GP principal) forget it, but you may get incapacity benefit instead.
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After 7 days of illness, a patient is required to get a sick note (usually a med 3) from their doctor. You as an NHS GP are obliged to give them one (if you consider them unfit for work), and cannot charge for doing so. You are certifying that they are incapable of performing their usual work. (i.e. if they are brickie with a broken ankle, you may consider that they could do a typing job, but they can still be signed off with a Med 3).
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SSP is currently £64.35 pw. (unemployment benefit – now called “job-seekers allowance” is currently £54.65 for those over 25 and requires them to be actively seeking work, hence patients without a job usually prefer to be off sick).
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Employees may be entitled to contractual sickness pay as well (have a look at your GPR contract for an example).
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Most patients are paid SSP via their employer.
Questions for group work.
Have you ever been asked by a patient for a sick note for all or part of the first 7d of an illness? What is your practice policy on such requests? Ask your trainer about this.
Suppose that you are unlucky enough to be damaged in a freak hang-gliding accident, and are unable to work until the orthopods have patched you together. This is likely to take 14-18 months. What income would you receive? Could you survive (the financial hit, not the orthopaedic surgeon…!)
Incapacity Benefit (IB).
Is paid to those unable to work because of illness or disability. It is dependent on having paid sufficient NI contributions (unless you are too young to have been able to make them).
- It is payable for those unable to work for >28w, and those not entitled to SSP (eg the self employed).
- For the first 28w of an illness (for those unable to claim SSP) it is assessed on the basis of being unable to perform one’s usual occupation (see above).
- After 28w (and this includes those moving from SSP to IB) it is dependent on a “personal capacity assessment”. Patients are asked to complete a questionnaire, and in most cases submit themselves for an examination.
- Such assessments are subcontracted by the DWP to a private company (easy money if you find GP land a bit stressful!) It is a functional assessment (ie based on what you can/cant do, rather than your pathology) and is done on a points basis. Eg “cannot turn the pages of a book with either hand” is 15 points, “needs encouragement to get up and dress” is 2 points. (only 2 points for me then…) 15 points are needed to qualify.
- Forms: Patients applying for IB need a Med 4 completing by their doctor (you will find these in your practice); basically a slightly more detailed Med 3. The DWP doctor will send you a copy of his/her decision on an IB85.
- Patients have the right to appeal for 1m after the medical decision is taken.
- IB varies according to how long it is claimed. For the first 28w it is currently £54.40 pw, £64.35 pw for 6-12m, and £72.15 thereafter. It is increased if the recipient has dependent adults (but not children) and generally reduced if in receipt of either a pension or other benefits.
Disability Living Allowance (DLA)
Is a benefit for adults and children with disabilities. It is tax free, not means tested and not dependent on previous NI contributions. It is made of 2 components; a care component (for help with personal care needs, and paid at 3 different levels) and a mobility component (for help with walking difficulties and paid at 2 different levels).
- Children can get DLA as well as adults.
- Those over 65 can get it, but generally only if they were receiving it before their 65th birthday.
- The care component is currently £15.50-£57.20pw, and the mobility £15.15-£39.95 pw.
- Patients are asked to fill a series of long and complex forms, again focusing on functional capacity. They often bring it along to their GP or DN for help. It includes the notorious “cooking test” (ie if you cant cook a main course). Passing this entitles a patient to the lowest level of benefit. Many male GPR’s should consider applying on this basis…
- The DWP often write for a report from the patient’s GP, and can insist on a medical.
Terminal illness.
This is a special case, and something GP’s need to be familiar with. Patients automatically qualify for the highest rate of DLA (if <65) or AA (if >65) if their death can be “reasonably expected” during the next 6 months. This is euphemistically known as “under special rules”. Your surgery will have a supply of DS1500 forms, which need to be completed by a GP or hospice doctor in such circumstances. Payment is expedited in such circumstances.
Attendance Allowance (AA).
Is a tax-free benefit for those over 65 years of age, who are physically or mentally disabled, and need help with personal care or need supervision to remain safe. The patient does not actually need to be receiving the care…
- The rules are virtually identical to DLA, and involve the same bureaucracy.
- It is currently £38.30-£57.20.
- There is no cooking test!
- There is no mobility element (on the basis that older people don’t need to move around??!)
- Patients on DLA usually move to AA at 65 (unless it is financially disadvantageous to do so – ie are on the very highest rates of of DLA – usually including a mobility component)
Carers Allowance (CA)
Is a benefit paid to those who spend >35hrs per week caring for a severely disabled person in receipt of DLA or AA. Recipients don’t have to be related or even living with the disabled person. It is paid on top of DLA or AA.
It is means tested (you don’t get it if you are earning >£77pw, or in receipt of several other benefits or a state pension for example).
Other Benefits.
There are huge numbers of other potential benefits for patients. Most are (perhaps not unsurprisingly) never claimed by those entitled to them… Be aware of: Maternity and disabled children benefits, death benefits and special compensation schemes (for industrial injuries, vaccine damage etc).
Questions for groupwork:
Huge amounts of welfare benefits remain unclaimed. Why? What is your role in advising patients about the benefits to which they are entitled? Where can you send them for help?
A patient with “ME” asks you to support them in claiming for DLA. What are the implications of this request? What if you suspect that they are being “economical with the truth” on the forms you are asked to sign…?
Written by: Bill Irish
Last updated: 29 August 2007