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Advice for GPs on Military Veterans attending with concerns on use of Mefloquine

Please find attached information from NHS England relating to Mefloquine, an anti-malarial which was prescribed to military personnel who were operating or training in Sub-Saharan Africa (not in Iraq or Afghanistan, with few exceptions) over the past 20 years. The attached documents provide information on what steps should be taken by practices if a patient presents with symptoms relating to the side-effects of Mefloquine.

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General Practice Forward View

Following the publication of the GP Forward View in May, NHS England has recently published further details about how it is going to invest in general practice. This includes details of the indemnity scheme, practice resilience programme, receptionist training and more.

Department for Work & Pensions GP Bulletin

Fit for Work

What is Fit for Work?

  • A supportive assessment of health and work and general health and work advice
  • You can refer your patient for an assessment if they are employed and have been off work sick for four weeks or more, or you think they are likely to be
  • A health professional will talk to your patient about their health, assess their circumstances and create a plan with their agreement providing recommendations to help them back into work (this is a Return to Work Plan).
  • Fit for Work will provide a thorough assessment of the physical and mental health problems, attitudes and beliefs and the social circumstances acting as obstacles and enablers to return to work.
  • Your patient can supply the Return to Work Plan to their employer as a statement of fitness for work, removing the need for you to supply a fit note once your patient has been referred to the service
  • You can also use and signpost your patients to the advice line which is accessible to all the public whether they are in or out of employment

How can Fit for Work help you and your patients?

Fit for Work provides:

  • Assistance in managing your patient’s understanding about the impact of their condition on their fitness for work
  • Support in managing difficult return to work consultations
  • Help which improves your patient’s chance of keeping their job
  • A Return to Work Plan with recommendations to support you, your patient and their employer in helping them to return to work
  • Removal of the need to issue repeat fit notes where a Return to Work Plan is in place

For further information on how to access Fit for Work please visit:

England & Wales: www.fitforwork.org

Scotland: www.fitforworkscotland.scot

Employment and Support Allowance

From 30th March 2015, claimants who were found fit for work on their previous claim for Employment and Support Allowance (ESA) have not been paid ESA on a repeat claim, unless they have developed a new condition or an existing condition has significantly worsened. GPs will be asked to provide fit notes in the normal way for these ESA claims

If, on the repeat claim, the claimant is found fit for work for a second consecutive time, no ESA will be paid whilst the claimant is awaiting the outcome of the appeal.

Jobseeker’s Allowance

From 30 March 2015, unemployed claimants who develop a health condition have been able to continue to claim Jobseeker’s Allowance on a voluntary basis for up to 13 weeks rather than having to claim ESA instead.

GPs will have to provide fit notes to support these claims in the same way as for ESA claims.

Work Capability Assessments – substantial risk

The WCA is a functional assessment and the majority of claimants should be identified by the functional activities. However, the assessment recognises that there will be small number of claimants who have an adequate level of function but for whom the decision that they must seek work or carry out work-related activity would be detrimental.

The relevant regulations refer to “substantial risk” to mental or physical health which has been defined by the courts as a risk “that cannot sensibly be ignored having regard to the nature and gravity of the feared harm in the particular case”. The substantial risk can apply to either the claimant or a third party, for example if there is a risk of injury to another person as a result of violent behaviour by the claimant.

If a claimant is found fit for work and chooses to apply for Jobseeker’s Allowance, the claimant will usually be expected to be available for work, to search for work and to accept suitable employment (this may involve an employer making reasonable adjustments under the Equality Act).

If a claimant qualifies for ESA and is allocated to the work-related activity group they will be expected to carry out any of a range of activities supervised by DWP, or a third party organisation, that assist the claimant to move closer towards the world of work. This is work preparation activity intended to give the claimant the best possible prospects of moving into work at a point when they are able.

This activity could include completing online tasks (such as a self-assessment or a diary of daily activities), phone or face-to-face discussions to discuss goals and agree specific activities, taking part in courses to improve skills or confidence, or continuing to engage in activity already taking place.

The requirement for work-related activity is different for each ESA claimant as it must be appropriate and personal to the individual. Claimants must not be asked by DWP to do anything that is unrealistic or could put their health at risk, or be required to undertake work-related activity that includes applying for a job or undertaking work as an employee or otherwise.

Evidence from a GP stating that, in their opinion, there is a substantial risk that their patient’s physical or mental health would deteriorate if they are found fit for work or for carrying out work related activity will be taken into consideration, but the decision whether to apply the regulations will be taken by the departmental decision maker.

Access to Work Mental Health Support Services

Please consider signposting patients with mental health problems to Remploy.

They provide a service designed to support people experiencing depression, anxiety, stress or other mental health issues which are affecting their work.

Remploy delivers this service on behalf of the Access to Work Programme and can talk to patients about the help they need and what support Remploy can provide.

http://www.remploy.co.uk/info/20137/partners_and_programmes/227/workplace_mental_health_support_service

DS1500 for terminally ill patients

Patients who are terminally ill are “fast tracked” when claiming ESA and Personal Independence Payment.  It is therefore very important to issue a DS1500 to patients who are terminally ill without delay. The form can be given to the patient or their representative or returned direct to DWP via NHS net.

In England and Scotland DS1500 and the fee form, may be completed electronically and submitted to DWP by using the NHSmail system. DWP can provide you with an electronic PDF version of the DS1500 and DS1500 fee form. You will need to send the following information from your current NHS.net e-mail address:

  • Your NHS.net e-mail address or addresses
  • Your surgery/hospital/office postal address and telephone number
  • A list of medical professionals using the same NHS.net e-mail address who complete the DS1500 and/or DS1500 fee form
  • Please advise where you require the DS1500 and DS1500 fee form, or the DS1500 ONLY
  • Send these details to:- PIP.E-DS1500@DWP.GSI.GOV.UK

Do not encrypt any part of the e-mail. GSI.GOV.UK is a secure e-mail domain, as identified by the NHS. Any e-mail from a non-NHS.net account will be automatically deleted.

Attached is a link to further information which you may find helpful: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/418831/medical-reports-completion-guidance.pdf

Fit note – updated guidance for GPs and myth busting with the CQC

There was an update to the GP version of the fit note guidance ‘Getting the most out of the fit note’ last year to reflect the GP’s role in referring eligible patients to Fit for Work.  This guidance, along with versions for employers and patients, can be found at https://www.gov.uk/government/publications/fit-note-guidance-for-gps.  CPD hours can be claimed for reading the guide and considering its implications.

Professor Nigel Sparrow OBE, the CQC’s Senior National GP Adviser, produced an article on fit note which was published on the CQC website last summer.  The article focused on how fit notes are used in GP practices to provide fitness for work advice and help return to work.  Common fit note misconceptions are also addressed. The article can be found here http://www.cqc.org.uk/content/nigels-surgery-40-gp-fit-note

Changes to Medical Records

As you’ll be aware, the PSU is now part of Primary Care Support England (PCSE) run by Capita on behalf of NHS England and you will have heard about some of the planned changes to services, including a change in how medical records are moved around.

In advance of this change, there will be a national record movement trial starting on February 8th 2016 and you will be receiving information about this directly from CitySprint.

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