Managing sickness in school children
Derby & Derbyshire LMC
With thanks to Cambridgeshire LMC
We are aware that most practices will at some point have received requests to provide sick notes, medical certificates or letters for a young patient to verify their absence from school or to excuse them from certain activities. This guidance seeks to clarify the obligations on GPs to provide such certificates and to help practices explain the situation to parents and schools.
Parents or schools requesting certification for absences from school
The headline is that GPs have no legal or contractual obligation to provide sick notes, medical certificates or letters for school children and if under specific circumstances they decide to do so then they are entitled to charge a fee for undertaking this work.
In most cases an explanation from the parents of an absence from school is sufficient for the purposes of the school.
While practices are entitled to charge for producing such certificates requested by schools, these certificates are rarely appropriate, and should not be requested in the first place. Schools, and Education Welfare Officers, should not seek routine confirmation of a medical reason for absence from GPs, and in most circumstances the GP will have no more information than that provided by the parents/carers.
Refusing to provide a medical certificate – the facts
• The provision of medical certificates for school children is not part of a GP’s responsibility or contractual obligations.
• Refusing to provide this certification is in accord with the current aims to reduce GP paperwork and preserve valuable GP time for clinical care
• GPs cannot issue ‘sick notes’ or fit notes to school children because they are designed for social security purposes
• GPs can refuse to issue private letters, be that certifying fact or giving an opinion, but if they choose to comply with the request, they may charge a reasonable fee
Another request that practices often receive is in relation to a pupil missing an exam as a result of illness. As a result of these requests, the GPC wrote to Ofqual and they confirmed that awarding organisations make no requirement for pupils to obtain a medical certificate in support of an application for special consideration and that medical proof is not required. A copy of this letter is available here.
MANAGING ILLNESS AND MEDICATION
The obligations of schools in managing illnesses of pupils
On 1 September 2014, a new duty came into force for governing bodies to make arrangements to support pupils at school with medical conditions.
The Department for Education produced guidance for schools entitled, ‘Supporting pupils at school with medical conditions’ which states that governing bodies:
• Must ensure that arrangements are in place in schools to support pupils at school with medical conditions
• Should ensure that all schools develop a policy for supporting pupils with medical conditions that is reviewed regularly and is readily accessible to parents and school staff
• Should ensure that the school’s policy covers the role of individual healthcare plans, and who is responsible for their development, in supporting pupils at school with medical conditions
• Should ensure that the school’s policy sets out clearly how staff will be supported in carrying out their role to support pupils with medical conditions, and how this will be reviewed.
• Must ensure that no child under 16 should be given prescription or non-prescription medicines without their parent’s written consent except in exceptional circumstances
The DfE has also produced various templates to help schools create individual health care plans and help them obtain written parental agreement to administer medicines to their child.
Prescribing non-prescription (over the counter) medication in nurseries and schools
The BMA have provided advice on ‘Prescribing non-prescription (over the counter) medication in nurseries and schools’. This re-iterates that non-prescription medication can be administered where there is parents' prior written consent. This guidance applies to nurseries and schools and states that it is appropriate for OTC medicines to be administered by a member of staff in the nursery or school, or self-administered by the pupil during school hours, following written permission by the parents, as they consider necessary.
The LMC is aware that practices have received requests from parents to prescribe over the counter mediations for their very young children because nurseries say they need to have ‘child specific’ bottles with prescription labels on them. It is a misuse of GP time to take up an appointment just to acquire a prescription for a medicine wholly to satisfy the needs of a nursery/school. The revised 'The Early Years Foundation Stage Statutory Framework’ which governs the standards of institutions looking after and educating children, allows them to give over-the-counter medication such as pain and fever relief or teething gel. However, they must get written permission beforehand from parents and must follow the same recording procedures as those for prescribed medication.
This view is reinforced by Ofsted which has produced a very useful factsheet which confirms that written permission from parents to administer over the counter medications is sufficient:
The Department for Education guidance provides guidance on prescription medication in schools and nurseries: ‘Prescription medicines should only be taken to a setting when this is essential and settings should only accept medicines that have been prescribed by a doctor, dentist, nurse or pharmacist.'
Education Welfare Officers (EWOs)
The role of an Education Welfare Officer is to support schools to work with parents and children of statutory school age to improve regular school attendance. Schools will make a referral when non-school attendance reaches the threshold of 90% or below over the previous 6 weeks, mostly unauthorised.
EWOs are employed by the local authority and part of their role is to prepare the case if an authority is considering taking legal action against parents or guardians for failing to send children to school.
There is no obligation on practices to provide information to EWOs and no information should be shared without the consent of the parents unless there is an immediate safeguarding concern.
GPs should always consider the possibility that a safeguarding issue exists and take appropriate action when necessary.
Public Health England has published ‘Guidance on Infection Control in Schools and other Childcare Settings’ that is designed to prevent the spread of infections such as rashes and skin infections, diarrhoea and vomiting, and respiratory infections. This is a useful reference document in the event that practices receive enquiries from schools that suddenly find themselves facing such a situation.