As winter arrives, many GPs will receive requests to certify patients for fitness to participate in winter activities. Given the potential for injuries from skiing, snowboarding, or even more extreme winter sports, GPs should bear in mind that signing without due consideration could leave them open to a complaint or claim for a large compensation amount should the patient come to harm.
In this article, we remind GPs of the key questions to consider when asked to certify ‘fit to participate’ forms.
1. Is your indemnity cover adequate?
Before signing any ‘fit to participate’ forms, a GP must ensure that they have adequate indemnity insurance. Since this work is outside the scope of the NHS terms and conditions, GPs will not be covered by the Clinical Negligence Scheme for General Practice and must make their own arrangements for the relevant insurance.
Please contact Medical Defense Society today for advice about your level of cover.
2. What fitness level is required?
A patient may pressure their GP to sign a ‘fit to participate’ form quickly, especially if they are making last-minute plans for the activity. But doing this without full consideration of the facts and potential risks could have dire medico-legal consequences.
The GP should first ask the patient for details of the activity in question and check what level of fitness is required. They may need to refer to an expert in sports medicine if they do not have sufficient knowledge of the activity.
Having this discussion with the patient is essential before providing certification of fitness. It may also prompt the patient to consider what they need to do to be well-prepared for the activity.
3. What does the patient’s medical history show?
Careful assessment of the patient’s notes is required to see whether pre-existing conditions or recent medical events could impact the patient’s fitness to participate in a winter sport. Examination of the patient and additional investigations may also be needed.
Since the General Medical Council expects doctors to recognise and work within the limits of their competence, GPs must consider whether they have enough information to certify the patient’s fitness. If not, they should ask for advice or refer the patient to a colleague with relevant expertise. For example, it might be appropriate for a patient who recently underwent surgery to consult with their surgeon, or for a patient with a chronic condition to see a specialist in that field.
GPs should also direct any patient with relevant medical history to talk to their travel and/or insurance providers for further advice.
If you are in doubt about signing a ‘fit to participate’ form for any reason, please seek assistance at Medical Defense Society.
4. Is the form worded responsibly?
It is important to remember that GPs cannot guarantee the future fitness of any patient for an activity or for the duration of a holiday, even after a full examination and medical history. Rather than signing that a patient ‘is fit to participate’, GPs should use wording that reflects the facts and the limits of their knowledge.
The British Medical Association guidance on medico-legal aspects of providing certificates advises using wording along the lines of: “Based on information available in the medical notes, the patient appears to be fit to travel.”
To accurately reflect the facts, GPs should also note any relevant medical information on the form, such as the severity and stability of a pre-existing condition.
5. Does the patient understand and give their consent?
Discussing the form with the patient, and providing them with a copy, is important to make sure that they understand the wording and why it was chosen. An informed patient may be less likely to make a complaint or claim if they do have an injury.
Furthermore, the patient’s informed consent must be obtained before disclosing any confidential medical information to a third party through a ‘fit to participate’ form.
As always, these discussions should be accurately documented. This will support the GP in justifying their actions if they later become subject to legal action.
Please contact us at Medical Defense Society immediately if any patient is injured when participating in an activity for which you have certified their fitness.
Additional advice on ‘fit to fly’ forms
Many people will be travelling abroad for winter sports and may also need ‘fit to fly’ forms. Further advice on this is available:
- UK Civil Aviation Authority: Assessing fitness to fly, Guidance for health professionals.
- International Air Transport Association (IATA): IATA Medical Manual.
Please get in touch at Medical Defense Society to review your indemnity cover and for advice regarding any ‘fit to’ forms.