ADVICE FOR SCHOOLS
Can a school give a child an over-the-counter (OTC) medicine?
Can a school give a child a prescribed medicine? Does it need an additional GP letter of authorisation?
Can a school or parent ask a GP to provide sick notes or certificates of absence for a child?
Can a GP verify that my child is safe to return to sports following a head (or other) injury?
Who should provide return to play assessments?
It is a common request from schools via parents that the GP write a letter to authorise the school to administer a medicine for a child, or to prescribe an over-the-counter medicine in order to provide GP approval and authorisation. Schools or parents sometimes request a letter from their GP explaining a child’s absence, give permission not to be involved in certain school activities, or return to sports following an injury (such as a head injury).
None of these, however, are normally required. The use of a GP appointment solely to satisfy the needs of a nursery or school is a misuse of the GP service as it restricts access for other patients.
MEDICINES IN SCHOOLS
1. Can a school give a child an over-the-counter (OTC) medicine?
The MHRA (Medicines and Healthcare products Regulatory Agency) licenses medicines and classifies them as over-the-counter, based on their safety profiles. A medicine being made available over the counter enables access to those medicines without a GP. This applies in the educational setting as well as in the home.
GPs would therefore not normally prescribe simple OTC medications for any patient, including children, and a doctor’s prescription should not therefore be required before administering such medicines to a child.
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.
However, schools should not give pupils under 16yo a medicine containing aspirin, unless prescribed by a doctor.
Medication should never be administered without first checking maximum dosages and when the previous dose was taken. Parents should be informed when the school give a child a medicine, and how much was given.
2. Can a school give a child a prescribed medicine? Does it need an additional GP letter of authorisation?
Giving a child a medicine that has been prescribed for them does not normally require an additional letter from the GP. Rather, the statutory guidance for schools says that written permission for that particular medicine should be obtained from the child’s parent and/or carer.
Where a medicine has been recommended for a child to take at school, the instructions on the prescription label, or as described by the parent (in the case of over-the-counter medications), are usually sufficient.
Where does it say all of this?
Schools and Parents may find the following links to statutory guidance helpful:
The Statutory Framework for the Early Years Foundation Stage (3rd April 2017).
The Health: Medicines section includes the following:
3.44. The provider must promote the good health of children attending the setting. They must have a procedure, discussed with parents and/or carers, for responding to children who are ill or infectious, take necessary steps to prevent the spread of infection, and take appropriate action if children are ill.
3.45. Providers must have and implement a policy, and procedures, for administering medicines. It must include systems for obtaining information about a child’s needs for medicines, and for keeping this information up-to-date. Training must be provided for staff where the administration of medicine requires medical or technical knowledge. Prescription medicines must not be administered unless they have been prescribed for a child by a doctor, dentist, nurse or pharmacist (medicines containing aspirin should only be given if prescribed by a doctor).
3.46. Medicine (both prescription and non-prescription) must only be administered to a child where written permission for that particular medicine has been obtained from the child’s parent and/or carer. Providers must keep a written record each time a medicine is administered to a child, and inform the child’s parents and/or carers on the same day, or as soon as reasonably practicable.
Supporting Pupils at School with Medical Conditions (December 2015) statutory guidance is for governing bodies of maintained schools & proprietors of academies in England.
Section 21, Managing Medicines on School Premises, says the following:
The governing body should ensure that the school’s policy is clear about the procedures to be followed for managing medicines.
Although schools may already have such procedures in place, they should reflect the following details:
Medicines should only be administered at school when it would be detrimental to a child’s health or school attendance not to do so
No child under 16 should be given prescription or non-prescription medicines without their parent’s written consent – except in exceptional circumstances where the medicine has been prescribed to the child without the knowledge of the parents. In such cases, every effort should be made to encourage the child or young person to involve their parents while respecting their right to confidentiality. Schools should set out the circumstances in which non- prescription medicines may be administered
A child under 16 should never be given medicine containing aspirin unless prescribed by a doctor. Medication, e.g. for pain relief, should never be administered without first checking maximum dosages and when the previous dose was taken. Parents should be informed
Where clinically possible, medicines should be prescribed in dose frequencies which enable them to be taken outside school hours
Schools should only accept prescribed medicines if these are in-date, labelled, provided in the original container as dispensed by a pharmacist and include instructions for administration, dosage and storage. The exception to this is insulin, which must still be in date, but will generally be available to schools inside an insulin pen or a pump, rather than in its original container
All medicines should be stored safely. Children should know where their medicines are at all times and be able to access them immediately. Where relevant, they should know who holds the key to the storage facility. Medicines and devices such as asthma inhalers, blood glucose testing meters and adrenaline pens should be always readily available to children and not locked away. This is particularly important to consider when outside of school premises, e.g. on school trips
SCHOOL ABSENCE OR EXCLUSION FROM ACTIVITIES
3. Can a school or parent ask a GP to provide sick notes or certificates of absence for a child?
In general, GPs do not provide certificates ('sick notes') for children. The parent’s explanation of the absence is generally sufficient for the purposes of the school.
Regardless of who requests a sick note, GPs are unable to issue these for extended periods of sickness absence (> 7 days) unless the patient was seen by the GP at the time of the illness.
In prolonged absence from school, the problem needs very careful assessment and the school, with appropriate consent, may seek additional medical information directly from the GP.
Provision of medical certificates or other medical opinion for school children’s activities is not part of a GP’s responsibility and a refusal to provide this is in accord with the Government policy to reduce GP paperwork and preserve valuable GP time for clinical care. GPs may charge a fee for undertaking non-contractual work such as letters for schools.
Helpful information can be found here: https://www.bma.org.uk/advice/employment/gp-practices/service-provision/supporting-pupils-at-school.
If you feel there are special circumstances which necessitate GP input, you may seek to discuss this directly with the child’s GP, with appropriate consent from the parent.
RETURN TO PLAY FOLLOWING HEAD (OR OTHER) INJURY
4. Can a GP verify that my child is safe to return to sports following a head (or other) injury?
Many traumatic injuries are initially best assessed by a minor injuries unit rather than the GP practice, though some practice offer this service. It is ok to check by calling 111 or the practice reception team if you are unsure.
GPs are, of course, happy to assess any person who thinks they are unwell - especially if the recovery is not going as predicted. However, GPs are normally unable to provide medical opinion on safety to return to sports following an injury. This is for the following reasons:
Decisions to return to sport may sometimes be complex and require specialist training. Many GPs are not formally trained nor have appropriate medical insurance to make these medical assessments.
Medical assessments for sport are not something GPs are contracted by the NHS to do.
Pressures on General Practice are significant. Practices must use their limited time wisely, and this normally includes declining to take on work for which they are not trained nor commissioned to do because this could jeopardise their core duty to deliver the services the NHS contracts them to do.
5. Who should provide return to play assessments?
The verification of the fact that a child is symptom free and sanctioning of return to play is a function that should be fulfilled by the school / club / parent.
Alternatively, there are organisations that provide Return to Play assessments for a fee.
You may find the following website useful: http://www.englandrugby.com/mm/Document/MyRugby/Headcase/01/30/49/22/returntoplayafterconcussion_Neutral.pdf