Benefits system (simplified guide)
The benefits system: a short guide for GPs
Consent to share information
A healthcare professional from IAS or Capita may occasionally phone you for more information.
Patients give consent for this to happen as part of their claim and you do not need to seek additional consent.
General Medical Council confidentiality guidance (paragraph 115c) states ‘you may accept an assurance from an officer of a government department or agency or a registered health professional acting on their behalf that the patient or a person properly authorised to act on their behalf has consented’.
For children under 16 years
Disability Living Allowance (DLA)
Eligibility. Child with disability or health condition requiring extra care (personal care or mobility) for three months, and be expected to need help for at least a further six months.
Payment made to Parents or Guardians
Composition of benefit ‘Care component’ AND/OR ‘Mobility component’. The care component can be paid from age 3 months (from birth if the child is terminally ill)
For working age people
Personal Independence Payment (PIP)
Eligibility. Adult with long-term condition (ill-health or disability expected to last 12 months or longer) who must have needed help with daily living or mobility activities for three months or more and be reasonably likely to need help for the next nine months.
PIP is based on how a person’s condition affects them, not the condition itself.
It isn’t affected by income or savings, it’s not taxable and people can get it whether they’re in or out of work.
Payment made to Claimant
Composition of benefit ‘Daily Living component’ AND/OR ‘Mobility component’.
Each component has two rates; standard and enhanced.
DLA for working-age people is being replaced by PIP
Employment and Support Allowance (ESA)
Eligibility. Adult with ill-health or disability who is unable to work; or may benefit from personalised help so that he/she can work if they’re able to
Payment made to Claimant
Type of benefit
New Style ESA (eligible if paid National Insurance contributions)
Contributory ESA (eligible if paid National Insurance contributions)
Income-related ESA (eligible if on a low income; now part of UC)
with subsequent allocation of the ESA approved claimant to either
‘Work-related activity group’ (potential to return to work) OR ‘
Support Group’ (limited capability for work, terminally ill)
GP Role
Fit notes are required until DWP makes a decision on their claim if the patient remains unfit for work.
The claimant will be referred to CHDA for a Work Capability Assessment
Communication from DWP in a letter known as ESA65B
Income Support (now part of UC)
Eligibility: Income-related benefit paid to people who work less than 16 hours per week (on average) and whose income, capital and savings are below certain levels.
People who might qualify include:
carers
lone parents with children under 5
pregnant women
sick and disabled people who need money to top up their Statutory Sick Pay
Jobseeker’s Allowance (JSA)
Eligibility
Unemployed people (or adult who works less than 16 hours on average per week) who is available and actively looking for work.
Claimants must attend regular work-focused interviews at a Jobcentre and provide proof that they are looking for work.
Type of benefit
Contribution-based JSA (eligible if paid National Insurance contributions, not means tested) AND/OR Income-based JSA (eligible if on a low income; now part of UC)
Universal Credit (UC)
Universal Credit (UC) is payable to people in and out of work.
It replaces the six main out-of-work benefits with one simple, monthly payment:
Income-based JSA
Income-related ESA
Income Support
Child Tax Credit
Working Tax Credit
Housing Benefit
GP Role
Fit notes are required until DWP makes a decision on their claim if the patient remains unfit for work.
The claimant will be referred to CHDA for a Work Capability Assessment.
For people of State Pension age and over
Attendance Allowance
Eligibility. Adult at State Pension age or over with a disability requiring extra help with personal care and must have needed help for six months.
Payment is not affected by income or whether a person works
Payment made to Applicant
Level of benefit ‘Lower’ or ‘Higher’ tariff
For carers
Carer’s Allowance
Eligibility
Aged 16 or over AND spend at least 35 hours a week caring for a person receiving:
Disability Living Allowance care component at the middle or highest rate
Personal Independence Payment daily living component at either rate
Attendance Allowance / Constant Attendance Allowance
Armed Forces Independence Payment
Payment made to Carer
Claims from people who are terminally ill
Attendance Allowance, DLA, PIP, ESA and UC all have special rules for claimants who are terminally ill.
For the purpose of these benefits, someone is considered terminally ill if they have a progressive disease and the person’s death in consequence of that disease can reasonably be expected within 6 months.
Claims made under the special rules are fast tracked and payments are guaranteed from the earliest point.
GP role
Complete a DS1500 form with factual information on your patient’s condition and treatment.