Should I sign my patient's 'fitness to participate' form?

GPs may be unsure about declaring patients fit to take part in physical events. Medical Protection provides advice on this common query.

______

While you may want to be supportive of your patient’s involvement in sporting activities and events – particularly when they have already invested time and money into training and travel arrangements - if asked to sign fitness to participate forms you should consider the possible medicolegal issues. Put another way: should the patient suffer harm as a result of undertaking the event with an unknown, but detectable, medical condition, could you be the subject of a civil claim? While this would be a rare occurrence, in theory – yes.

This does not mean GPs must simply refuse to sign these forms, but rather that we consider if and how this can be approached safely, for both the patient and for you as their doctor.

A safe approach

Good communication is key - from the wording used on the form you are signing to the conversation you have with your patient. It may help to see the question from a different angle. Rather than thinking “this patient is fit for…..” ask yourself “are there any obvious reasons why they shouldn’t do this, considering the information you have?”

Before assisting, you should take a careful history (and family history) from the patient, ensuring that there are no concerning symptoms, in particular those that could be associated with undetected cardiac conduction defects. 

You must be confident that you understand the nature of the event and have sufficient knowledge about the patient. If you do not have the required expertise or information to assess whether the patient is fit to take part in an event, then you should obtain further advice. The GMC advises in Good Medical Practice (GMP) that you “must recognise and work within the limits of your competence.”

You should consider the patient’s current and past medical history, and any relevance this has to the event in which they are intending to participate. If in doubt about contraindications to participating in the event, you could advise the patient to seek further information from the event organisers.

If the patient’s medical history is not straightforward you may need to seek advice from a specialist; for example, if they have recently received treatment it may be appropriate to contact their consultant. If you feel that judging a patient’s fitness for an event is not within your expertise or knowledge of the patient, then you should not sign a declaration. 

Ensuring reports are not misleading

If presented with a form by a patient, consider the wording of statements and declarations carefully. For example, it may be possible and appropriate to sign a form with a qualifying statement, offering factual information about a patient’s condition that may be relevant.

If, when asking yourself “are there any obvious reasons why they shouldn’t do this…?”, the answer is “no”, another reasonable approach could be to state this on the form and make clear that it is based on the information available to you. It would also be advisable to explain to your patient that there are no guarantees and that you cannot mitigate for the ‘unknown unknowns’. Record the conversation and agreed approach in the patient’s notes.

The GMC states in GMP that you “must be honest and trustworthy, and maintain patient confidentiality in all your professional written, verbal and digital communications…you must make sure any information you communicate as a medical professional is accurate, not false or misleading.”

Indemnity

Signing fitness to participate forms for patients is considered private GP work and would not be covered by state-backed indemnity schemes. GPs should contact Medical Protection, or their Medical Defence Organisation (MDO) to ensure that they have appropriate and adequate indemnity for such work - ideally with no caps or limits to the compensation that will be paid in the event of a claim. Although very rare, when some more extreme events go wrong the injuries may be serious and the compensation sought if a claim is successful may be high.

GP Partners and Practice Managers are advised to check that all GPs in the practice have adequate and appropriate indemnity, in case a claim against a GP without adequate professional protection is deflected to the practice under vicarious liability or non-delegable duty of care.

GP members of Medical Protection can request assistance with redirecting a vicarious liability claim regarding non-NHS contracted work, to the treating clinician. We provide legal support and assist with trying to extricate our members from the case.

We do not provide a vicarious liability claims product for GP’s which includes indemnity against any damages awarded as compensation. GP clinical negligence claims arising from NHS contracted work in England and Wales have been covered by state-backed indemnity since 2019. Claims in relation to non-NHS contracted work are infrequent, and vicarious liability claims for non-NHS contracted work are very rare. There has therefore not been demand for such a product from Medical Protection, but we continue to keep the products and services we provide under review.

In the event that you complete a fitness to participate form and a patient subsequently comes to harm whilst participating in their event or activity, you should contact Medical Protection or your MDO to request assistance as soon as possible.

Summary

• Try to remain objective when asked to sign fitness to participate forms
• Take a detailed history from the patient and review any relevant clinical notes
• Be confident that you have sufficient knowledge about the patient and the nature of the event
• Avoid undertaking assessments beyond your area of clinical competence
• If you feel able to proceed, review the wording of any form and declaration carefully, and consider whether you need to provide a qualifying statement, or simply offer factual information regarding a patient’s medical history
• Where a patient’s medical history is not straightforward or they are under the care of a specialist, consider obtaining advice first or refer the patient to a doctor with relevant expertise
• Fully explain your actions and any concerns to the patient and record it in their notes
• Ensure your indemnity, and that of other GPs in the practice, is appropriate and adequate.
• When in doubt, contact Medical Protection or your MDO for advice.