School letter requests
Toilet passes
Highfield Surgery understands that schools are sometimes requesting medical letters or evidence from parents to grant children permission to use the toilet during lessons. We wish to provide clarity on our position regarding these requests.
At Highfield surgery, we firmly believe that access to safe, timely, and appropriate personal hygiene is a fundamental human dignity. This is especially crucial for girls who have periods, which can vary significantly in timing and heaviness, particularly during the years surrounding menarche.
While we recognise the importance of maintaining classroom discipline, and that a small number of pupils may abuse toilet access, it is vital to understand that a child’s need to use the toilet is generally not a medical issue. It is also not an NHS matter for us to provide evidence of a child’s lack of continence, urinary or faecal urgency, or menstrual difficulties.
Singling out a pupil with a “toilet pass” due to perceived toileting difficulties can be deeply undignified and harmful to their self-esteem. Furthermore, deliberately dehydrating to avoid needing the toilet or withholding stool or urine can have serious medical ramifications, potentially worsening continence issues. The mental wellbeing of a young person is also significantly impacted by the risk of an incontinence episode in class or being prevented from accessing menstrual hygiene, leading to soiling.
In these uniquely challenging times, all public sectors, including the NHS, face significant strain on both workload and finances. It is simply not possible for us to take on additional, unfunded administrative work. Crucially, we are not prepared to charge children or their families for paperwork that allows them basic dignity and access to essential bodily functions.
Therefore, Highfield surgery will not be providing separate medical notes or letters to specific pupils to allow them to use the toilet.
Whether an individual child can reasonably delay their needs until the end of a lesson is a matter for the school, the child, and their family to discuss.
If you require confirmation of our stance, please accept this social media post as a formal statement that Highfield surgery considers all children have a fundamental need to access a toilet when they need to use it for urinary, defecation, or menstrual reasons.
School’s request for medical evidence to support authorised absence due to illness
It is the responsibility of schools (not parents) to decide whether a pupil absence should be marked as authorised or unauthorised. Authorised absence means that the school has either given approval in advance for a pupil of compulsory school age to be away or has accepted an explanation offered afterwards as justification for absence.
The Department for Education guidance explains that it is a matter for schools to determine if they require evidence to support the authorisation of an absence in the form of a prescription or
appointment card. The guidance relating to the marking of registers for illness and medical
appointments states:
Code I: Illness (not medical or dental appointments):
Schools should advise parents to notify them on the first day the child is unable to attend due to illness. Schools should authorise absences due to illness unless they have genuine cause for concern about the legitimacy of an illness. If the authenticity of illness is in doubt, schools can request parents to provide medical evidence to support illness. Schools can record the absence as unauthorised if not satisfied of the authenticity of the illness but should advise parents of their intention. Schools are advised not to request medical evidence unnecessarily. Medical evidence can take the form of prescriptions, appointment cards, etc. rather than doctors’ notes.
GPs receive a significant number of requests for sickness certificates or appointment cards for school children. GPs do not provide sick notes for school children. When children are absent from school owing to illness, schools may request a letter from a parent or guardian. Where this includes sickness during an exam period, or if the authenticity of the illness is in doubt, schools could request that parents provide medical evidence (not a doctor’s sick note) as per the DfE guidance above. GPs cannot provide retrospective sickness certification. When a child suffers from a long-term condition, any certification will be provided by the responsible specialist.
Requests for GP letters for examinations
Medical Certification & Special Consideration Letters
When a child suffers from a long-term condition, any certification will be provided by the responsible specialist and should not be requested from the GP, unless the request isfor medical information such as a copy of a patient’s medical records.
In cases where a child has recurrent short-term illnesses this is a matter for very sensitive and expert management by the school and the School’s Health Service in consultation with the parents and the child. The Link School Nurse (or School Doctor for some private schools) should seek any additional medical information by directly contacting the GP with the consent of the parent or the child if competent to give legally valid consent. It is not a GP’s responsibility to issue letters. At a time where the NHS is seeing record breaking requests for medical care, we need your help to reserve NHS appointments for the most vulnerable.
Exam related stress
JCQ will not consider exam related stress as a special consideration. Please do not request letters or medical evidence for this. JCQ will only consider special consideration if the pupil has stress or anxiety where medication has been prescribed and/or has a substantial long term adverse effect on their ability to carry out normal day-to-day activities.
When a child misses an examination
GPs are not contractually obliged to provide a sick note for pupils who are off sick from school. GPs do not provide short term sickness certification for periods of less than 7 days and we are unable to issue medical certificates for longer periods of sickness absence unless the patient was seen by the GP at the time of the illness.
GPs are also not obliged to provide sickness certificate for students that miss an exam or believe their performance was affected due to illness
