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Benefits system (simplified guide)

Dr Rajesh Varma

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

  1. New Style ESA (eligible if paid National Insurance contributions)

  2. Contributory ESA (eligible if paid National Insurance contributions)

  3. 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:

  1. Income-based JSA

  2. Income-related ESA

  3. Income Support

  4. Child Tax Credit

  5. Working Tax Credit

  6. 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:

  1. Disability Living Allowance care component at the middle or highest rate

  2. Personal Independence Payment daily living component at either rate

  3. Attendance Allowance / Constant Attendance Allowance

  4. 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.