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Section A - Introduction

A.1. Purpose

A.1.1 This Circular gives guidance on the procedures for assessing the physical and mental fitness to teach of intending and serving teachers, and of other staff whose work falls within the scope of the Teachers Regulations. To assess medical fitness, all providers of Initial Teacher Training and all employers of teachers must seek advice from a medical adviser who is a qualified medical practitioner. The medical adviser should be able to demonstrate competence in occupational medicine, for example as evidenced by inclusion in the specialist register of the General Medical Council or by holding a recognised post-graduate qualification in occupational medicine. The Faculty of Occupational Medicine of the Royal College of Physicians can advise on this if necessary.

A.1.2 The Circular explains the implications of regulations 7 to 10A of the Teachers Regulations and amendments shortly to be made to them, and of the Disability Discrimination Act 1995, both of which are relevant to employing teachers.

A.1.3. Throughout this Circular the terms 'must' implies legal duty; 'should' implies recommended good practice.

A.2. Statutory Basis

A.2.1 Section C gives guidance and a statement of best practice for Initial Teacher Training providers about assessing the medical fitness of trainees proposing to enter the teaching profession. One of the Secretary of State's requirements for courses of Initial Teacher Training set out in Annex 1 to Circular 4/98 is that entrants to courses meet the medical fitness to teach requirements.

A.2.2 Sections D and E explain, and give guidance about implementing, regulations 8 and 9 of the Teachers Regulations respectively. Under regulation 8, no teacher can be appointed to "relevant employment" unless his or her employers are satisfied that he or she has the necessary health and physical capacity. Under regulation 9, a teacher cannot continue in "relevant employment" if his or her employer is satisfied that he or she does not have the necessary health or physical capacity. The meaning of "relevant employment" (regulation 7) is explained in paragraph A.2.3. The Teachers Regulations are shortly to be amended to add "mental capacity" to the medical fitness requirements and to make it clear that in making assessments under regulations 8 and 9 employers are bound by their duties under the DDA.

A.2.3 "Relevant employment" means employment (which includes engagement not under a contract of employment, for instance as a supply teacher) of the following types:

• employment by a Local Education Authority, as a teacher (either at a school or further education provider) or as a worker with children or young people;
• employment (whoever the employer is) as a teacher at a maintained school, a non-maintained special school, a further education institution which is either maintained by a Local Education Authority or is in the further education sector, and until 1st September 1999 at a grant-maintained school; and

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• employment by the governing body of a maintained school, a non-maintained special school or a further education provider or until 1st September 1999 at a grant-maintained school as a worker with children or young people.

A.2.4 Section F explains the Secretary of State's powers under regulations 10 and 10A of the Teachers Regulations to bar or restrict the employment of teachers on medical grounds. This section applies to all teachers and workers with children or young people in relevant employment and to two additional categories of employment: 

employment by the proprietor of an independent school as a teacher or worker with children or young people; and
employment (whoever the employer is) as a teacher or worker with children or young people at an independent school.

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as a source of reference for employers, managers and human resource professionals. It is contained in a pack, which includes a series of short cards summarising much of the Guide's information and advice and is aimed at organisations of all sizes. Employers will be able to contact the DDA Helpline for advice or to obtain copies of the Guide.

B.2.2 Examining medical advisers must consider whether disabled candidates applying for ITT courses or employment, or staff who become disabled while working, will be able to carry out their duties effectively once any necessary reasonable adjustments have been made. A person's physical capacity to manage his or her work may be enhanced with appropriate technical or human support and advice from such experts as the Employment Service Disability Service, as well as institutional arrangements. Medical advisers must consider fully the health, education, safety and welfare of pupils or trainees likely to be in that teacher's care.

B.3. The DDA and the concept of reasonable adjustment

B.3.1 DfEE Circular 3/97 explains the implications of the DDA for the governing bodies of schools and Local Education Authorities as employers. The paragraphs below cover the main points relevant to teachers and other workers with children, and cross-refer to Circular 3/97 where relevant.

B.3.2 The employment provisions of the Disability Discrimination Act 1995, which have applied since 2 December 1996, mean that:

• employers may have to make reasonable adjustments to their employment arrangements or premises if these substantially disadvantage a disabled employee compared to a non-disabled person. For prospective employees they must find out whether any reasonable adjustment would overcome a disadvantage to a disabled applicant before deciding that that person is the most suitable for the job;
• discrimination may only be justified if material and substantial reasons, even after reasonable adjustments have been made, mean a person's disability makes him or her unfit to do the job effectively.

B.3.4 Under the DDA, employers may have to make reasonable adjustments to their employment arrangements or premises so an employee or prospective employee with a disability is not at any substantial disadvantage compared with a person who is not disabled. See paragraph 25 of 3/97 for examples of adjustments which governing bodies and Local Education Authorities might reasonably have to make.

B.3.5 The employment provisions of the DDA cover employment in higher education (HE). However, the provisions on access to goods, facilities and services do not apply to trainees including trainee teachers. Nonetheless, ITT providers may make reasonable adjustments to offer accessible facilities to benefit both their employees (for whom they have responsibilities under the DDA) and trainees. This may help suitable disabled trainees gain teaching qualifications through the availability of suitable facilities. Reasonable

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adjustment may give access to teaching to those who might otherwise consider themselves unable to teach because of a disability.

B.3.6 Changes are shortly to be made to the Teachers Regulations to reflect the requirements of the DDA. Previous regulations placed the onus on employers not to employ anyone unless they were satisfied that the person concerned was medically fit to teach. The DDA renders such an evaluation too subjective. There must be material and substantial reasons, which cannot be overcome by reasonable adjustment, before a person may be denied employment because of a disability.

B.4. Medical advisers

B.4.1 A medical adviser to an Initial Teacher Training provider or employer of teachers must be a qualified medical practitioner. The medical adviser should be able to demonstrate competence in occupational medicine, for example as evidenced by inclusion in the specialist register of the General Medical Council or by holding a recognised post-graduate qualification in occupational medicine. The Faculty of Occupational Medicine of the Royal College of Physicians can advise on this if necessary Medical advisers may clarify the general professional considerations about teacher fitness with the DfEE's Medical Adviser.

B.4.2 Neither the Secretary of State nor the Department's Medical Adviser can adjudicate on questions about the physical and mental fitness of individual teachers or candidates for teacher training. The only exception to this is when the Secretary of State is considering barring or suspending a person from employment on medical grounds, or to making such employment subject to conditions (Regulation 10 and 10A of the Teachers Regulations).

B.4.3 Medical advisers needing professional advice on individuals who they consider may be barred or restricted should send the DfEE Medical Adviser the completed declaration of health questionnaire, a full medical report (including a specialist report where appropriate) and other relevant background information. Documents should be marked 'Medical in Confidence'.

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C.1.3 Providers' selection and admissions procedures should ensure that all entrants to training have the physical and mental fitness to teach, based on the advice of the provider's medical adviser.

C.2. Declaration of health

C.2.1 Before final acceptance on a course, all candidates offered a firm or conditional place on a course of Initial Teacher Training should complete and return to the provider a declaration of health questionnaire, which may be produced by the provider. Candidates should be asked to return the completed questionnaire directly to the named medical adviser. This information will be considered by the medical adviser who will request additional information if necessary. Candidates should be asked to return both the questionnaire and any additional information promptly, and to mark it "Medical in confidence". Where the medical adviser considers that further assessment is necessary before a decision can be reached, then a medical examination will be arranged. This is only likely to be required in exceptional cases.

C.2.2 All declarations should be checked by medically qualified staff. A suitably trained registered nurse may sift applications. However, the nurse should have access to professional advice from the provider's medical adviser, who can make judgements where any questions are raised by the completed declaration.

C.3. Administration of applications/health declarations

C.3.1 Admissions staff are responsible for ensuring that health declarations have been received from all candidates and recording whether medical advisers have recommended acceptance or rejection. A trainee should not start teacher training if they have not completed an assessment of medical fitness. Admissions staff should check any gaps in trainees' employment or educational records which may raise doubts over their medical fitness.

C.4. Role of medical advisers to Initial Teacher Training providers

C.4.1 The declaration of health questionnaire and if necessary, more detailed medical reports, are the basis for determining a candidate's fitness to teach. The medical adviser may decide that a candidate needs a medical examination. If further information is necessary, the medical adviser should write, with the candidates consent, to the GP or specialist, copying the letter to the candidate. Alternatively a medical examination may be arranged by the medical adviser.

C.4.2 Many people with disabilities or chronic illnesses may be medically fit to teach and medical advisers will record this in advising on candidates' fitness to teach. The medical adviser's recommendation must reflect:

• whether the person is fit for a career in teaching, assuming that employers make reasonable adjustments in accordance with their duty under the DDA;
• whether training providers may need to consider changes similar to those which would make up reasonable adjustment for employers to enable the person to undertake an Initial Teacher Training course;
• any traits or indicators which might affect the candidate's fitness for teaching;
• any medical condition likely to limit the candidate's ability to communicate with children, manage classes and secure effective learning.

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C.5. Candidates who are judged unfit to teach on medical grounds

C.5.1 If the medical adviser advises that medical factors in the physical or mental health of a candidate make them unfit for teaching, the provider should follow that advice and not admit that individual. However, the final decision on whether to accept such a candidate rests with the teacher training provider.

C.5.2 The selection of candidates for training involves both assessing the suitability of their personal and intellectual qualities, and their physical and mental fitness to teach. The medical adviser may report problems which, while significant, do not rule the candidate out on medical grounds. In these cases, the admissions tutor should decide whether the candidate has the potential (subject to trainers and/or employers making reasonable adjustments where necessary) to meet the standards required for Qualified Teacher Status. In doing so, admissions staff may consider advice from non-medical specialists, serving teachers, and any evidence from the individual candidate, such as relevant experience of work in a school or with children.

C.5.3 In some cases a candidate may be affected by a condition which is in remission at the time of applying for a training course, but is liable to relapse in the future and could affect his or her fitness to teach. In such cases, medical advisers should make a judgement on fitness in the light of an informed assessment of the potential for risk to pupil welfare. This will be based on knowledge of the nature of the candidate's condition, including its probable development and is likely to involve reference to appropriate specialist reports.

C.6. Candidates who wish to contest rejection on medical grounds

C.6.1 A candidate who is not admitted to teacher training on medical grounds should be invited to provide any further medical information that he or she feels is appropriate. The case should be referred to another specialist occupational health physician, preferably with experience in the field of occupational health of teachers, and having no connection with the provider concerned. Any consultation fee should be met by the teacher training provider. Should the candidate wish to consult an occupational health physician other than the one selected by the provider, any fees incurred should be borne by the candidate. The final decision on whether to accept such a candidate rests with the provider.

C.7. Making medical information available to other providers

C.7.1 It may be necessary for the medical papers of a candidate to be passed to another provider, although the candidate's consent will be required. For example:

• a provider's medical adviser may consider that a candidate has some impairment which makes him or her unsuitable for entry to that particular provider but which may be no bar to acceptance elsewhere;
• a candidate may not fulfil the academic requirements of a conditional offer and want his or her application considered by other providers through the clearing scheme;
• a candidate may change his or her choice of provider between application and acceptance, and starting a course;
• a trainee may wish to move from one provider to another during his or her training.

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C.7.2 In all such cases the declaration of health should immediately be returned to the candidate. Other medical documentation may be returned to the candidate unless this would be contrary to medical advice. Declarations of health and other medical papers should always be marked "Medical in Confidence" and sent in sealed envelopes. Occupational health records may be sent in confidence between providers with the consent of the candidate.

C.8. Confidentiality

C.8.1 Medical advisers are responsible for the confidentiality and privacy of the procedures under medical ethical practice. All information provided by a candidate to a health professional is also subject to the common law duty of confidence. Such information may not be used for any purpose other than the one for which it was provided without the consent of the individual concerned. Those receiving advice from medical advisers about a candidate's physical and mental condition are also subject to this duty of confidentiality. Medical information cannot be passed to third parties without the consent of the individual unless there is some overriding public interest in doing so, such as the need to protect others from harm. Even then, only the minimum information necessary may be passed on; which in practice means that, wherever possible, the information should be anonymised.

C.9. Trainees' access to their own records

C.9.1 If a trainee asks for information supplied as part of his or her declaration of health, comments by the medical adviser, or any report obtained from an independent medical practitioner, release is at the discretion of the medical adviser who provided the information.

C.10. Medical fitness in training

C.10.1 A trainee whose health deteriorates during training should consult the college medical adviser about any implications for continuing training or for teaching in the future. Individuals should not judge their own fitness to teach outside the context of trivial and self limiting ailments. A potential conflict of interest could arise where the medical adviser to a provider is also its medical officer, in terms of confidentiality of information provided to the doctor in his/her role as the GP of the trainee. It is therefore recommended that assessment of fitness to teach should be undertaken by a medical adviser who is completely independent of the candidate's GP. College medical officers should tell trainees of any doubt about fitness to teach and record the fact confidentially. It must only be passed to a prospective employer's medical adviser with the trainee's consent, unless there are concerns that the trainee poses a risk to the health and safety of others.

Where a trainee becomes temporarily or permanently disabled or has a progressive disability and wishes to continue into teaching, the provider should consider with the trainee whether particular help as in paragraph B.3.5 above might enable the trainee to meet the required standards for the award of Qualified Teacher Status.

C.11. Failure to disclose relevant medical information and providing false information

C.11.1 If a trainee is found to have:

• failed to disclose information which would otherwise have made them ineligible;

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• given false information, including appropriate information about medical problems which arise during training;
• failed to comply with conditions imposed by the provider's medical adviser such as regular monitoring or check-ups during the course;

C.12. Information to be given to employers

C.12.1 Once a candidate is considered to have the physical and mental fitness to teach and has accepted a training place, the provider's medical adviser should keep the declaration of health and any supporting papers for as long as he/she considers necessary to answer potential enquiries from the medical advisers of prospective employers. Medical information may only be released to a third party, with the consent of the person to whom it relates at the time disclosure is to be made. A candidate (whether deemed medically fit or not) who for some reason unconnected with medical fitness does not immediately enter Initial Teacher Training, will need a new and satisfactory declaration of health before admission to an ITT course.

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D.1.5 If the medical adviser to the prospective employer considers that a specialist opinion is necessary, the applicant may be offered the opportunity to choose a specialist on the advice of their GP, or the medical adviser may propose a specialist with the agreement of the applicant. An applicant who does not agree with the recommendation of the prospective employer's medical adviser may seek another specialist's opinion, again guided by his or her GP. The employer's medical adviser should consider in the light of any such second opinion, whether his or her previous advice should be revised. The decision on whether to accept such an applicant on grounds of medical fitness rests with the employer.

D.2. Teachers on first appointment

D.2.1 For newly qualified teachers, the prospective employer's medical adviser should obtain details of the applicant's medical history from the medical adviser to the training provider, with the written consent of the teacher. For most newly qualified teachers, the information will be confined to the pre-course declaration of health as few will have had a medical examination or doctor's report before or during their course. Possession of qualified teacher status (QTS) does not indicate the Secretary of State has been satisfied that a teacher is medically fit to teach.

D.2.2 The employer's medical adviser may, in the light of local factors, recommend routine health screening or other requirements for teachers and teacher trainees on first appointment. Trainees and serving teachers should keep their immunisations up-to-date. Immunisation Against Infectious Disease, HMSO 1996 gives details. The need for any other immunisation, e.g. against hepatitis A or B or further BCG should be assessed on the basis of advice from the medical adviser and the local consultant in communicable disease control.

D.3. Entry to teaching by employment-based routes

D.3.1 The Graduate Teacher (GT) and Registered Teacher (RT) Programmes provide a tailor-made training route through employment as a teacher. These programmes in maintained schools and non-maintained special schools require all trainees to be medically fit to teach. The candidate must provide information as required to show that he or she is medically fit. The recommending body of the GT or RT should ask the candidate to complete a declaration of health for checking by the employer's medical adviser.

D.4. Employment in the Further Education sector

D.4.1 Employers in further education colleges maintained by LEAs or by the Further Education Funding Council must be satisfied about the health and physical capacity of all teachers who are to be appointed to their college (Regulation 8 of the Teachers Regulations). The candidate must provide information to allow employers to assess medical fitness to teach within this sector. The prospective employer should ask the candidate to complete a declaration of health for checking by the employer's medical adviser.

D.5. Teachers changing schools

D.5.1 No employer should confirm an appointment without being satisfied that a teacher has the health and physical capacity to teach. The employer must also consider whether reasonable adjustment would enable a disabled candidate to work effectively. In appointing teachers with recent previous service in Great Britain, the employer's medical adviser may, where it seems reasonable, consider medical records from previous employment to decide that the person

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is fit to teach. Prospective employers must obtain the teacher's consent before requesting medical information from a previous employer. When considering past records, care should be taken not to discriminate against someone who has had a disability but who has continued to work.

D.6. Supply teachers engaged through employment agencies or businesses

D.6.1 The Teachers Regulations have been amended to provide that the agency is responsible for determining the fitness to teach of agency and supply teachers. Those taking teachers from agencies should seek evidence that the agency has checked the teachers' medical fitness. Where the teacher has recent previous service in Great Britain agencies may, where it appears reasonable, rely on medical records from previous employment. The teacher should be told if a prospective employer is to approach a previous employer. If medical records are not available or not recent, or where the agency believes more information is required, the agency should ask candidates to complete a declaration of health questionnaire, to be checked by the medical adviser acting for the agency. Under the DDA, employers are liable for the actions of their agents, so agencies should not turn away workers because of medical fitness when reasonable adjustment could enable them to work effectively.

D.6.2. If a Local Education Authority, school or FE establishment directly engages a supply teacher it is responsible for carrying out these checks. 

D.7. Non-teaching jobs covered by the Teachers Regulations

D.7.1 Some non-teaching posts are covered by the medical fitness requirements in the Teachers Regulations. The definition of 'relevant employment' in the Regulations includes employment, other than as a teacher, which brings the person regularly into contact with children or young persons under 19 years old. Some non-teaching posts (e.g. classroom assistant, school crossing supervisor) may involve more contact with children than others (e.g. cleaner, bursar). Employers should decide whether an individual will have regular contact with children and young people under 19, and if so, seek medical advice as they consider necessary in deciding whether a person is medically fit to undertake a particular non-teaching job.

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E.1.3 A governing body or head teacher must take emergency action when they consider a teacher may have become medically incapable of performing teaching duties if this may put at risk the health, education, safety or welfare of pupils. Employers have the wider remit of considering whether a teacher in relevant employment has become medically unfit to perform teaching duties (whether or not emergency action has been taken by a school).

E.1.4 Many teachers who become disabled through illness or injury can continue to carry out their duties effectively if the employer makes reasonable adjustments. Advice is available from Circular 3/97, relevant disability organisations and from the Employment Service's Disability Service Teams, who administer the "Access to Work" programme, and can be contacted at local Job Centres.

E.2. Suspension or dismissal

E.2.1 Governing bodies and head teachers of maintained schools with delegated budgets have powers to suspend teachers where necessary. Several medical conditions may lead to the suspension of a teacher from duty but suspension should only be carried out on the advice of an appropriately qualified medical adviser, as outlined in para A1.1. The suspension may only be lifted by the governing body.

E.2.2 Where the issue of dismissal of a teacher on medical grounds arises, under regulation 9 of the Teachers Regulations, the employer must give that teacher the opportunity to submit medical and other evidence and to make representations, and must consider such evidence and representations. If the teacher so asks, the employer must arrange for a medical examination; the teacher's own medical adviser may, on request, be present at the examination. Consideration must be given to whether reasonable adjustment may enable a disabled teacher to continue to perform effectively.

E.3. Monitoring staff sickness absences

E.3.1. All schools should have a clear written policy for handling staff sickness absence and for taking decisive action to reduce absence levels which disrupt children's education. This should include clear procedures, drawn up in consultation with staff, for the monitoring of staff absences, for taking appropriate responding action, and for encouraging the promotion of good health.

E.3.2. Governing bodies and head teachers must be adequately informed about staff sicknesses if they are to carry out effectively their responsibilities for ensuring that there is no risk to the health, education or welfare of pupils. These responsibilities also cover non-teaching staff whose work brings them regularly into contact with children and young persons who have not reached the age of 19. Appropriate monitoring of sickness absence is an essential early warning measure for these responsibilities and also has a wider benefit to the general well-being of the school as good practice for human resource management.

E.3.3. The essential features of school staff sickness absence monitoring procedures should include the following:

• clear guidelines for staff to report absences on the first day of any absence and beyond;

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• regular contact with absent staff and, on each occasion, agreement on the date and form of the next contact;
• recording the number of absences and the working time lost for each spell of absence of each member of staff, and the reason, where known;
• undertaking return to work interviews after each spell of absence, setting clear guidelines about the conduct and content of such interviews and recording the actions agreed;
• defining trigger points for management action based on an individual's cumulative absence, setting clear guidance on the range of management actions available;
• setting clear guidelines for referrals to occupational health services.

E.3.4. All employers have wider responsibilities for the health and safety of their staff and this includes a requirement to maintain a safe and healthy working environment. In addition governing bodies and head teachers should consider adopting or participating in health awareness programmes for their staff, and encouraging staff to make full use of welfare and counselling services in order to minimise sickness absence.

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employment. However, broadly speaking barring will only be considered in cases where a person is suffering from an illness that implies a risk or potential risk to the safety and welfare of pupils and colleagues. It is most likely to be considered for a person suffering from mental illness who has displayed psychotic or manic symptoms, and in cases of severe alcohol or drug misuse.

F.1.7 When the Secretary of State decides to impose a bar, he will always suggest a review period after which he may be prepared to consider reviewing the decision. The review process is not performed automatically, but only at the request of the barred individual. When the Secretary of State undertakes a review, he will decide if the criteria laid out at paragraph F.3.1 have been met. It does not follow that simply due to a review period having elapsed the Secretary of State will withdraw, or vary, a previous Direction.

F.1.8 There is no provision in the Teachers Regulations for an appeal against the Secretary of State's decision. However, decisions can be challenged in the courts through judicial review on grounds of illegality, irrationality or procedural impropriety. A decision by the Secretary of State not to undertake a review, or not to withdraw or vary a Direction after review, could also be challenged through the judicial review procedure.

F.2. Barring - procedures

F.2.1 A medical adviser who believes there may be medical grounds for barring an employee, trainee teacher or prospective trainee teacher, from relevant employment, must consult the Department's Medical Adviser first.

F.2.2 If the Department decides to consider barring or restricting the person's employment, the person is informed of that and invited to make any representations, including submitting any medical evidence and any other material, for example testimonials from people whose knowledge or opinions may be relevant.

F.2.3 Usually the Department will also require a medical report from the consultant responsible for the person's treatment. The Department's Medical Adviser will refer the person to an appropriate consultant, and the Department will pay the consultant's fee. The person may voluntarily provide medical evidence as part of his or her representations, if he or she believes that would be helpful, regardless of whether the Department requires a medical report. The Department cannot pay for medical reports which are provided voluntarily.

F.2.4 Sometimes, from that report and a person's written representations, it is clear that it is unnecessary, or inappropriate, to give further consideration to barring or restricting the person's employment. The person will be told of this in writing.

F.2.5 When further consideration is necessary, the Department allows a person to make oral as well as written representations where practicable, by attending an interview at the Department. At interview the person may be accompanied by a "friend" of his or her choice, such as a legal representative, an official of a professional association, a former colleague, or a member of his or her family. Interviews are normally held in the Department's Darlington offices.

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F.2.6 It is for the individual to decide whether to make representations, and what information and reports to include. The Department cannot:

• require a person to make representations;
• dictate the form and content of representation;
• seek testimonials on the person's behalf;
• meet the cost of making representations, including costs involved in attending an interview.

F.2.8 It is not possible to set a timescale for concluding cases, because progress depends on the Department receiving information from several independent sources. However, the Department aims to settle a case within 3 months of receiving all necessary information, including any representations made orally at interview.

F.2.9 'List 99', held by the DfEE, contains the names, dates of birth and teacher reference numbers of people whose employment has been barred or restricted, either on grounds of misconduct or on medical grounds. If a person's employment is restricted, the entry shows the types of employment in which he or she is permitted to work. People barred on medical grounds are listed separately from those barred on misconduct grounds, but no details of the person's illness are given.

F.3. Barring - review

F.3.1 There is no provision in the Teachers Regulations for appeal against a decision by the Secretary of State. The Secretary of State does, however, have power to withdraw or vary a Direction and may do so where appropriate based on:

• information which he did not have at the time the Direction was made; and/or
• evidence of a material change in the person's circumstances since the Direction was made.

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Appendix 1 - Guidance to medical advisers

App.1.1 The purpose of the provider's declaration of health questionnaire is to decide a candidate's medical fitness for teaching and prospect of giving efficient service in a profession that is very demanding both physically and mentally. The provider's medical adviser should consider sympathetically the full facts of the case where there is an unfavourable medical history and particularly where a candidate is currently free from signs or symptoms of disease. Deformity or permanent disability should not of themselves make up medical reasons for rejection. Given reasonable adjustments by employers and/or changes by trainers similar to those falling within an employer's duty of reasonable adjustment, it may be possible for such individuals to carry out all their duties effectively.

App.1.2 If there are doubts about the medical fitness of a particular candidate to perform satisfactorily in the intended age phase or main subject in which the candidate intends to specialise, medical advisers should act as advised in sections C3-C4 of this Circular. For anyone who has a condition which may relapse and which may present a risk to children's safety or development, specialist advice should be sought before a decision is made about their fitness to enter training. Specialists should be asked to explicitly address prognosis, any likely aggravating or alleviating factors (including the effects of medication) and advise on suitable follow up in the occupational context.

App.1.3 Having considered the declaration of health (and evidence from a medical examination and specialist advice if necessary) the medical adviser should classify the candidate in one of three categories:

• Those who are in good health and free from conditions which might be likely to interfere with efficiency in teaching;
• Those who are in generally good health but who suffer from conditions which are likely to interfere to some extent with their efficiency in teaching either all subjects or certain specified subjects, though these conditions are not serious enough to make the candidate unfit for the teaching profession. This includes those whose disability could require employers to make reasonable adjustment to enable them to provide effective and efficient teaching; or
• Those whose condition is such as to make them unfit for the teaching profession. Candidates should not normally be included in this category unless they have a psychiatric or physical disorder likely to interfere seriously with regular and efficient teaching of either general subjects or the subject in which they intend to specialise e.g. PE or science subjects, or if they have an illness which may carry a risk to the safety or welfare of the pupils.

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App.1.5 When reporting on candidates, medical advisers should take specific account of the age group and/or main subject in which the candidate intends to specialise, although it may also be necessary to consider the likelihood of candidates undertaking additional duties. It should also be borne in mind that teachers in mainstream schools and further education colleges are increasingly likely to have responsibility for pupils with special educational needs, some of whom may be profoundly disabled. It is not within the scope of this guidance to provide detailed assessment of the impact of all medical conditions on fitness to teach, but key considerations are:

• the prevention of abuse of children;
• the requirement for teachers to have sound judgement and insight, and
• the requirement for teachers to be able to respond to pupils' needs rapidly and effectively.

App.1.6 When considering the medical fitness of candidates providers' medical advisers should bear in mind employers' duty under the Disability Discrimination Act to make 'reasonable adjustment' to enable disabled persons to work (see paragraph B.3.5). A medical adviser cannot know the facilities available from, or adjustments which could be made by, all prospective employers. The medical adviser may however seek advice from the provider's admissions staff, who are likely to know (or can find out) whether the provider's partnership schools could accommodate a trainee with a particular disability.