Foster carer assessment medical checks

This is an important area, and one where there is a clear and consistent message emerging across the sector.

At NAFP, we have brought together current member insight alongside previous sector evidence and engagement. The picture is remarkably consistent.

There are a number of clear and recurring themes.

1. The issue is systemic rather than isolated

Across independent providers and local authorities, the same patterns come up repeatedly:

• Long waits for GP appointments, often several months
• Delays after the appointment for forms to be completed and returned
• Forms being lost or incomplete, requiring resubmission
• Significant variation in fees, from no charge to £200+
• GP services treating this as non-core or low priority work

These delays are often compounded by inconsistent processes within GP surgeries. In some cases, forms are completed during the appointment and handed to the applicant. In others, they are retained for later completion, with no clear timescale for return. In some instances, paperwork is lost entirely, requiring the process to restart.

This aligns with earlier sector analysis which found that delays are inconsistent but widespread, with only around a quarter of medicals consistently completed in a timely way.

The key point is that these delays sit almost entirely outside the control of both the applicant and the fostering service.

2. It is now a major contributor to delay in approvals

Medical checks are consistently cited as one of the main bottlenecks in the assessment process, alongside DBS and references.

In practice this means:

• Assessments are ready but cannot proceed to panel
• Panel dates are missed or rearranged
• Applicants disengage due to delay and frustration
• Recruitment is slowed at a point where the system needs more carers

Given the current sufficiency challenge, this becomes a system level issue rather than an administrative inconvenience.

3. There is a question about proportionality and value

There is a growing view across the sector that the current model has become more of a compliance exercise rather than a meaningful assessment.

In most cases:

• Relevant health issues are already disclosed and explored through the assessment
• The GP report tends to confirm known information rather than identify new safeguarding concerns
• The variability in quality means the usefulness of reports is inconsistent

At the same time, we need to retain the learning from serious case reviews that reliance on self-report alone is not sufficient, and that health information must be properly tested and understood.

The issue is not whether medical information matters. It clearly does. The issue is whether the current universal GP led model is the most effective and proportionate way of obtaining it.

4. The process itself introduces avoidable inefficiency

The current system remains largely paper based, which introduces additional risks and delay:

• Forms are posted, carried by applicants, or emailed inconsistently
• There is no standardised tracking or accountability
• There are increased risks around data loss and handling of sensitive information
• Significant administrative time is spent chasing GP surgeries and managing payments

There is also no consistent relationship between cost and performance. Higher fees do not lead to quicker turnaround times or better-quality reports.

5. COVID demonstrated that alternative approaches can work

During COVID, many services moved to a self-declaration model supported by medical adviser scrutiny in order to keep assessments moving.

That approach was not perfect, but it demonstrated two important things:

• Assessments can proceed safely using a more flexible, risk-based approach
• Agencies are capable of exercising professional judgement when the system allows it

This provides a useful proof of concept for a more proportionate model.

6. The core design issue is ownership and incentives

At present:

• GPs do not own the process
• It is not part of core NHS contractual activity
• There are no clear expectations around timeliness, quality, or consistency

As a result, the system relies heavily on goodwill and local relationships, leading to wide variation in practice and outcomes.

7. Emerging practice points to a more effective model

Some providers are beginning to explore alternative approaches in response to these challenges.

This includes working with medical professionals who take a more holistic, person centred approach to assessments, considering not only medical history but also the practical implications of health on the fostering role.

This approach moves beyond a binary “fit to foster” judgement and instead provides more meaningful insight into:

• Physical, mental and emotional health
• The likely impact of health conditions on caring capacity
• Practical advice to support long term wellbeing

While this is not yet systemised, it points to a more useful and practice relevant model of medical input.

8. Likely directions for reform

From what we are hearing; there are three broad options worth exploring:

1. Strengthen and standardise the current model

• National expectations on timescales and fees
• Clearer engagement with GP services, potentially via ICBs
• Defined turnaround expectations

2. Move to a proportionate, risk-based model

• Structured self-declaration as the starting point
• Targeted medical input where risks or conditions are identified
• Greater use of medical advisers to interpret and advise

3. Decouple from GP provision entirely

• Commission alternative medical capacity
• Potentially through regional or national arrangements
• Greater control over quality, timeliness, and cost

Our view is that a blended, risk-based model is likely to offer the most effective and proportionate solution.

A purely self-declaration model would not provide sufficient assurance. However, the current universal GP led model is not working as intended.

9. Clarity on roles and accountability

There is also a need to clarify roles within the current process:

• Medical advisers provide advice on health implications
• They do not determine suitability to foster
• The final judgement sits with the agency decision maker

Clearer articulation of these roles would support better decision making and reduce the risk of medical input being treated as determinative.

Conclusion

There is a clear and consistent message across the sector that the current approach to foster carer medical checks is not operating as intended.

It introduces delay, inconsistency, and administrative burden, without consistently adding proportional safeguarding value.

There is an opportunity to reform the system in a way that:

• Maintains robust safeguarding
• Reduces unnecessary delay
• Improves the quality and usefulness of medical input
• Supports the recruitment and retention of foster carers

This feels like an area where relatively small, practical reform could unlock significant system benefit.