How to Get Your Medical Certificate
The medical certificate is the cornerstone of your ECO4 Medical Route application. This document, issued by a registered healthcare professional, formally certifies that someone in your household has a chronic health condition that is worsened by cold temperatures. Here's exactly how to obtain one and what it must contain.
Who Can Issue a Medical Certificate?
Medical certificates must be issued by a registered healthcare professional with direct knowledge of the patient's condition. Accepted professionals include:
Primary Care
- • General Practitioners (GPs)
- • Practice nurses
- • NHS district nurses
Secondary Care
- • Hospital consultants
- • Specialist nurses (cardiac, respiratory, etc.)
- • Occupational therapists
Required Certificate Information
Your medical certificate must include the following mandatory information to be accepted by ECO4 providers:
Mandatory Certificate Contents:
- Patient Details: Full name, date of birth, and address
- Medical Condition: Specific diagnosis (not just "chronic illness")
- Cold Temperature Impact: Statement confirming condition is worsened by cold
- Professional Details: Healthcare professional's name, role, and GMC/NMC registration number
- Date and Signature: Certificate dated within 12 months, with original signature
- Practice Stamp: Official practice or hospital stamp (where applicable)
Step-by-Step: Requesting Your Certificate
Download the Template Form
Visit the Ofgem ECO4 website or your local authority's website to download the standardized medical certificate template. This ensures your certificate contains all required information.
Book GP Appointment or Request Online
Contact your GP surgery to request a medical certificate appointment. Many surgeries now accept online requests through patient portals. Explain you need certification for the ECO4 Medical Route scheme.
Attend Appointment with Template
Bring the template form to your appointment. Your GP will review your medical records, confirm your condition qualifies, and complete the certificate. Processing typically takes 5-10 minutes during the appointment.
Collect Signed Certificate
Some GPs complete certificates on the spot; others require 3-5 working days for administrative processing. You may be charged an admin fee (£20-£50)—however, many surgeries waive fees for vulnerable patients, so ask about fee exemptions.
Income Requirements and Means-Testing
One of the most misunderstood aspects of the ECO4 Medical Route is income requirements. Unlike the standard benefit-based Route 1, the Medical Route has more flexible eligibility criteria. However, specific requirements vary significantly by local authority based on their LA Flex participation. Here's what you need to know.
The ECO4 Medical Route is implemented through Local Authority Flexible Eligibility (LA Flex) schemes, which means each council sets its own income thresholds and eligibility criteria within Ofgem's framework. Always check your specific local authority's requirements before assuming you don't qualify.
Three Medical Route Eligibility Scenarios
If you receive any of the following disability-related benefits, you automatically qualify for the Medical Route with NO income assessment required:
- • Personal Independence Payment (PIP) - any level
- • Disability Living Allowance (DLA) - any component
- • Attendance Allowance
- • Carer's Allowance (for someone caring for qualifying person)
✓ This is the easiest Medical Route pathway—no income checks, faster processing.
If you don't receive disability benefits, your local authority applies income thresholds. Typical thresholds (varies by council):
Homeowners
£31,000
Annual household income limit
Private Tenants
£36,000
Higher threshold for renters
Note: These are typical thresholds. Some councils set limits as low as £25,000 or as high as £40,000. Check your council's specific LA Flex Statement of Intent.
Some progressive local authorities waive income checks entirely for severe medical cases. Conditions typically include:
- • Terminal illnesses or life-limiting conditions
- • Severe immunosuppression (e.g., organ transplant recipients)
- • Severe respiratory failure requiring oxygen therapy
- • Children with serious health conditions
Contact your council's ECO4 team to ask if they operate medical priority waivers for exceptional circumstances.
Check Your Medical Route Eligibility Now
Answer a few quick questions to find out if you qualify for the ECO4 Medical Route and receive a free boiler replacement. Results in under 2 minutes.