PIP Activity 3: Managing Therapy - Complete Scoring Guide

Activity 3 is the most commonly underscored activity. It covers managing medication, monitoring a health condition and therapy you do at home, and since 2017 the regulations score those three things differently. This is PIP2 Question 5. If you take multiple medications, attend regular appointments and need help managing it all, you should be scoring on this activity.

What Counts as "Therapy"?

Since 16 March 2017 the regulations split this activity into three things, and the difference decides how many points you can score. "Medication" is medicine you take at home that a doctor, nurse or pharmacist has prescribed or recommended, whether tablets, inhalers, creams or injections. "Monitoring a health condition" means checking for changes that would make you worse and acting on them, such as testing blood sugar or blood pressure. "Therapy" is non-drug treatment you do at home that a registered doctor, nurse, pharmacist or a professional regulated by the HCPC (a physiotherapist, dietitian or psychologist, for example) has prescribed or recommended. The DWP assessment guide gives physiotherapy, exercise regimes, home dialysis, compression bandaging and special diets as examples. The regulations say in terms that therapy does not include taking or applying medication or monitoring a health condition. That matters because only therapy is scored by the hour. Needing help with medication or monitoring scores 1 point however long it takes, and hospital or clinic appointments are not therapy done at home.

The Descriptors and Points

a. Does not receive medication or therapy and does not need to monitor a health condition, or can manage medication or therapy or monitor a health condition unaided - 0 points.

b. Needs an aid or appliance, or supervision, prompting or assistance, to manage medication, or needs supervision, prompting or assistance to monitor a health condition - 1 point. A dosette box, alarms or reminders, someone reminding you to take your tablets, checking your inhaler technique or helping you test your blood sugar. Very common with depression (no motivation) and ADHD (forget). It is a single point however many medicines you take and however long the rounds take.

c. Needs supervision, prompting or assistance to manage therapy that takes no more than 3.5 hours a week - 2 points.

d. Needs supervision, prompting or assistance to manage therapy that takes more than 3.5 but no more than 7 hours a week - 4 points.

e. Needs supervision, prompting or assistance to manage therapy that takes more than 7 but no more than 14 hours a week - 6 points.

f. Needs supervision, prompting or assistance to manage therapy that takes more than 14 hours a week - 8 points.

The hours in c to f are therapy hours only, and the DWP guide measures them by the time someone has to supervise, prompt or assist you. Time spent taking medication or monitoring your condition does not count towards them, whoever helps you.

How to Calculate Your Weekly Therapy Time

Count only therapy done at home that a registered professional has prescribed or recommended, and only the time another person has to supervise, prompt or assist you with it. Add up a typical week:

• Physiotherapy or exercise programme set by a physiotherapist, done with someone prompting or supervising: 15-30 minutes a session
• Wound dressing changes or compression bandaging done by a carer or district nurse at home: 20-60 minutes each
• Home dialysis, including set-up and clean-down, where someone assists: several hours a session
• Speech and language, swallowing or breathing exercises prescribed by a therapist, with someone supervising: 10-20 minutes a session
• Exercises set by a psychologist or CBT therapist that someone has to sit with you for: 15-30 minutes a session
• A special diet prescribed by a dietitian that someone has to help you follow at home: the time they spend helping

Do not add medication rounds, injections, inhalers or creams, blood sugar or blood pressure checks, or hospital appointments and the travel to them. Those are medication, monitoring or appointments, not therapy at home, and needing help with medication or monitoring scores descriptor b (1 point) instead. A nebuliser counts as medication or therapy depending on what it delivers, so say what is in it. Genuine therapy time adds up more slowly than people expect, so be accurate rather than generous: an assessor who sees medication time counted as therapy will discount the whole estimate.

The Key Question: Do You Need Help?

If you take all your medication independently without any reminders, you score nothing here. If anyone prompts you ("have you taken your tablets?"), fills your pill box or checks you have taken them, that is descriptor b and worth 1 point. The higher descriptors only open up when someone has to supervise, prompt or assist you with therapy at home, so if a physiotherapist has set exercises that you only do when your partner does them with you, that is the time to count.

Supervision vs Prompting vs Assistance - The Critical Distinction

All three count under Activity 3 but they mean different things, and the DWP often refuses to score the descriptor because the claimant did not use the right word:

• Supervision means another person needs to be present and watching while you do something - for example, someone watching you inject insulin in case you have a hypo or sitting with you during a CPAP setup in case the mask leaks. Supervision is the highest-quality time because the carer cannot do anything else.
• Prompting means another person tells you to do something or starts the activity off. Reminding you to take medication, telling you it is time to do your physio or starting a CBT exercise with you all count as prompting.
• Assistance means another person physically helps you do something - filling a pill organiser, applying a cream to your back, changing a wound dressing, drawing up an injection.

You only need ONE of these to qualify. The DWP wording in the regulations is "supervision, prompting OR assistance" - any of the three triggers the descriptor.

Reliability Criteria Apply Here Too

Under PIP Regulations 2013 reg 4(2A), you only count as managing therapy independently if you can do it:

• Safely - without risk of harm to yourself. Forgetting insulin, taking wrong dose, missing critical medications all fail this test.
• To an acceptable standard - all doses taken correctly, all equipment cleaned and maintained.
• Repeatedly - every day, not just on good days.
• Within a reasonable time - not 4 hours to take a 10-minute medication round because of fatigue.

If you cannot do it on the majority of days because of pain, fatigue, depression, anxiety, cognitive impairment or any other reason, you should score for prompting at minimum.

Worked Example - Medication and Therapy Scored Separately

Take a claimant with type 1 diabetes, COPD and depression whose partner reminds them about insulin and inhalers, checks their blood sugar readings and prompts the antidepressant each morning. However long all of that takes, it is medication and monitoring, so it scores descriptor b: 1 point.

Now add that a physiotherapist has prescribed a daily breathing and exercise programme for the COPD, and the claimant only does it when the partner sits with them and talks them through it: 20 minutes a day, 7 days a week, is about 2.3 hours. That is therapy with prompting and assistance of no more than 3.5 hours a week, which is descriptor c: 2 points. Only one descriptor can be awarded for an activity, so the claimant scores 2 points for Activity 3, not 3.

If the exercise programme were 45 minutes twice a day with the partner present, the therapy time would be about 10.5 hours a week and descriptor e (6 points) would apply. The medication time never changes that.

Common Mistakes That Cost Activity 3 Points

• Counting medication time as therapy hours. Pill box filling, ordering repeat prescriptions and checking you have taken your tablets all support descriptor b, so describe them, but they score 1 point in total, not hours in c to f.
• Counting appointments and travel. Clinic and hospital appointments are not therapy done at home. Mention them as evidence of your treatment, but do not add them to the weekly hours.
• Not mentioning "as required" medication. Rescue inhalers, anti-emetics, breakthrough pain relief or PRN psychiatric medication still need managing, and needing someone to prompt or check them is descriptor b.
• Saying you "manage your own medication." Even if you swallow the tablets yourself, you may still need someone to remind you, fill the box, order repeats or check you took them. That is supervision, prompting or assistance with medication.
• Treating prescribed exercises as optional. If a physiotherapist prescribed home exercises and someone has to prompt you or do them with you, that is therapy, and the time they spend with you is what the hours in c to f measure.

Evidence That Helps Activity 3 Claims

• Repeat prescription list from your GP or pharmacy showing every regular medication
• Appointment list - hospital outpatient letters, mental health appointments, physio sessions
• Letter from a family member or carer confirming the support they give with medication and therapy
• Pill organiser or chart photograph if you use one
• Therapy plan from a psychologist, physiotherapist or specialist nurse
• Diary showing typical day with timings

Frequently Asked Questions

Does taking one tablet a day count for any points?

Only if you need an aid such as a dosette box, or supervision, prompting or assistance, to take it. That scores descriptor b (1 point). Taking it independently scores nothing for Activity 3, and adding up appointments or blood tests does not change that, because medication and monitoring are not scored by the hour.

I have a weekly pill organiser - does that affect my score?

Yes. Needing an aid or appliance such as a pill organiser to manage your medication is descriptor b (1 point) in its own right, and so is needing someone to fill it or prompt you to use it. Say who fills it and what happens when it is not filled.

Do hospital appointments count as therapy time?

No. Therapy for this activity has to be done at home, so clinic and hospital appointments and the travel to them do not count towards the weekly hours. They are still worth mentioning as evidence of your treatment, and if you need someone with you to get there, that may score under planning and following journeys (Activity 11) rather than here.

What about checking blood pressure or blood sugar at home?

That is monitoring a health condition, not therapy. If you need someone to supervise, prompt or assist you with the test, or to act on the readings for you, it scores descriptor b (1 point). The time it takes does not count towards the therapy hours, however intensive the regime.

Can the same time count for both Activity 3 and Activity 1 (preparing food)?

No. The DWP does not allow double-counting. Choose the activity where the support is most clearly therapy-related. Insulin calculation before a meal is Activity 3; preparing food to manage diabetes is Activity 1.

I attend therapy weekly (CBT, counselling). Does that count?

The sessions themselves do not, because they are not therapy done at home. Exercises your therapist sets for you to do at home do count, but only for the time someone has to prompt you or sit with you to do them. Note that time in your log.

What if I refuse or stop my medication?

Be honest. Many people with chronic conditions cannot tolerate their medication, or stop because of side effects, cost or mental health. Explain why. Refusing prescribed treatment does not lose you points provided you have a reasonable explanation - inability to tolerate, side effects or psychiatric symptoms preventing compliance.