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Independents' Day

Occupational health professionals reject GP calls to overhaul fit notes

Occupational health professionals have rejected the BMA's push to change the 'fit note' system to reduce GP workload.

The BMA voted overwhelmingly at its annual representative meeting earlier this year that 'there should be an extension of self-certification for illness from seven to 14 days'.

But occupational health professionals have argued that the current period of seven days 'works well for patients and employers', because it allows for an earlier conversation about how an employee may be helped to stay in, or get back to, work.

The Faculty of Occupational Medicine said in a position statement: 'We understand the strain GPs are under but from a patient perspective it is in their best interest to have a conversation sooner rather than later about how they might best return to work if they "may be for fit for work".

'That conversation starts with their GP and their employer.'

The faculty argued that 'getting employees successfully back to work is in everyone’s interests' because 'stable employment is important to good health', adding that 'the longer an employee is off work the more difficult it is to return successfully'.

Meanwhile, a survey of 122 occupational health professionals carried out by The At Work Partnership has found that nearly nine in 10 occupational health professionals disagree with the BMA's proposal.

In all, 86% of respondents said that self-certification should remain at seven days and only 7% agreed that it should be extended to 14 days. A very small number, 2%, thought it should be extended further.

One respondent to the survey said: 'I believe [the proposed extension] will result in individuals being off sick for longer, which will not be good for the employee or the employer who will not have medical advice on how to manage and support their member of staff.

'The whole purpose of the fit note was to get people back into work as quickly as possible. Extending the length of time for self-certification goes completely against this and would not be supported by many, if any, employers, particularly in the public sector.’

Another respondent said: ‘I perceive that this [proposed extension] would be abused by some employees who may see it as an easy way to take an extra holiday.’

As it stands, patients have to see a GP to get a fit note for their employer if they are sick for more than seven days, with the note stating whether the emploee is 'not fit for work' or 'may be fit for work'.

In the latter case, employers are urged to discuss with the employee what changes can be made so that the employee can return to work.

GPC deputy chair Dr Richard Vautrey said: 'There was strong support from the BMA's ARM for this idea from across the range of doctors present at the meeting. It's also not just about reducing GPs workload but to empower patients to a greater extent.

'However it does not prevent patients discussing issues with their GP when it is clinically appropriate and necessary for them to do so, and so there is no reason to believe that it would mean people would be off work any longer than they needed to be. As now, if any individual was abusing the system, this should be an issue for employers to deal with.'

Why do GPs want to change the fit note?

The BMA ARM voted in June that 'there should be an extension of self-certification for illness from seven to 14 days', amid GP complaints that the Fitness to Work scheme places too much of a burden on GPs.

The BMA also voted that 'a change in legislation is required to allow other health care professional such as midwives, allied health professionals and nurse practitioners to complete fit notes for patients'. And, it further demanded that 'the Department of Work and Pensions should establish their own means of determining benefits'.

Arguing in favour of the motion at the ARM, former GPC negotiator Dr Peter Holden told the meeting of a single day when 10% of his consultations were to certify people off sick for between seven and 14 days, including one request for a sick note that came from a hospital.

The Government announced in October that it will look into reducing GP workload by allowing non-doctors to sign off fit notes, as part of a wider review of the Fitness to Work scheme.

Readers' comments (16)

  • Dear Faculty of Occupational Health,

    Let me tell you how it goes

    Patient - (on emergency triage phone) Doc I've been off all of last week with the flu. I'm still feeling rough and I don't feel well enough to be climbing a ladder as a roofer

    GP - ok I'll sign you off for another week but you can go back earlier I'll you feel ok. Call back in a week if you still feel unwell.

    Clearly lots of dialogue about a phased return after 1 week off sick!

    Get real Occupational Health and stop propping up businesses who use GPs as a deterrent instead of performance managing their staff with high sickness levels. It's a clear abuse of the NHS.

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  • In Canada and Australia ,patient pays for his sick note
    its usually 15-20 dollars or 8-12 pounds so BMA should just lobby just introduce a 15 pound fees in UK collected by GP surgery to manage the increased work load.Why do we have to provide it free of charge .No body has come to harm to other countries they are working age people .

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  • The lesson is other health professionals find it very easy to say no.

    We're still find it too difficult!

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  • High sickness absence rates are determined by working conditions, financial incentives and management/work culture much more than medical issues. I would have thought occupational health doctors would understand this.
    One type of management failure is to treat employees like children and not believe them regarding illness, and the above views from the Occy Health Faculty members is complicit in this attitude.

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  • I'd argue the final decision is not for The Faculty of Occupational Medicine to make as it's not them having to do it. General practice is now on its knees with practices closing all over the UK. If we can't take simple action like extending self-certification how are we ever going to make the difficult decisions about commissioning and which services to save?

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  • There appear to me to be at least two problems here...

    The number of GPs at ARM vastly outnumbers the number of occupational health doctors. There is a risk that the OH doctors' professional views become irrelevant against such huge opposition - one of the problems with democratic principles.

    However, there's also a risk that - since fit notes are issued almost exclusively by GPs (I imagine - does anybody have the facts) - it's GPs who do this, know about it, and know the true costs and benefits of the current and proposed systems.

    I'm convinced by the GPs' arguments; but it would be nice to see the pros and cons laid out clearly on both sides.

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  • Ugh, got interrupted and ended up posting garbage... What I think I meant with my second point was that there's a risk that OH doctors will not be familiar with the actualities of how fit notes are requested and provided in reality. One of the things you learn in public health is that specialists over-value their own speciality: to a surgeon, all problems can be solved with an operation; to a tertiary care paediatrician meningococcal septicaemia is a common problem that the public should know more about... I exaggerate, of course; but you'll recognise a kernel of truth in this.

    Whereas it is GPs who actually sign and provide (I imagine) the vast majority of fit notes - I'd be amazed if more than 1% of them was provided by OH doctors. (I'd bet surgeons do many times more than OH doctors do.)

    This isn't to knock OH doctors; but to recognise that they see OH issues all of the time, and from a very different perspective from other clinicians.

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  • Actually, many fit note continuations are drafted by receptionists who wave it under the GPs nose to sign.

    On a busy on call day the temptation is to just sign them. I try very hard to not just do so, and open their notes. That way I have stopped many a patient getting away with multiple sick notes and no discernible review. We need the pressure taken of us now. It is no longer safe.

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  • We do these notes so should be able to change the system at will. No GP will ever dare to refuse a note therefore the system is useless. I tried to say "no" as a registrar but got a barrage of telephone abuse and threats so I quickly did the note and learned my lesson.

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