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Over three quarters of GPs feel obliged to issue sick notes

More than three-quarters of GPs are feeling under pressure to issue sick notes to patients even if there is no clear clinical need, a Department for Work and Pensions (DWP) survey has found.

The DWP survey of more than 4,000 GPs found that 77.4% feel obliged to issue sickness certificates, renamed fit notes in 2010, for reasons that were ‘not strictly medical’, a situation that has not improved since last year when the figure was 77.2%.

The GPC said that GPs are not equipped to deal with work issues and their time would be better spent keeping people healthy.

The survey asked a random sample of 4,179 GPs from England, Wales and Scotland 19 questions about their attitudes to health and work between September and November 2012 and the results were compared to a similar survey from the previous year.

The report said: ‘In 2012 as in 2010, the vast majority of GPs felt that a patient did not have to be fully recovered from their condition before they were able to recommend a return to work.

‘However, the vast majority felt obliged to issue sickness certificates for reasons that were not strictly medical.’

The survey also revealed that some GPs did not feel equipped to deal with patients’ work issues. Almost two fifths (37.6%) disagreed that they felt confident in dealing with patient issues around a return to work, though the vast majority (98.4%) agreed that work was generally beneficial for people’s health.

The DWP said that GPs knowledge of the benefits system and knowledge of local services to help patients get work-related advice could be improved, as only 27.6% agreed that their knowledge of the benefits system was up to date and less than one in five GPs (18.6%) agreed that there were good services locally to which they could refer their patients for advice about a return to work.

They added they could also improve training in health and work, after 89.6% of GPs reported they had not received training in health and work within the past 12 months.

Dr John Canning, chair of the GPC’s Professional Fees and Regulation committee and a GP in Middlesbrough said GPs often issue sick notes for people going through difficult periods as there is no other way for them to take time off work.

He said: ‘It comes down to the question ‘what is illness?’. An awful lot of people that you see with bereavement or family problems cannot work. In practice, it might not be illness, it might be an emotional reaction to a situation. There are better ways of taking sick leave, but most employers don’t see it that way so GPs will issue a sick note. If you think about it, it’s not a safe situation if you’re worrying about your child or your wife so you can’t work.’

He added that GPs were not the right professional to give work advice, and should stick to giving advice on health: ‘The reason that GPs don’t feel equipped to deal with work issues is that most of us have chosen to be GPs , we’re not occupational physicians. Providing more training on work isses is all very well, but where do I find the time to do it? There’s a person at the job centre who provides advice on work and they’d be much better at it than me, my time would be better spent keeping people fit and well rather than giving work advice.’


Readers' comments (4)

  • Refusal to give sick notes not only disrupts the doctor patient relationship but also may have legal ramifications as well.I'm aware of a significant number of patients on incapacity benefits they clearly do not deserve.Its very easy to play the system and feign conditions for which there are no objective tests such as pain syndromes and various psychiatric illnesses.Just get a DSM manual and take your pick.

    The politicians have abrogated their responsibility to deal with this broken system and as with "immigration checks" on patients passed on the buck to GPs.

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  • Your faith in 'the person at the job centre' is touching.....but shows a worrying lack of awareness if it encouragers another abrogation of responsibility to look after a person's overall health issues

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  • Some of the answer should be a greater willingness by employers to consider compassionate leave and flexible working, which would be a more sensible way of dealing with certain life events which impact on ability to work but don't really come under 'illness'.

    There are both ethical and practical issues around the extent to which GP's do or don't get involved in issues related to work. Most GP's realise that the DWP/JobCentre Plus often make inappropriate decisions about people's fitness for work, which means that most would feel the need to protect patients from such damaging decisions by providing sickness certification. If DWP and its contractors had a better record on getting these decisions right, rather than making decisions on the basis of wanting to stop paying benefit, GP's could more justifiably pull back from this area.

    But these are difficult issues, because health impacts on work and work impacts on health, so GP's can't really absolve themselves of responsibility in this area. The biggest problem, which may be what the author is alluding to at the end of the article, is that Government makes onerous demands on employees or potential employees whilst seemingly denying the need for employers to have a more positive attitude to employing, or continuing to employ, people who are sick or disabled. Until employers are required to put their own house in order, patients and their GP's will still struggle with this issue which has a huge impact on quality of life and well-being.

    The Government's proposals around occupational health support for small and medium sized businesses are helpful, but such support must be unbiased, not provided on the basis of reducing the benefit bill. If unbiased, INDEPENDENT occupational health support were available to employers, things could start getting a little easier for GP's.

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  • A GP who takes a holistic and preventative approach to patient care should have no problem with issuing a 'Fit Note'. There is little point in declaring someone fit for work on 'strictly medical grounds'...and a clear definition of that seems to be absent....only to find that a return to work is not sustainable or leads to to patients returning to work and then finding that doing so makes their health worse. This is often the case where either the patient needs to get back to work because they cannot afford to be off sick or because they have not faced up to the limitations they have to live with after diagnosis or treatment. This is particularly true of chronic conditions but also for acute but life changing problems like cancer. 'Strictly Medical' must acknowledge that physical illness has an emotional and psychological impact and mental illness can lead to neglect and physical ill health.

    Employers, no matter how helpful they are, need clarity on a person's health and their ability to do the job for which they have been employed.

    The DWP meanwhile makes no such distinction, the WCA is an 'all work' test which attempts to establish if a person is capable of doing any work, it does not seek to identify if doing so would be actually good or bad for a person's health. In order to do that it relies on doctors telling it.

    In short: employers have their own agenda, they want workers who can do the job. The DWP wants people off benefit.

    It is entirely within the range of a GP's competency to know if a person is well enough to return to a particular kind of work....and whether or not, if they lose their benefits this would prove injurious to their health either through stress or through impoverishing them.

    That these issues are being raised now by GP's says more about their work loads and how they see their role than about their actual ability to do what they have always done.

    I understand the need to manage and increasing work load but what use to a patient is a doctor who won't help them when they need it? Patients will not use the services of GP's perceived to be unhelpful and that will seriously undermine public health. Patients will not use the services of a GP again if they have had a bad experience at a crucial point in their lives.

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