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GPs urged not to consider patient's job when assessing fitness for work

GPs should consider a patient ‘fit for work’ if they safely able to do some types of work, but not their current job, according to revised Government guidance on fit notes.

The Department of Work and Pensions guidance emphasises that GPs should tick the ‘may be fit for work taking account of the following advice’ box if patients can do some form of work, and that this advice should not be ‘job specific’.

The new guidance - which was written in conjunction with the BMA, the RCGP, also recommended using computer generated fit notes, as they have added benefits including being easy to read, removing the need to issue duplicates, and improving continuity of care.

Released last month, the revised guidance says GPs should give advice about the functional limitations of a patient’s condition on their fitness to work, including stamina, mobility, effects of treatment etc, but are not expected to have specialist knowledge of workplaces or occupational health, and do not need to suggest possible changes to patients’ jobs or workplaces, the guidance says.

It said: ‘Your assessment about whether your patient is fit for work is about their fitness for work in general and is not job-specific. Always consider if your patients could do work of some kind before advising that they are not fit for work.’

‘Remember to consider carefully whether advising your patient that they are not fit for work increases the long-term health risks of worklessness.’

The advice further clarifies previous guidance, released in 2010 when Med 3 and Med 5 notes were combined into the new fit note, in which there was less emphasis on advising that a patient is fit for work if they are able to carry out some form of work.

Dr John Canning, chair of the GPC’s Professional Fees and Regulation committee, said that while the guidance may be more strongly-worded, it ‘did not represent a change in policy’ and was simply a ‘statement of fact’.

Readers' comments (4)

  • well, this should certainly see the end of 'not fit for work' notes.

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  • Fundamentally nothing has changed.GPs are still expected to do the government's dirty work because it cannot be bothered to make any radical changes to the welfare system.Why lose votes when patient's can blame doctors instead if denied sick notes.Most patients that i issue sick notes to are essentially work shy and better off on welfare benefits than returning to a minimum wage job.It should be a simple matter of preparing a list of medical conditions for which sick notes can be issued.The way i see it its a political matter not a medical one.At the end of the day we're left carrying the can with the doctor-patient conflict not the politician.

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  • Do GPs need to be involved in notes at all.
    Sickness and fitness to undertake duties, is between an employer and the employee, and businesses should be using their own occupational health services, and not be subsidised by the NHS.
    Benefit claimants have to be reviewed by ATOS anyway.
    There is no need for GPs to be involved in these disputes and arguments.

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  • Of course GPs must continue to be involved in helping people to decide whether they are well enough to work, and in certifying this view where it will help both patient and employer. It is disappointing that your above anonymous correspondents are so intent on reducing their own workload that they want to offload to anyone, however unsuitable. Patients trust their GPs (though perhaps not your second anonymous correspondent above). We are not paid by either the Benefits Agency or by their employers, so our view on fitness for work can be taken from the patient's perspective. (We ARE paid for sickness certification through target net income, but we are not under any pressure from the DH (yet!) to achieve any particular level of certification of fitness.) If we don't know enough about occupational health to advise our patients, it is about time we learned about it. It is far more relevant to general practice than a great deal that the rarer causes of B12 deficiency or peripheral neuropathy. In contrast to your cynical second anonymous correspondent, my experience in over 25 practices In Leeds and district is that many patients need to be persuaded to take time off, especially those with depression, or in whom their sickness is a threat to others' health, or indeed to their own health. Many feel intimidated by employers to stay at work when it is neither in their or their employers' interest that they do so.

    As regards the question of whether the certificate should reflect fitness for current job or any job, this surely must depend upon the period of time of, the nature of the illness (whether recovery is to be expected, and whether the patient actually has a job to return to. If your above correspondents had myocardial infarcts or bowel resections, they would expect to take time off work (I hope) and have it certified by their GP, even though they might still have the capability to write a prescription or a sick note!

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