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GPs go forth

GPs are signing 7% more fit notes than a year ago

The number of fit notes issued by GPs in England has risen by more than 7% in the space of a year, official figures have shown.

NHS Digital statistics show the number of fit notes – previously known as sick notes – authorised by GPs increased from 2,292,182 between July and September 2018, to 2,462,938 during the same period in 2019.

GP leaders said the steep rise could be down to the tendency for hospital doctors to pass on the activity to GPs, in combination with increasing numbers of patients being too ill to work.

There is an ‘urgent need’ to reform the way fit notes are issued, particularly at a time when GPs are already struggling with workload demands, they said.

Fit notes, signed by GPs after a patient has self-certified their ill health for seven days, replaced sick notes in 2010 under the new system of assessing claims for welfare benefits when someone is too ill to work.

Between July and September 2019, mental and behavioural disorders were the most common reason for a patient needing a fit note signed by their GP.

A total of 261,127 notes were signed for mental health conditions – around 11% of all those authorised.

The rise in number of fit notes issued by general practice is partly due to other areas of the NHS passing on the extra workload, according to GP leaders.

Dr Peter Scott, a Birmingham GP and chair of Solihull LMC, said hospitals should be doing more to help.

He said: ‘The hospitals do often throw the workload on to the patient’s GP when they come home. Sick notes could be generated in the hospitals, but they are thrown onto primary care. It’s easier to pass it on.’

Dr Richard Vautrey, chair of the BMA’s GP Committee, highlighted the workload pressures facing GPs and called for a wider range of hospital staff to be able to sign fit notes to ease the burden.

He said: ‘This is yet another indicator of the workload pressures GPs are under, and the growing number of patients who are too ill to work because they are living with conditions like anxiety, stress and depression.'

Dr Vautrey added: 'It’s clear there is an urgent need to see reform of the fit note arrangements. This must include extending the period of self-certification and enabling more healthcare professionals to issue fit notes, including hospital practitioners.’

A Pulse survey of over 800 GPs taken in 2018, found that a fifth of GPs said the advice they gave on fit notes was ignored by employers.

A Pulse investigation into welfare benefits last year found that among those patients who go on to try and claim employment support allowance, but are told they are fit for work, the majority (68%) win their appeal. GPs warned the system of assessment was not fit for purpose.

 

Readers' comments (19)

  • "Do DWP think that we GP are best placed to supply fit note? "

    - No the obvious answer to that is we are 'free'. Such a simple thing to sort isn't it, GPC could simply say NOPE we're not doing this anymore, and I'm sure a vote would be in favour of that overwhelmingly. And yet...

    |More Money for No New Work! | GP Partner/Principal|06 Feb 2020 9:13am

    - UBI doesn't work. Tried in Finland. Go look at the studies. Such a surprise really (being ironic), that its a new concept that throwing money at people doesn't work. Applies to just about most benefits really. Negative income tax, a Friedman idea, is promising though.

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  • '- UBI doesn't work. Tried in Finland. Go look at the studies. Such a surprise really (being ironic), that its a new concept that throwing money at people doesn't work. Applies to just about most benefits really. Negative income tax, a Friedman idea, is promising though.'

    There is effectively a UBI already - you just have to develop chronic pain or depression and fill in the right forms. Do you suggest housing benefit and ESA/PIP is any better?

    Negative income tax isn't much different from UBI once you adjust tax thresholds etc, just a different way of accounting for it.

    DOI - generally a low government, reduce the NHS supporter and fan of Friedman and Hayek.

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  • |More Money for No New Work! | GP Partner/Principal|06 Feb 2020
    "There is effectively a UBI already - you just have to develop chronic pain or depression and fill in the right forms. Do you suggest housing benefit and ESA/PIP is any better? "

    - I totally agree. So no I think whatever name you give it, it does more harm than good. The difference with NIT over UBI, is the threshold that you set must adequately incentivise working even a low wage job, over NOT working. I believe Friedman suggested half? the annual average income per capita, so that it covers the 'bottom 10-20%'? That can always be debated if we ever move in that direction. But I'm glad we're on the same team :)

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  • @Christopher Ho- Yes, to be effective it needs to be tiered so that every increase in income guarantees a higher take home. It does provide a UBI in most models where someone earning 0 gets money which gradually reduces as wages increase until at a certain wage it flips, and income tax is paid, but never so much that extra work is disincentivised. Like a blunt UBI, which as you mention is ineffectual, the system of multiple different means tested benefit IS eliminated hopefully saving costs.

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  • life is sh## out there for people at the moment. what do they expect?

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  • I dont think fit notes should be due to GPs to issue anymore. They should be done by OH doctors paid for by employers or just trust their employees word. And I am sick of employers sending patients to see me to be 'signed back to work' to cover the employer

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  • MED3s are bonkers - especially when occupational health ask us to do a sick note! What a waste of time!

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  • research shows " a fifth of GPs said the advice they gave on fit notes was ignored by employers."
    and the worst 'employer' in this regard is DWP who will not accept our advice on what patient is fit for!
    All British-trained Doctors and Nurses and all those in training posts know all about Fit Notes, but some choose to lie and distress patients because they are too lazy to issue in hospital.
    GMC is supposed to have vouched for the knowledge of foreign-trained consultants, but I am not so sure....

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  • For those of you plagued by employers asking for 'fit to work' documentation just give the patient page 19 of the following document (better still get the admin team to)!

    https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/465918/fit-note-gps-guidance.pdf

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