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NICE hands GPs responsibility for getting long-term sick back to work

By Nigel Praities

GPs are to be handed a key role in the Government's controversial drive to get patients off long-term incapacity benefit, under new draft guidelines released by NICE.

The guidance takes GP involvement in assessing patients' suitability for work from political imperative to new territory as part of a doctor's clinical work.

NICE says ‘suitably trained experts' – such as GPs or occupational health nurses – should make a formal assessment of the prognosis for returning to work within 12 weeks of an employee starting sick leave.

The guidance recommends GPs be involved in appointing a case worker and developing a ‘return-to-work programme' with employers, which could involve identifying tasks a patient could perform or suggesting modifications to the workplace.

The draft guidelines outline the framework for implementing Government policy to reduce the number of people claiming incapacity benefit by one million by 2017, with GPs placed in a central position in preventing people taking long-term sick leave.

They follow a controversial report published in March recommending sick notes be replaced by ‘well notes', with GPs informing potential employers what patients are fit to do at work.

That report was condemned by BMA chair Dr Hamish Meldrum as turning GPs into the ‘policing arm of the Department for Work and Pensions', and GPs expressed similar fears over these proposals.

Dr Clare Gerada, vice-chair of the RCGP, said it was ‘very stressful' for GPs to the gatekeepers to sick leave and that she was uncomfortable with the new guidelines.

‘I just don't think it is our territory. Many of these people have mental health problems and it is very difficult to challenge somebody and say "You can work",' she said.

Dr John Canning, a GP in Middlesbrough and chair of the professional fees committee at the BMA, said he welcomed the emphasis on employers taking action, but had concerns over the effect of the guidelines on the doctor-patient relationship.

‘If the patient is thinking "This is the doctor who can take away my benefits", that is not a good context in which to have a good therapeutic relationship,' he said.

Dr Canning said the assessments should be conducted by specially trained GPs or occupational health GPSIs and not the patient's own GP.

The consultation on the draft guidelines will close on the 17 September.

What does NICE want GPs to do?

- Assess need for sick leave and prognosis of returning to work within 12 weeks of a person starting sick leave (and ideally between 2 and 6 weeks)

- Ensure the co-ordination and delivery of interventions is agreed by employee and employer

- Be involved in appointing and working with caseworker

- Develop return-to-work or rehabilitation programmes

- Arrange more specialist input when there is recurring long-term sickness

- Reduce risk of further sickness absence

Dr Clare Gerada: claims getting long term sick back to work should not be GPs' territory Dr Clare Gerada

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