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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.