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GPs ‘can spot long-term sick three years early’

By Lilian Anekwe

GPs can identify patients with mental health problems who are likely to be on long-term incapacity benefit up to three years before they stop work, according to a BMJ study.

An analysis of more than 37,000 responses to surveys in England and Scotland found that patients had worse general health and consulted their GP more frequently in the years before starting to claim incapacity benefit.

The results prompted the primary care researchers to say GPs should target patients who consult frequently with emotional distress, as this predicts increased risk of becoming dependent on benefits, in order to prevent the development of mental health problems.

For the 1,877 individuals who claimed incapacity benefits in at least one of the 17 British Household Panel surveys analysed between 1991 and 2007, there was a significant increase in the prevalence of frequent consultations – more than ten a year – with a GP before claiming incapacity benefit.

Rates of frequent consultations rose by 1.8 times in the three years before patients began claiming incapacity benefit.

And a comparison of performance on the General Health Questionnaire, a 12-item assessment where higher scores indicate more complex mental health problems, showed the rates of GHQ scores of four of higher rose by 1.6 times in the two years before a claim.

Becoming a frequent visitor to a GP increased the risk of going onto incapacity benefit to 5%, 6% and 8% in years one, two and three respectively.

Having a GHQ score of more than four and being a frequent visitor increased the risk to 6%, 13% and 16% in years one, two and three.

The researchers also examined the variation in incapacity benefit claims across Scotland. But after adjusting for differences in population characteristics there was no significant variation in the level of claims for incapacity benefit across general practices.

This, the researchers argued, was evidence that GPs were not issuing sick certificates inappropriately, and that ‘initiatives targeted at practices with high levels [of incapacity benefit claimants] are unlikely to be effective'.

Professor Jill Morrison, professor of general practice at the University of Glasgow, led the study and concluded: ‘General practitioners are well placed to identify people who are vulnerable to becoming dependent on benefit up to three years before this occurs by identifying frequent consulters with emotional distress.'

‘Much current policy is aimed at getting people who are on long term benefit back to work. It might, however, be more effective to focus on keeping those vulnerable to becoming dependent on benefits in work, rather than getting them back into work after a long period of absence from the workplace.'

But Professor Morrison argued GPs and vulnerable patients would need more support than is currently available.

‘Once such people are identified, however, it is not clear what general practitioners can do to maintain these patients in work, if that is the most appropriate outcome for individual patients', she wrote.

BMJ published online 18 August 2010.

Researchers found there was no evidence to suggest GPs were issuing sick notes inappropriately Researchers found there was no evidence to suggest GPs were issuing sick notes inappropriately

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