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GPs sending more patients back to work with ‘fit notes’

By Gareth Iacobucci

GPs are sending more people back to work following the introduction of fit notes, but the new system has led to an increase in consultation times for half of GPs, new Government research has shown.

The preliminary results of an academic evaluation of fit notes, commissioned by the Department for Work and Pensions to review the first six months of the scheme, found that half of GPs had sent more patients back to work since the scheme was introduced, with nearly three quarters claiming the scheme had helped their patients make a phased return to work.

The increase prompted the DWP to hail the scheme as a success, but the study, which surveyed over 4,000 GPs, also found that half had reported an increase in consultation times since they began using fit notes – raising questions about the workload being placed on GPs' shoulders.

Only one GP in five said they had good local services available in their area which they could refer patients for either advice or support in returning to work.

Fit notes were introduced in April 2010 to replace the previous sick notes system, and require GPs to issue a note following an assessment of the activities and duties patients are fit to perform.

The evaluation by the former National Primary Care Research and Development Centre also found that 61% of GPs thought the fit note had improved the quality of their discussions with patients about return to work, while 62% felt it had made a change to their practice.

The evaluation was led by Professor Bonnie Sibbald, professor of health services research at the University of Manchester.

Professor Sibbald concluded: ‘The majority of GPs perceive the fit note to have had a positive impact on the quality of consultations, the advice they give on fitness for work and importantly, outcomes for patients.

‘GPs were evenly split on whether the fit note had increased the length of consultations. This may be because at six months after implementation it was too early for GPs to assess the impact of the fit note on consultation times. As the fit note further embeds into GPs practice, future research may be able to identify consensus on this issue.'

Lord Freud, parliamentary under secretary for work and pensions, and a minister for welfare reform, said: ‘The evidence clearly shows that although there is still much to do, the fit note concept is working.

‘Not only has it improved the advice offered by GPs and the quality of discussions they have with patients but it has also helped people get back to work sooner.

‘Improving communication between GPs, individuals and their employers is critical if we are to stop people when they develop a health condition needlessly falling out of work and risking a lifetime of benefit dependency. The fit note is a key part of this.'

A longer report describing all the findings from the research and presenting more detailed analysis will be published in summer 2011.

GP fit notes Fit notes evaluation

48 % agreed that it had increased the frequency with which they recommend a return to work
70 % of GPs agreed that the fit note had helped their patients make a phased return to work
49% said fit notes had increased the length of consultations
20 % of GPs agreed that there are good services locally to which they can refer patients for advice about a return to work.
19 % reported that there are good services locally to which they can refer patients who need support in returning to work.

Source: General Practitioners' attitudes towards patients' health and work, DWP, April 2011