Dr Copperfield urges GPs to see the bright side of the proposed fit note reform
I know I’m always banging on about the dangers of deconstructing primary care. But losing responsibility for signing Med 3s (or being ‘stripped of the right to issue them’ as The Times hilariously described it) gets a massive smiley face and thumbs up from me. Because it’s not so much a fragment of general practice as it is actually a massive piece of perianal shrapnel.
Signing sickies (or ‘fitties’, as said by no one, ever), is at best an administrative hassle and at worst an appointment-gobbling waste of time and energy. To those who might offer the reflex protest that GPs are ‘best placed to judge a person’s fitness to work’, I would say, after careful consideration, that this is utter bollocks – both in theory and practice.
In fact, I am best placed to simply cave in: I have no objective sick-ometer, nor any real idea how their ‘sickness’ impacts on their work. The only thing that I am certain of is that Med 3 refusal will cause anything from tantrums and destruction of the doctor/patient relationship, to formal complaints. So when’s the last time you said, ‘No’? Exactly.
Yes, I know there’s genuine sickness out there and that mental illness (to take one big example) is an area with zero service provision at present. But do me a favour – why sign off for the following?
- Depression – how does loss of structure/income/role help, exactly?
- Bereavement – yes, it’s sad and disruptive, but why do I have to validate as an illness a perfectly normal human reaction just for people to get the time and space they need?
- Work-related stress – by definition, that’s a work rather than clinical problem, and being signed off sick is simply the most effective and prolonged way of failing to address the real issue.
These examples, and countless more, simply show how ridiculous the current system is and also denigrate the truly sick and deserving.
I’ve no idea how the new set up might work, but I’m all in favour of it so long as the appeals process isn’t worse than the original issue. And I don’t want to come across as a rabid far-righter or a complete bastard. I’m not right wing and I’m only a partial bastard. But Med 3s are Mad 3s, and I’m completely sick of them.
Dr Tony Copperfield is a GP in Essex
Tony, you’re completely wrong on this, mate. Med3s are the easiest consultations allowing me to catch up, plus the bonus of gratitude from the patient. Why hand them over to some privatised knobs? In fact, you could do with a med3 yourself, for 6 weeks. Condition: 1. funnybonectomy , 2. “partial bastard” disorder (self-diagnosed) , 3. Baaarking sheep fixation, 4. Essex.
Catch up and recharge with some Derek and Clive classics or Stewart Lee vids..
A lot of our Med 3 work is actually very straight forward and it is right we do it. The problem is longer term Med3s with ‘hidden disabilities’ where barriers to return to work is affected by non medical external factors.
The reality is decisions could probably be made by a citizen’s jury rather than needing any medical input
Maybe a start to remove pretend diagnoses of ‘fibromyalgia/ chronic fatigue from acceptable conditions for fit notes, so this sad cohort do not become sadder/ more unfit and fatter.
I’m 100% with Tony on this one. As GPs we are our patients’ advocate. Be honest, you always side with them. It’s done by a separate system in Scandinavia and Canada. The only thorn with a new system is providing reports- but factual ones.
An appointment for a med3?! Are you mad? They have mostly been tasks completed under 10 seconds and in bulk ( from what I’ve been told.)