Columnist Dr Katie Musgrave questions whether signing twenty-somethings off work will really help them in the long run
Another day, another request for sick notes. This time it has been a handful of twenty-somethings. They’ve been signed off for months, haven’t engaged with social prescribers, and all have a diagnosis of depression or anxiety. They live with their parents and don’t feel able to go to work. I say ‘they’ because I’m signing off the third of the day. Not only is this sad, but it is also worrying for our society.
I don’t know about you, but I struggle nowadays to make time to explore my patients’ willingness (or not) to go to work. I remember in the past, as a fresh-faced trainee, discussing barriers to work and trying to encourage patients to look for jobs that they could manage. But in the midst of mounting pressure, it seems these conversations about work have been deprioritised. Have we given up the battle? Are we now all just signing everyone off, no questions asked?
The sickness absence rate in the UK (the percentage of working hours lost because of sickness or injury) increased to 2.6% in 2022, up 0.4 percentage points from 2021, and 0.7 percentage points from the 2019 pre-pandemic level. It is now at its highest point since 2004, when it was 2.7%.
Looking at the chart over recent decades, there has been a steady decline almost year on year from when the records began in 1995. Something happened in 2020 that has sent the rate soaring. Was it sending everyone home for several months and giving out lots of money in furlough? Was it the stress of isolation, loss of social connections, the mental health impacts of the pandemic and lockdowns, as well as government / public health messaging around this time?
Is it sky-high rates of long Covid, and permanent disability in the population as a result of the virus? Is a more insidious societal malaise and ennui filtering through – resulting from our addiction and enslavement to modern technology, particularly marked in the young? Or might it simply be that GPs are too overworked and overwhelmed to engage with patients about their employment, and now simply sign off anyone who asks for a sick note?
‘Who cares?’, you might be thinking, ‘I’m not paid to police people’s work, and I haven’t got the time or inclination to enter into a debate about it with my patients.’ But when 20-year-old after 20-year-old presents with a request to be signed off for months on end, with no physical disability and a diagnosis of anxiety, you have to start to question who we are helping.
By signing off yet another 20-something, am I not helping to consign them to a destiny of worklessness, increased anxiety, reduced activity, dependence on benefits, and ultimately a shorter life expectancy? The more young and physically healthy people that we sign off as being unfit for work, the lower the productivity rate of the UK, and ultimately the poorer the public services available to help them lead healthy lives. There is, of course, a big difference between signing off a 68-year-old with arthritis, and a fit twenty-year-old; with hugely different lifetime and societal impacts.
It doesn’t make sense to me that GPs should be the arbiters of whether patients are fit to work. First, we are too busy dealing with medical problems (has anyone noticed the crisis in our numbers?). Second, there is no incentive whatsoever for us to enter into a debate with a patient about this – we offend them, they complain about us, and the patient-doctor relationship is eroded. And third, we are all just too soft to push the issue anyway. It’s far better to have an independent system where a print-out of recent consultations can be taken to a workforce assessment, and someone else can determine what kind of work might be possible.
Still, on current trends, in another few decades there may be no one left in the workforce. If that includes GPs, then we won’t be able to dole out any more sick notes.
Dr Katie Musgrave is a GP in Devon and quality improvement fellow for the South West