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Not fit for purpose

GP For Hire predicts the fall-out from the introduction of the new 'fit note' next month.

Fit Notes. Heard of them? No? Well from the 6th April 2010 they are meant to be replacing the Med 3 and Med 5 forms.

No longer will it be an all or nothing for patients – e.g. sore finger so they can't type so they are signed off sick. Instead the new form will allow the GP to state the patient is fit for work as long as it doesn't it doesn't involve typing .

That's right, GPs can specify what a patient can and can't do. Never mind the fact that you are not an occupational health doctor and have no training in assessing what a patient can and can't do. So when seeing a patient needing a fit note you would ideally take a detailed history about how their condition affects them, examine them and ask about what the patient does at work and what adaptations can be made (perhaps even phoning work?).

However we don't live in an ideal world and we are not occupational health doctors. We have 10 mins to take a history, examine, check for QOF points and listen to excuses why they can't work.

You tell them that you think they could work if their employer made some changes but then follows a tirade of excuses why their employer can't do this and if you could just say they can't work it would be a lot easier. You think about arguing the point but notice that you are now running late. Instead you sigh, sign on the dotted line and off home the patient pops with a diagnosis of stress related problem and they can't work for two weeks.

Of course the patient pops back in 2 days saying work wants a proper sick note as they haven't heard of fit notes. Brilliant.

Let's be a bit more optimistic. A few weeks later another patient sees you needing a fit note. This time the conversation goes a bit better and you persuade them that they can get back to work as long as certain changes are made. They then go back to work, have an accident and then promptly blame and try and sue you for saying they could work when they couldn't. Genius.

GP For Hire