New Research With GPs Suggests Sick Notes Are A Complex Issue, UK

Main Category: Primary Care / General Practice
Also Included In: Public Health
Article Date: 04 Jul 2008 - 2:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

New qualitative research presented today (2nd July 2008) at the Annual Scientific Meeting of the Society of Occupational Medicine suggests that GPs have widely differing views about their role in filling in sickness certificates, find it difficult to assess fitness for work and are concerned about their lack of training in Occupational Health.

This research has important implications for one of the key recommendations of Dame Carol Black's recent Review - that the outdated paper-based sick note should be replaced with an electronic 'fit note'. This Review into the health of the working age population 'Working for a Healthier Tomorrow' found that ill health was costing the country a £100 billion a year - enough to run the entire NHS.

The Society of Occupational Medicine called today for occupational health doctors to be involved in the redesign of the new electronic 'fit note' and for further research and robust trials to be undertaken before any new system is put into place. GPs also need to be able to access the expertise that occupational health doctors and nurses offer and have fast access to treatments such as physiotherapy and psychological support.

The new research was carried out by the Centre for Occupational and Environmental Health, University of Manchester. The researcher undertook in depth telephone interviews with 31 General Practitioners who had issued sickness certificates in cases submitted to The Health and Occupation Reporting network for GPs (THOR-GP). These interviews examined issues such as the nature of the interactions between the GP and the patient, the factors that influenced whether a sicknote was given and the GP's overall views on their role as providers of sicknotes.

One of the other key themes was a perceived conflict with the doctor/patient relationship. One GP interviewed in the study was quoted as saying:

"I think it affects a doctor-patient relationship, and I tend to be, in terms of preserving that, to be on the patients' side. I don't think that it's appropriate for us to be policing social services."

Professor Raymond Agius, Leader of the Occupational and Environmental Health Research Group at the University of Manchester said "This research was carried out with GPs who have a qualification in occupational health and yet many of them felt ill-equipped to deal with certification. Complex interactions underlie the provision of a 'fit note' and we need to be providing more education in Occupational Medicine to all medical undergraduates and to provide further opportunities for GP training in this specialty as well as giving them and workers more access to specialist occupational health physicians"

The findings of a separate quantitative study from the same research group were also presented at the conference. This analysed 1263 cases of work-related ill-health seen by GPs. Over half (55%) of all the days given a sickness certificate were down to mental ill health but that very few of these cases were referred on to hospital specialists. This finding highlights the importance for GPs to have adequate training in occupational health and also to have the time to deal with what can be complex cases.

Gordon Parker, President of the Society of Occupational Medicine said "These findings confirm what we have believed and understood for many years - that GPs struggle with the ethical and technical judgements that are required when issuing sick notes. Many members of the Society of Occupational Medicine are either GPs with a particular interest in work and health, or are specialists who have had first-hand experience of general practice. The Society is keen to support GPs through training and through peer support for members, particularly if the nature of the "sick note" is going to change to a more positive "fit note".

Notes

The Society of Occupational Medicine is the largest UK organisation for all doctors with an interest in Occupational Medicine.

Occupational Health Doctors:

• Help prevent work-related ill health
• Advise on fitness for work
• Advise on appropriate adjustments in the workplace to help people stay in work
• Provide rehabilitation to help people return to work
• Identify and advise on what people CAN do, so that alternative suitable work for people with health problems can be found
• Promote healthy lifestyles and health in the workplace
• Advise employers on appropriate policies to maintain a safe workplace

The Occupational and Environmental Health Research Group, at the University of Manchester runs a national research programme entitled The Health and Occupation Reporting Network (THOR) in which more than 2000 doctors participate including 300 GPs

The qualitative research is entitled 'What prompts GPs to issue sickness certificates". The authors are Money A, Hussey L, Thorley K, Turner S, Agius R, from the Occupational and Environmental Health Research Group at the University of Manchester

The quantitative study referred to in this media release is entitled General Practitioners' referral patterns for cases of work-related ill-health. The authors are Hussey L*, Turner S*, Thorley K*, McNamee R+, Agius R* . * Occupational and Environmental Health Research Group, The University of Manchester, UK and +Biostatistics Group, The University of Manchester, UK

Society of Occupational Medicine