Overhaul Of The Sick Note System Is Long Overdue, Says British Medical Association

Main Category: Public Health
Article Date: 25 Nov 2008 - 9:00 PST

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The package of measures announced today to get people back to work and to help them stay in work may be a step in the right direction, the BMA said today. Commenting on the government's response to Dame Carol Black's review of the health of the working-age population, Dr Laurence Buckman, Chairman of the BMA's GP Committee, said:

"The BMA has been calling for the sick note system to be reviewed for over ten years and we believe a Fit for Work service to help people back into employment may be the right way forward. The new 'fit note' has potential, but we would like to see the findings of this evaluation because it's crucial GPs can continue to act as the patient's advocate and don't end up policing the system for the Department for Work and Pensions."

Dr Paul Nicholson, Chairman of the BMA's Occupational Medicine Committee, said:

"We're glad the government has recognised more needs to be done to help small and medium sized businesses deal with employee health, though we would have liked to have seen a commitment to making sure every worker has access to basic occupational health services. Employers do need to take more responsibility, particularly in difficult economic times like now, as work-related ill health problems may well become more common."

The following background note explains how the situation works at the moment, regarding the role of GPs in issuing sickness certificates.

GPs do not make decisions on Incapacity Benefits (IBs).

Statutory sickness benefit is payable from day three of an illness and is available for 26 weeks.

From day three to day seven of an illness the patient should fill in a self certification form (SC1) provided by the employer.

If a patient is still off sick after about week 20 the patient is told by the Department of Work and Pensions (DWP) to get a "Med 4". They go back to the GP for this form which gives fuller details of the patient's condition than the original Med 3 sickness certificate. Based on the information in Med 4, the DWP may be able to decide that a patient is incapable of work and would therefore qualify for Incapacity Benefit. An example might be someone with a fractured femur, with no unison of the bone, and scheduled to go into hospital for surgery to insert a pin and plate.

However, if further details of the illness are required by the DWP, the DWP writes to the GP and the NHS GP has to complete a form IB113 (contractual obligation).

On the basis of IB113 information, the DWP decides if the patient gets called up for a Personal Capacity Assessment (the All work Test). This assessment is not done by the patient's GP.

If a Personal Capacity Assessment is required it will be conducted by an examining medical practitioner employed by a contracted agency who act as agents for the DWP.

The examining doctor does not decide if the patient gets the Incapacity Benefit. That decision is made by a lay adjudication officer.

In short GPs are required to provide facts (not opinions) and do not take decisions on who gets benefits.

British Medical Association