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Give occupational therapists power to sign fit notes to free up GPs, research suggests

by Awil Mohamoud
21 August 2020

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Giving occupational therapists the authority to complete and sign fit notes could reduce GP workload, a study by the Royal College of Occupational Therapists (RCOT) has concluded.

The study, which included interviews with 12 health professionals, found GPs largely felt appointments for fit note provision were ‘a waste of their time and expertise’ and that occupational therapists were better placed to assess patients’ work and health needs ‘due to their better understanding of workplaces.’

According to NHS Digital data, demand for fit notes has grown in recent years, with 9.5 million issued in 2018/19, up almost 9% from 2016/17 (8.7 million). This, coupled with the national shortage of GPs and increased waiting times for appointments, places an increasing burden on practices, the RCOT report said.

A practice manager interviewed in the study did, however, question whether occupational therapists should be given the authority to complete fit notes, as they felt it is GPs who ‘have the responsibilities, knowledge, skills and experiences to assess the clinical implications of a patient’s diagnosis’.

‘Easier to see occupational therapist’

The study also examined public perceptions of the Allied Health Professionals Health and Work Report (AHP H&WR), which was introduced in 2013 to provide advice on a patient’s fitness for work and make suggestions for possible workplace modifications, which would enable them to stay in work.

Of 12 patients interviewed for the study and who had received a H&WR, all reported finding them valuable. Patients said the process involved more discussions with the occupational therapist, compared with the more hands-off approach of the GP-completed fit note, and that it felt ‘less rushed’ than the ‘restricted time available for a GP appointment, allowing them more time to discuss their work demands’.

‘Patients lamented the lack of GP appointments available at their surgeries, citing the AHP H&WR as being the preferred option as it was easier to get in to see the occupational therapist,’ the report added.

Occupational therapists interviewed also viewed the H&WR positively and believed that if they were also able to fill out and sign the GP fit note, it would free up time for GPs and patients.

Other health professionals and employers interviewed generally saw the H&WR report as a valuable tool, but there were some frustrations around ‘its standing and even its name’, the study found.

The report concluded the current name was ‘cumbersome’ and that the profile of H&WRs needs to be raised nationally ‘as a matter of urgency’ to help maximise the role of occupational therapists.

‘Use ARRS to recruit now’

Patients and health professionals interviewed for the study were recruited from two UK primary care pilot study sites, involving eight practices, which are part of another research project on the use of an Occupational Therapy Vocational Clinic to support patients to return to or remain in work.

Genevieve Smyth, professional adviser at the Royal College of Occupational Therapists and one of the research authors, said: ‘These pilots [of H&WR] clearly showed reductions in workload for GPs and faster return to work rates. Particularly during Covid-19, many workers are struggling with anxiety and occupational therapists can help get the workforce back up and ready for a return to work.

‘New funding from NHS England under the Additional Roles Reimbursement Scheme (ARRS) means GP surgeries can now employ occupational therapists to issue AHP Health and Work Reports. The funding is time limited so it’s crucial that primary care providers move fast now.’