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GPs feel “ill-equipped” to provide sickness certificates

2 July 2008

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GPs have widely differing views about their role in filling in sickness certificates, according to new research presented today (2 July 2008) at the Annual Scientific Meeting of the Society of Occupational Medicine.

In addition, many GPs also find it difficult to assess fitness for work and are concerned about their lack of training in occupational health.

The research was carried out by the Centre for Occupational and Environmental Health at the University of Manchester, and involved indepth telephone interviews with 31 GPs 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 GP interviewed in the study was quoted as saying: “I think it [providing sickness certificates] 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.”

A recent review into the health of the working age population found that ill health was costing the country a £100bn a year – enough to run the entire NHS.

One of the key recommendations of this review was that the outdated paper-based sick note should be replaced with an electronic “fit note”.

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.

It also claims GPs 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. 

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 provide further opportunities for GP training in this specialty, as well as giving them and workers more access to specialist occupational health physicians.”

In a separate study, of more than 1,000 cases of work-related ill-health seen by GPs, over half (55%) of all the cases given a sickness certificate were due to mental ill health. However, very few of these cases were referred on to hospital specialists.

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.”

Society of Occupational Medicine

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