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Dealing with sickness absence in the practice

1 October 2010

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Management Consultant

Hilary has run her own management consultancy business for the last 18 years in human resources and organisational development for the primary healthcare sector. She lives in Cardiff with her husband and son. Hilary enjoys exotic travel, sampling meals cooked by others (ie, visiting restaurants), and practising her very poor tennis technique

Staff who are absent with sickness need to be actively managed. How this happens varies enormously between practices. Some treat sickness absence as an act of God, something that has to be tolerated and endured, rather than a management or organisational issue, which can be successfully addressed.

The first step in managing absence is to ensure that all staff are aware of their contractual obligations to the employer, and that the information given to employees – usually through the statement of terms and conditions of employment – details the procedures to be used when staff are absent from work.
Does the contract of employment specify:

  • By when and to whom the employee is to contact on the first day of absence?
  • How the employee should contact the practice? (For example, allowing messages by text or email bypasses the opportunity for the practice to discuss with the employee the nature of the illness, predicted length and arrangements for keeping in regular contact.)
  • When self- and medical certificates 
are required?
  • The maximum number of days in any 
one “sick year” that can be covered by 
  • The number of episodes of sickness that 
will trigger a return-to-work interview 
and/or a formal review of the employee’s sickness record?
  • The right of the practice to request a medical examination of the employee?
  • The period of time after which the practice may consider terminating employment?

Ensuring that comprehensive and clear rules and procedures are communicated to staff will provide the framework within which sickness absences are managed. But the issue of “unauthorised absence” must first be addressed. Sometimes the first day of a sickness absence will be unauthorised, as will gaps between the dates of certificates – both self-certificates and 
medical certificates.

Unauthorised absence
Where staff fail to contact the practice to explain their absence/sickness, action needs to be taken. This is “unauthorised absence”. It is important that you act promptly and fairly in dealing with the situation.

The first step is to attempt to contact the employee during the first day of absence; this also gives the message to other staff that attendance at work is important and that absences will be dealt with promptly.

If telephone calls fail to establish contact then a letter should be sent asking the employee to contact the practice immediately on receipt. This should be followed by further attempts to telephone – the employee may be too ill to contact the practice or may be suffering some form of trauma.

If contact cannot be established, a further letter should be sent detailing the employee’s contractual obligations and explaining that failure to contact the practice may result in the commencement of disciplinary action. Of course, real life is not so straightforward as this, and you may no doubt know the employee’s family or friends, which will help in establishing contact.

Before any disciplinary action is commenced, it is important that every attempt is made to see and talk to the employee. Also, the way in which such absences are handled will be determined by the employee’s history (have they ever done this before?) and length of service. A member of staff new to the practice will obviously be treated differently to a longstanding employee with no history of such behaviour.

At all times, it is essential that the practice is seen to be behaving professionally, reasonably and with appropriate regard to the employee’s role, length of service and history.
Ultimately, you can dismiss an employee for breach of contract. However, any such dismissal should follow the practice’s disciplinary procedure, which itself should follow the ACAS code on discipline.

Sickness absence in the practice
Sickness absence generally comes in three forms:

  • Staff who are occasionally ill.
  • Regular absentees – staff who are regularly absent through unrelated illnesses.
  • Staff on long-term sickness.

It is accepted that we all fall ill at some point in our lives, and indeed this is recognised by the state and through contracts of employment, which allow for absence from work due to sickness or injury. It is the second and third types of absence that can prove problematic.

The regular absentee
This type of employee is often the most difficult to manage. Absences will be covered by self- or medical certificates. Since these absences are unexpected and for a short duration, it is very difficult for the practice to plan and manage the employee’s work.

In managing all sickness absences, but particularly staff with a poor attendance record, it is wise to adopt the practices outlined below.

When the employee first contacts the practice to report ill, the manager receiving the call should ask the following questions:

  • What is the nature of the illness?
  • How long does the employee anticipate the absence lasting?
  • Can the practice do anything to help?
  • When will the employee call again?

The above questions are also relevant to any type of sickness absence.

On return to work, the manager/senior receptionist should interview the employee to discuss the illness and enquire how the person is feeling. Too often, self-certificates are not followed up and can facilitate malingering.

If a pattern of absences is emerging (regular monitoring of the practice’s sickness records is essential here), you need to talk to the employee concerned, draw their attention to the pattern and attempt to find out why they have had so much time off work and whether the practice can offer any support. If the cause is work-related, you and the employee can start to address the problem, and hopefully the absences will stop.

Where there are a number of such people in the practice, you need to look a little deeper at the problem. Is there a common factor? For example, are they supervised by the same person? Do they all work closely with one of the partners? Do they share the same workspace?

High absence figures are one of the most common indicators of low staff morale. If the problem is widespread then you will need to look wider and deeper at the whole management of the practice and the effect on staff. It might be worthwhile to compare your practice’s sickness record with neighbouring practices of similar size and national statistics to assess the extent of the problem. ACAS provides annual figures on average lengths of sickness absences in terms of days per annum, as does the Confederation of British Industry (see Resources).

If there are no underlying issues, often a quiet chat about the pattern of behaviour will be enough to see an improvement in the employee’s attendance. If the absences continue, you may need to commence your disciplinary procedure.

If the illness is not a chronic condition and the absences are due to unrelated medical complaints, resist the temptation at this point to refer the employee to a doctor for a medical opinion, unless you are contemplating dismissal as the next step. You will get embroiled in a medical issue and this sort of absence pattern (unless related to a mental illness) is a management, not a medical, issue. Patients who are also employees of the practice can prove very problematic. It is wise, if possible, to ensure that employees are not registered with the practice.

Long-term sickness
Staff on long-term sickness absence are often treated rather preciously in the mistaken belief that absences covered by medical certificates have some legal protection against intervention by 
the practice.

Often the issue of a member of staff on long-term leave is only addressed when they are approaching the expiration of their sickness-leave entitlement. This can be interpreted as uncaring and can also  delay both the practice’s ability to manage the absence constructively and the handling of any future termination of employment on grounds of capability.

When an employee is absent due to an illness you anticipate may be long term, it is important to establish regular contact. Not only does this ensure that the employee is aware that the practice cares about them, but also allows you to follow the progress, and hopefully the eventual recovery, of the employee, which will provide information in preparing for the employee’s return to work – whether a phased return or a complete return to work.

For those few employees who exploit their sickness-leave entitlement, regular monthly face-to-face contact – at their home or the practice – ensures that they are aware that the absence is being actively managed and monitored.
Also, if an employee cannot return to work they may lack the confidence or knowledge of how to broach the subject. Regular meetings provide the opportunity for discussing the employee’s future with the practice.

Any eventual dismissal on grounds of capability needs to be handled sensitively and within the current employment legislation, including the Disability Discrimination Act.

Fit notes, not sick notes
The introduction of “fit notes” in April this year was an explicit recognition that illness is not incompatible with work.
To encourage a quicker return to work, the fit note was introduced in response to Dame Carol Black’s report Working for a healthier tomorrow. This report was predicated on the view that work improves people’s health, both mental and physical, and helps them to make a 
faster recovery.

Dame Black (the UK’s National Director for Health and Work) reported that the cost to the economy of sickness absence and unemployment due to ill health amounted to £10bn a year. Mental health makes up between £30-40m of this amount.
The fit notes move the GP into a more occupational health role with which many, legitimately, will feel uncomfortable unless they receive support through training and education in this area of medicine.

Fit notes now have to state whether a person is fit for some work or unable to work at all. GPs will know what happens in the medical and administrative environment, but little about other occupations or job groups.

In order for GPs to complete these forms accurately there needs to be more communication between the employer and the doctor. This is where information from the practice to the employee’s doctor, via the employee, plays a vital role. When discussing the management of an illness with your employee, do provide them with sufficient information about their current job, hours, responsibilities, pressures and the work environment, and encourage them to share this information with their GP.

This will enable their doctor to complete a fit note, which is helpful to the employee (a quicker return to work albeit, at times, on a phased return basis) the employer (you are reducing your occupational sick pay budget) and of course the state (through a reduction in statutory sickness pay and other benefits). If it operates effectively, it is of benefit to all concerned.



Confederation of British Industry