Just over 1,000 of the UK’s 35,000 GPs have received training to develop their skills for health and work consultations and to raise their understanding of the impact of worklessness on health, according to their professional body.
The Royal College of GPs (RCGP) is rolling out 100-150 half day workshops over the next two years with the aim of training up to 4,500 GPs. In the meantime, GPs will be expected to advise patients on adjustments that could help them return to work, when the fit note is launched on 6th April, depsite evidence that they do not feel confident about this role.
“With the change of emphasis that these new fit notes are really trying to engender, it seems very sad to me that the roll-out has not been earlier and clearer,” said Dr Hugh Laing, a practising NHS GP who works with the insurer Aviva. He said that some GPs “don’t feel comfortable” about completing the notes, but stressed that education was key to ensuring their engagement.
“GPs would be greatly helped if they could have access to an occupational health adviser,” he added.
The most notable change to the process of certification is the removal of the option to state that a patient is “fit for work” and introduction of a new “may be fit for work taking account of the following advice” option. Extra space has been provided to encourage GPs to recommend adjustments that may facilitate the return to work.
This approach is already well-established among group risk insurers providing rehabilitation services to employers, who offer access to trained assessors who are trained to work with line managers to facilitate the return to the workplace.
A survey of 452 GPs carried out last year found that 95% of GPs do not feel they are the appropriate person to complete fit notes. The RCGP has acknowledged that there is evidence that GPs find sickness absence management “particularly challenging” because of their duty to act in the best interests of patients. Guidance to GPs issued by the Department of Health states: “You do not need specialist occupational health expertise or a detailed understanding of your patient’s job to complete a form”. Yet the survey found that 81%of GPs think that occupational health doctors are best able to make judgements about a patient’s ability to work.
“In many cases, a GP will be making recommendations for change without having knowledge or fair understanding of the employer’s business or the employees’ job duties and risks involved,” said Claire Birkinshaw, solicitor and legal information manager at Abbey Legal Services.
Although the GP’s recommendations are not binding on employers, Birkinshaw said that employees could use the fit note as evidence when making claims under the Disability Discrimination Act. She also raised questions about the implications of an employee refusing to return to work despite their GP’s recommendation that this was possible, with adjustments.
“Does the employer take the fit note recommendations at face value, stop paying statutory sick pay and threaten to discipline the employee?” she asked. “This situation has the potential to arise a lot.”
While surveys of GP sentiment in the run-up to the launch have cast doubt on their commitment to the scheme, there are signs that the profession has grasped the importance of tackling worklessness. The workshops are over-subscribed and the RCGP is firmly supportive of the initiative.
“I am very much in favour of GPs being proactive and positive about encouraging patients to return to work with whatever modifications are necessary and when they are able to do so,” said Dr Laing. “The benefits of work are terrific.”