Well notes: the cure for sickness absence?

21 February 2008 07:00

'Well notes' rather than sick notes have been met with a mixed reaction from occupational health professionals and GPs.

The government announced, yesterday, that GP sick notes are to be replaced with well notes that list the tasks employees are fit to carry out.

Health secretary Alan Johnson said the well note would help to cut sickness absence and he also encouraged employers to run health clinics.

Well notes: OH reaction

Occupational health nurses and doctors have reacted by saying that more emphasis should be put on improving access to OH services rather than putting the onus on GPs and the well note, essentially a redesigned sick note, to cut absence rates.

Well notes are expected to part of Dame Carol Black's review Well notes will form part of the recommendations in Dame Carol Black’s review of the health of working age people to be announced in March. Black is likely to propose a digital version of the ‘well note’ so that details about patients can be shared by practitioners in multi-disciplinary return-to-work teams and with doctors in secondary care.

The well note announcement was welcomed by Prof Sayeed Khan, chief medical adviser of the Engineering Employers Federation (EEF), who said, “Too often there is an emphasis on what the employee cannot do rather than what they can do and this system should help us tackle sickness absence in a positive manner.”

However OH practitioners have raised a number of doubts about the scheme and, despite a mention of the OH role by Johnson on breakfast television, feel too little is being done to educate GPs and employers about the role of OH in returning employees to work.

Posts on the JISCmail OH website raise a range of concerns:

Well notes could see the end of the current Med 3 sick note The government is putting too much emphasis on the role of the GP and fails to understand the role of OH practitioners in return to work.

GP consultation times are too short to get information about what tasks jobs involve and assess a patient’s fitness to do them.

The well note will not be helpful for the majority of employees who work for small firms which will not have return to work arrangements in place.

Gail Collins, an OH adviser at Burton's Foods, said in a letter to Occupational Health journal that the existing Med 3 certificate (right)already allows GPs to offer patient advice but GPs were reluctant to use it for this purpose.

“I have tried to get the GP involved in early return with support with no luck,” said Collins. “This year I am trying a new tack. Instead of writing to a GP to ask if he will support any restricted early return and getting absolute silence I am now writing to tell them I am arranging restricted early return and if they feel it’s inappropriate they can contact me.”

Dr Gordon Parker, president of the Society of Occupational Medicine, wrote to Occupational Health to say that well notes “might be part of the answer.” But Parker added: “The real issue is not getting GPs to do something ‘different’, but helping GPs to access support for their patients who can (and want to) return to some form of work.”

“Both GPs and patients need to access support for their patients that occupational health doctors and nurses offer.”

Well notes: GP reaction

GP leaders have said the well notes plan will not work. According to Dr Peter Holden of the BMA's GPs Committee, "Confirming that a patient is unwell is very different from making a judgement on whether someone is well enough to do their job… GPs should not be there to police the system."

However the Royal College of General Practitioners has called for greater training for doctors and more co-operation with specialists so they can recommend employees return to work on light duties instead of remaining on sick leave.

Sick notes and sickness absence - external resources

National Statistics: Sickness absence from work in the UK
Female employees and younger employees most likely to be absent from work due to sickness

EEF: Sickness absence and rehabilitation survey 2007
Absence rate in EEF member organisations shows a further decline to 3% or 6.7 days per employee compared to 3.1% (7.1 days) in 2005 and 3.6% (8.1 days) in 2004

HSE: Managing sickness absence

TUC: Sickness absence

Sick notes - Frequently Asked Questions