The thorny issue of sicknotes issued by GPs is still no closer to being resolved after pilot schemes examining alternatives to the current certification system produced few, if any, tangible conclusions (Personnel Today, 14 November).
The year-long trials were stymied by a combination of union resistance, employee suspicion and lack of business buy-in. The pilots even failed to determine whether GP workloads could be cut – one of the main reasons they were run in the first place.
The pilot projects were set up in the wake of a new contract for GPs, agreed by the government, which said that, eventually, doctors should give up sickness certification, something most find onerous and irrelevant.
Barbara Kneale, occupational health (OH) and safety adviser at car maker Peugeot Citroen, and a member of the research team evaluating the project, rejected accusations that it had all been a waste of time.
“The pilots are the first time anybody has properly looked at alternatives. We expected them to perhaps leave more problems than solutions, but it has raised awareness of the problems surrounding certification,” she said.
Alternative view
Kneale admitted that the team underestimated the extent of feeling about the official Med 3 sicknote.
“The first thing that became clear during the project was that the vast majority of people were unhappy with the Med 3,” she said. “It’s quite clear the issue is not going to go away – the system has to change.”
The problem stems from the historical nature of the certification system. It has been noted that the Med 3 is probably the only form that Aneurin Bevan – the driving force behind the welfare state in the 1940s – would recognise nowadays.
Staff need a sicknote to claim their statutory sick pay. Employers complain that doctors are too willing to issue them, and GPs are frustrated with sick workers clogging up their waiting rooms.
But the one thing employers, GPs, OH professionals and unions all agree on is that something has to change if the UK is to make a dent in its £13bn annual sickness absence bill.
Dr Peter Holden, a GP and chairman of the professional fees committee at the British Medical Association (BMA), said the doctors’ body had long been lobbying the government to convince it that GPs should not be involved in short-term certification. General practice is already operating at close to capacity. Making doctors sign sicknotes is a waste of GPs’ time and skills, Holden said.
“GPs are adding nothing medically by issuing sicknotes. Our role should be in the provision of information for OH practitioners to make a decision on an individual’s fitness to work,” he said.
Holden placed the blame squarely at the feet of employers for not tackling the problem at its root.
“Better absence management is the issue,” he said. “Firms want to [pass] responsibility for this topic to GPs. Talking to employees about absence is difficult, and going the sicknote route is an easy cop-out for employers.”
Self-certification
The CBI strongly disagrees with this point. Hanna Haas, policy adviser in the employee relations group at the employers’ body, pointed to its annual absence survey, which shows steadily falling levels of sickness absence.
“The CBI appreciates that GPs are under a lot of pressure and we would like to work with them to make sure the government acts on this issue,” she said.
One point where the two groups remain poles apart is the length of absence before sicknotes are handed out. The BMA believes that patients should self-certify for up to four weeks. Only then should doctors become involved. The CBI, meanwhile, insists that a sicknote after seven days – as happens now – is an important deterrent to absenteeism.
“On the timing question, we probably won’t find agreement, but otherwise I think we have shared ground,” Haas said. “But both the CBI and BMA are asking for change and more leadership from the government.”
So what is the government’s stance on the future of sicknotes?
The Department for Work and Pensions, which co-funded the pilot sicknote schemes, said that it had yet to examine the full results. However, a spokeswoman did confirm that the government wanted GPs to provide more comprehensive information on the existing Med 3 form, and was consulting on the best way forward.
No quick fix
According to Cynthia Atwell, a senior OH consultant, the government should stop tinkering around the edges, be revolutionary, and scrap sicknotes altogether. But she concedes that is unlikely, “as the government is always looking for a ‘quick-fix’ because of political implications and costs”.
“It would take a long time to change, and the system will probably carry on as it is,” she said.
But all parties agree there is a real need for more education about self-care.
“Employees must be encouraged to take more responsibility for their own health,” said Atwell.
But unless employers buy into this and offer viable alternatives to the current sicknote system, the status quo is likely to remain unchallenged for some time.
Sicknote soundbites
“The concept of the GP being involved in sickness certification is radically flawed. It benefits no-one – not the patient, the employer, nor the GP. You can’t make the current system work.”
Dr Simon Fradd, medical adviser, Developing Patient Partnerships
“Our members want the sicknote to remain as a deterrent to absenteeism. How they are done is outdated – actually being able to read the writing would be helpful.”
Hanna Haas, policy adviser, CBI
“There has to be central co-ordination from government to look at the problem. But it’s a political ‘hot potato’ that it doesn’t really want to tackle.”
Barbara Kneale, OH and safety manager, Peugeot Citroen
“GPs don’t know what people do at work; it’s not for them to make a decision. It’s as much about peoples’ attitudes to work as anything else.”
Dr Peter Holden, chairman, professional fees committee, BMA
For more on the sicknote debate, see December’s Occupational Health
Next month in Occupational Health
Stress, bullying and the sicknote pilots go under the microscope.
Personnel Today’s sister publication, Occupational Health, is a monthly magazine dedicated to keeping you on top of occupational health issues. Click here to subscribe, or call 01444 445566. Out on 1 December
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