Do GPs have the time or skills to issue workers with ‘fit notes’?

As we are all aware, the government wants to cut the £100bn annual cost to the economy of illhealth. As part of this drive, next year GPs will be responsible for writing ‘fit notes‘ for workers who take time off sick, setting out the duties they can do.

The announcement by health secretaryAlan Johnsonwas welcome news because it will go some way to reduce the 172 million working days lost each year to sickness and help boost productivity, which is crucial in the current economic climate.

Pilot schemes

Currently there are two pilots involving more than 500 GPs using the fit note system. These are supported by increasing publicity and seminars on the topic, such as the recent workshops run by the Royal College of General Practitioners (RCGP).

You may have seen the publication of the expressions of interest for the Fit for Work service projects, and will be aware of the oft–quoted mantra from Is Work Good for your Health and Wellbeing?by Gordon Waddell and Kim Burton of the benefits of work versus worklessness.

There is clearly an increasing head of steam for Dame Carol Black’s initiative to succeed in the national roll–out of the fit note by 2010. But surely the big question is: do GPs have the time or skills to issue fit notes? The RCGPhas clearly recognised that GPs need to improve their knowledge base in respect of the workplace and rehabilitation, assisted by the need for them to engage in this new system and actively work with other stakeholders.

The answer, from GPs themselves, lies in the fact that they are ill-equipped to do so. Although they support the view that it is good for people to work if at all possible, they are concerned that OHrequires a specific skill set and this is not something they are equipped for.

Many employers agree. In a recent survey of a major health insurer‘s corporate clients, almost two–thirds of employers said that OH specialists, and not GPs, are best placed to assess someone’s fitness to return to work. Eight out of 10 said they would like to see them work with GPs to write fit notes.

Of course, there will always be cases of long-term sickness absence, which need proper and appropriate management. The extent to which an individual is motivated to go back to work after a long period of absence is a strong predictor of the success of a rehabilitation programme. More often than not, the path to full rehabilitation is chequered.

Such arrangements must be flexible, tailored to each individual, and involve both GPs and rehabilitation specialists, including those qualified in OH.

As we all recognise, workplace health services are particularly beneficial when combined with skills training and helping businesses develop a culture that promotes the benefits of being in work. Nine out of 10 employers told the insurer that they want support from the government to invest in health at work and over half would invest more if there were incentives to do so.

There is evidence that health services in the workplace help companies to improve their bottom line by delivering a reduction in sickness absence, an increase in productivity and a reduction in long-term disability.They also allow employers to demonstrate a duty of care towards their employees, act as an aid to recruitment and retention, and mitigate the risk from increasingly litigious employees.

However, if workplace health service providers are to convince employers of the business case for investing in workplace health, a difficult call in these challenging times, we need evidence that clearly demonstrates the benefits of such interventions.

A report to be published in the summer will explore how policy and practice can be improved to enable more employers to actively support the health and wellbeing of their workforce. Supported by Bupa, The Work Foundation, Rand Europe and The Oxford Health Alliance, the report will look at the benefits of workplace health services to individuals, companies, and the UK economy and health system.

The study will explore key issues including trends in office-based work – with nearly 700,000 people now working mainly at home, almost twice as many as 25 years ago – and the changing demography of the workforce, as people retire later and more workers combine work with caring for children or elderly relatives.

Triple win

Overall there seems to be an increasing acceptance that government and business investment in workplace health provides a triple win: better health for the individual, better productivity for the employer and increased profitability for UK plc.

And, although private healthcare already makes an important contribution to workplace health, without more evidence about the effectiveness of health interventions, our industry will not be able to show its true potential in keeping Britain healthy.

Graham Johnson, OH nursing development manager, Bupa Wellness

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