A consultant in occupational medicine says there is an obvious solution to
the escalating problem of GPs issuing sicknotes without any serious
consideration of the consequences for employers
I have been following the discussions
around managing employee sickness and feel compelled to add a couple of
I am a specialist occupational physician working in both the corporate and
public sector. In one area of my life I am an employee, and in the other,
regularly act on behalf of employers and employees.
I deal with employment lawyers, pension funds, private medical insurers and,
occasionally, the court system. I have also seen the detrimental affects on
team members when one of them is ‘off sick’ for a long period of time and
others have to pick up their work; particularly if it is felt that the
individual is ‘working the system’.
In reading the different views from HR, there is an overwhelming sense that each
of the different ‘stakeholders’ appears uninformed about the factors driving
the others. By factors I mean legislative frameworks, professional
requirements, some of the emotional underpinnings that may drive behaviours
and, possibly, the nature of disease itself – particularly its relationship to
I would like to suggest an approach that removes accusations and
Imagine a situation where we spend that energy in looking at each ‘party’ as
the member of one team. In other words, address the issue as one of
teambuilding. It is just that in this case, the team members work for different
First, try to establish a common goal. Something like ‘let’s invest the time
to obtain as clear a diagnosis and prognosis as possible, but with the aim of
getting the employee back to work’. Then look at the roles, responsibilities
and driving agendas for each of the ‘team’ members and aim to achieve a way of
working together to reach that goal.
The GP, for example, is the first link in the chain and is expected to
diagnose and explore the workplace environment within a five- to 10-minute
slot. Their primary responsibility is to the individual and they normally have
no understanding of the knock-on effects of sicknote decisions.
The GP is unlikely to be able to probe much beyond what is presented and is
often working within an NHS not geared up to getting people back to work
quickly (eg, waiting lists for specialist diagnoses). They are bound by patient
confidentiality (which can extend to what is written on the sicknote). Also,
doctors know that time is a key feature in disease – it can heal or reveal – so
while not always obvious to others, the GP may be buying some of that time to
achieve a clearer diagnosis.
The employer and its HR department is unlikely to have spare capacity to
absorb someone away. It has to be aware that every ‘sick’ case can set a
precedent, and needs to balance the needs of the business (including the needs
of other employees) against that of the individual.
The employer is desperate for precise diagnosis and prognosis to allow for
planning, despite the fact this is often impossible. The employer is also
working within a growing raft of legislation, which is often so prescriptive
and restrictive as to invalidate the very thing that would probably allow the
most mutually acceptable and human resolution: skilled, honest conversations
The patient/employee wants to keep an income as long as possible – whether
justified or not. They may really want to come back to work even if to do so
would be detrimental (eg, some musculoskeletal issues) and not to allow them to
do so might precipitate another form of anxiety-related illness.
So let’s imagine addressing this as we would as a team of individuals. The
productive way forward would be for each to spend time understanding the issues
of the other and, equally importantly, educating the others in their own issues
Here I feel my own speciality of occupational medicine could be more
proactive. We should act as facilitators among this group of diverse agendas.
We have the privilege of being able to discuss patients within the bounds of
We understand (or should) the pressures of those in industry and the fact
employers do not have the luxury the GP does of only having the one
individual’s interests as their driver. They have other employees who rely on
their management to manage and resource appropriately. We should be educating
the employers about the pressures experienced by GPs and vice versa.
One solution would be to recommend a system whereby a GP can only sign an
individual off work for a specified amount of time before having to refer to an
occupational health specialist to work together to achieve the goal. This would
still mean there were occasions when the other stakeholders believe they are
not receiving sufficient information for their own purposes – but might be a
step on the way.
There could be different solutions, but they all rely on a willingness not
to assume the worst of each other. Otherwise, the only real losers will be the
As we move towards an increasingly knowledge-based employment base, I can
foresee the issue becoming worse. It is this type of economy that breeds the
most difficult of all cases to handle well – those linked to the mental rather
than the physical state.
We can all see the inevitability of this area increasing so surely this is a
good enough reason to take a more holistic approach for the benefit and sanity
of us all.
Dr Tony Yardley-Jones is an independent consultant in occupational medicine
and works part-time at the Chelsea & Westminster and London Bridge
By Dr Tony Yardley-Jones, Consultant in occupational