‘Well notes’ are not the cure for sickness absence in the UK

The announcement last month of the well note to replace the Med 3 sickness certificate has divided opinion among those with responsibility for employees’ health and absence management.


Sickness certification is still a source of tension between employers and occupational health managers on one side, and GPs on the other, especially because of the habit of many GPs of signing patients off sick without considering the option of a return to work on full or restricted duties. However, after the failure of last year’s pilot projects to hand over certification responsibility to OH practitioners, it seems GPs will remain part of sickness absence certification for some time to come.


The well note will put the emphasis on what people can do rather than certifying, as happens at the moment, that the patient is ‘unfit for work’ altogether. But is this the answer employers have been waiting for, or yet another initiative which is large on headlines and small on detail?


Issues for OH


As well as the practical issues raised by the change to certification, there are a number of legal issues that OH practitioners should bear in mind.


Health secretary Alan Johnson has called on employers to promote health and wellbeing in the workplace. There’s nothing new about that. This has been a legal obligation on employers since 1974 when the Health & Safety at Work Act was introduced.


Johnson also called for employers to identify and address potential health risks. What has happened to joined up thinking? There have been longstanding obligations on employers for more than 20 years to do just that, with the latest set of regulations being the Management of Health & Safety at Work Regulations 1999 (www.opsi.gov.uk/SI/si1999/19993242.htm).


Regulation 3, in particular, already requires employers to make a suitable and sufficient assessment of risk to the health and safety of all employees, and that assessment includes both physical and mental health.


Challenges for GPs


So what of the new role of the GP? Assuming they are not sitting around reading newspapers and watching daytime television, where are they going to find the time to take a detailed history from both the patients and their employers to provide the well-informed well note the government proposes?


Detailed research published by the Health and Safety Executive (HSE) in 2003, aimed at the successful rehabilitation of employees back to work after stress-related absence, found inaccurate diagnosis and inappropriate treatment by GPs was “relatively common”.


The research commented that GP assessments were of limited use, whereas prompt referral to the local psychiatric department for specialist outpatient care was a key factor in any successful rehabilitation programme.


The report identified a failure to properly identify all the relevant causes of a stress-related problem as a real threat to successful rehabilitation. So where is the already busy GP going to find the time to:




  • discuss all the relevant causes of stress in the patient’s life?


  • offer guidance as to how these may be addressed?


  • find out about the tasks the employee is required to perform at work?


  • liaise with the patient, HR and the line manager to establish and operate a rehabilitation plan?


  • liaise with all other medical specialists to ensure that the appropriate treatment is given, including providing access to the wide range of counselling and other therapies that have often proved to be successful?

Perhaps even more important than the question of available time is the challenge of acquiring the necessary skills and knowledge in occupational health.


Sidelined knowledge


Why is the government proposing to ignore the wealth of ready-made specialist knowledge that occupational health practitioners already have? The proposals also ignore the nature of the patient/GP relationship. Patients go to their GP for patience and understanding. These proposals introduce the potential for conflict and disagreement.


If the government really wants to address the sicknote culture in the UK, it should invest in a properly funded OH service that is independent of GPs, and should leave the questions of work-related sickness absence to OH specialists.


One of the key cases relating to sickness dismissals requires the employer to establish the ‘true medical position’ before making any decisions.


On the basis of the proposals announced by the government I, for one, will not be advising my employer clients to rely on ‘well notes’ provided by GPs, however well intended they may be. Instead, I shall continue to advise them to obtain specialist occupational health advice and, where appropriate, reports from consultants who are specialists in their individual fields.


By Jonathan Whittaker, partner, SAS Daniels

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