‘Well notes’, not sicknotes: Solution or more chaos?

Everyone has a list of examples where they believe GPs have been prepared to sign people off to take the easy way out and to avoid possible confrontation with their patient. The government’s answer is to replace sick notes with well notes, the emphasis being placed on what work people can do rather than certifying, as they do at the moment, that the patient is “unfit for work” altogether.

So is this the answer employers have been waiting for or yet another initiative which is large on headlines and small on detail?

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

Johnson has 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.

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.

Well notes: nothing more than eye catching headlines?

What of the new role of the GP? Assuming GPs are not sitting around reading newspapers and watching day time television, where are they going to find the time necessary to take a detailed history from both the patients and their employers to provide the detailed and well-informed ‘well note’ the government proposes?
Detailed research published by the HSE in 2003 directed at the successful rehabilitation of employees back to work after stress related absence identified both inaccurate diagnosis and inappropriate treatment by GP’s as “relatively common”. 

It went on to comment that the assessment by the GP was of limited use, whereas prompt referral to the local psychiatric department for specialist out-patient 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 with the patient all the relevant causes of stress in their life
  • Offer guidance as to how these may be addressed
  • Fing 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 which 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 work-related health. 
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 cthe potential for onflict and disagreement.
If the government really wants to address the sicknote culture in the UK it should invest in a properly funded occupational health service which is independent of GPs, and should leave the questions of work-related sickness absence to occupational health 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 upon ‘well notes’ provided by GPs, however well intentioned they may be. I shall, instead, continue to advise my clients to obtain specialist occupational health advice and, where appropriate, reports from consultants who are specialists in their individual fields.

Jonathan Whittaker is employment partner at SAS Daniels

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