One in five GPs believes that the ‘fit notes’ they issue to get people back to work are being ignored by employers. Doctors are handing out more notes than ever to help their patients return to the workplace, but more than 20% think that the advice outlined is not being followed through.
NHS Digital data shows that 1.4m fit notes were issued between July and September 2017 - a 9% increase on the 1.3m given out during the same period in 2016. Almost 14% were for mental health and behavioural issues, reflecting the rise in people living with stress, anxiety and depression.
But a survey by leading GP publication Pulse reveals that 21% of GPs thought employers didn't usually follow their advice, compared with 44% who did. Some GPs have also labelled the fit notes ‘confusing’, whilst the BMA’s GP committee said that more investment is needed in mental health services in particular.
Revised fit notes were introduced in 2010 to allow GPs to give more advice about the modifications and support needed to allow a patient to return to work. There have been attempts by the NHS to reduce the burden on GPs of form-filling regarding patients’ fitness for work, but latest figures show an increase of 8.7%, as well as a slight rise in the number of notes for five weeks or longer, from 34% to 35%.
BMA GP committee chair Dr Richard Vautrey said: “This is yet another indicator showing the workload pressures GPs are facing as they strive to respond to demand from their patients and, in particular, the growing number of people living with stress, anxiety and depression.
“Despite this, mental health funding has lagged behind, exacerbating the problem. The vast majority of adults with mental health problems are looked after in primary care, but our own research has shown unacceptably long waiting times to access talking therapies, which can often lead to patients taking longer to recover and the further impact being felt in general practice. This is why we need more investment in local mental health therapists and IAPT services.”
Cambridgeshire GP locum Dr Alice Hodkinson said: “I find a lot of employers - and employees - don’t understand how fit notes work, and it takes up a lot of our time for no good reason. Some big companies want sick notes after two or three days.”
Also known as a Statement of Fitness for Work or a Form Med 3, the fit note system applies across England, Wales and Scotland and provides evidence for employers and those claiming benefits from the Department for Work and Pensions. Notes are issued to a patient after seven days of absence from work due to sickness if the GP believes that the patient’s ability to work is hindered by their health.
The doctor can deem the patient ‘unfit for work’ or ‘fit for work subject to the following advice', with suggested changes to the role or workplace that will allow them to continue working. But in 2016, GP leaders narrowly voted that fit notes were a waste of clinical time that could be better spent, with Merseyside GP Thomas Kinloch calling them ‘confusing’ for employers, patients and doctors.
“What do you expect when you call a form issued to cover sickness a fit note?” he said. “There is absolutely no evidence that fit notes helped early returns to work or reduced overall absence rates and patients still make inappropriate appointments just to get their fit notes in their droves.”
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