Fit for work? Changing fit note practice among GPs

The influence of prior training on GPs’ attitudes to sickness absence certification post-fit note

“…Some evidence indicates, however, that fit notes are failing to return employees back to work early, and crucially, the fit note advice received by employers from GPs has yet to improve (Coole et al, 2013;Confederation of British Industry, 2013). Some of the evaluations (Hillage, 2012;LeicesterFit4Work, 2012;Thomson et al, 2012;Allied Health Professions Federation, 2013) identified the importance of using an 'impartial' GP (ie, not the patients' advocate) for undertaking fit for work consultations and signing of fit notes. One evaluation of 58,700 fit notes issued between 2011 and 2013 found that in 7% of cases, the GP had not provided any additional advice for the employer and/or patient (Shiels et al, 2013).…”

“…From the GPs’ perspective evaluations are largely positive (Welsh et al , 2012; Chenery, 2013; Shiels et al , 2013). However, the reaction from industry and employers is less so (Thomson et al ., 2012; EEF, 2012; 2013). A fundamental change to the well-established certification system might produce difficulties for GPs who, as reported, can find this aspect of their job both complex and challenging (Tellnes, 1989; Hiscock and Ritchie, 2001; Aylward, 2004; Hussey et al , 2004; Roope et al , 2009; Wynne-Jones and Mallen, 2009; Money et al , 2010).…”

Perceptions of health professionals towards the management of back pain in the context of work: a qualitative study

“…Although a quicker return to work is not necessarily in the best interest of all patients as some patients will benefit from an extended period of time away from work. The aim of the fit note, however, is to challenge the assumption that illness and work are incompatible and that work is an impediment to recovery [9]. The focussed advice that GPs are able to provide should stimulate a more in-depth discussion with the patient around their health and their specific work role, with the proviso that the GP is fully reliant on information from the patient [10].…”

“…Evidence suggests that GPs find the fit note a useful tool and that it is helpful in initiating and negotiating discussions around health and work [11]. However, in-depth discussion about work takes more time in an already time limited consultation and there are questions around how GPs make their assessments of fitness for work such as being able to discuss the patients job thoroughly and identifying suitable adjustments to facilitate resumption of work [9]. …”

First do no harm: the review frequency of illness depends as much on family dynamics as on material factors

“…1,5,6 And we can convey how benefit/risk equations change as we move from reactive care of consulting patients to pro-active care of the non-consulting general public: 7 symptoms have different predictive values, interventions have the same risk but less benefit, lead-time may lengthen morbidity but not longevity, benefit may be statistical rather than clinical, disease-specific mortality may be reduced but all-cause mortality unchanged, and -because of delay in benefit and immediacy of harmsome people die before benefiting. 8,9 HArMinG Managing each episode of illness as an isolated event, being profligate with resources, prescribing antibiotics regardless of the development of resistance, medicalising, converting people into patients by prescribing, 10,11 encouraging dependency, 3 colluding with avoidable worklessness 12 and perceived disability. Targeting symptomless people -in a state of pre-disease -through product-branding marketing strategies.…”