Overstretched doctors urge two-week absence before workers need to see GP

Requiring a sick note after one week takes time away from patients who may need appointments more, doctors say.


Powered by Guardian.co.ukThis article titled “Overstretched doctors urge two-week absence before workers need to see GP” was written by Denis Campbell Health policy editor, for The Guardian on Tuesday 21st June 2016 23.01 UTC

Staff who fall ill should be able to stay off work for up to two weeks before they need a sick note in order to relieve the strain on overstretched GPs, leading doctors believe.

Leaders of the British Medical Association want the time an employee is off work because they have certified themselves as sick to be doubled from one to two weeks before they need to see a GP. But the doctors’ union wants employers to trust that workers can be genuinely ill for that long, as part of an overhaul of sickness absence to help family doctors.


Writing so-called “fit notes” for people who only need to be off work for a couple of weeks takes away appointments from patients who may need them more, according to Dr Richard Vautrey, deputy chairman of the BMA’s GP committee.

“If you’ve got a patient who very clearly has an illness that is going to last 10 days to two weeks, why do they need to make an appointment with a GP just to get that note to tell their employer what their employer probably knows already and what the patient should be trusted to be able to pass on?” said Vautrey, a GP in Leeds.

He was speaking before the BMA debates a motion at its annual conference on Wednesday which “demands that certification of fitness to work (‘fit notes’) need not be done by a medical professional and that there should be an extension of self-certification for illness from seven to 14 days”.

Doctors also want the law changed so that other health professionals, including midwives, physiotherapists and senior nurses, can sign a sick note, too. But organisations representing employers rejected the call and warned that it could lead to more people staying off work falsely claiming to be ill.

“Federation of Small Business members are concerned this change could lead to a rise in absenteeism,’’ said Mike Cherry, its national chairman. “Fit notes are an important check in the system, and smaller firms would not want to see them undermined.”

Neil Carberry, director of employment and skills at the CBI, said: “When someone is sick enough to be off work for a week, they should try to see a doctor. Self-certification is only appropriate for short-term absences, when a doctor’s visit may not be required.”

Speaking ahead of the BMA debate, Vautrey said: “It’s about empowering patients and trusting patients and reducing unnecessary appointments with GPs. “This is just a motion that is trying to do something to reduce the unnecessary appointments that GPs have and thereby increase the number of appointments that are available for people who genuinely do need to see a GP.”

If someone was to abuse the new system it would be an issue between them and their employer, Vautrey said. “We just have to trust people to do the right thing. The vast majority of people want to work, they don’t want to be off work for significant amounts of time. If people are just needing those extra few days why waste a GP appointment when it’s not necessarily needed?”he added.

But the Department of Work and Pensions said it would not alter how sick notes operate. “The system was set up following consultation and we believe it supports individuals and employers without overburdening GPs. We have no plans to change the existing policy.”

The BMA’s call comes as GP leaders urge the NHS to enable patients to bypass seeing a family doctor and get treated by a physiotherapist, mental health specialist or experienced nurse instead to help tackle the “pressure cooker” of GP work.

Dr Chaand Nagpaul, the chair of the BMA’s GP committee, said people with sore backs and other musculoskeletal problems should be allowed to seek help directly from a physiotherapist without having to first see a GP, as already happens in some parts of England. “We want that rolled out across the country,” he said.

Those with minor mental health problems should be able to self-refer to a therapist, and a pilot project in Devon which offers that is working very well, he said. Similarly, advanced nurse practitioners, some of whom are able to prescribe drugs, could take on more of the role of visiting the growing number of housebound patients.

“At the moment it’s a pressure cooker, so we need other health professionals to support us,’’ Nagpaul added. “There’s a real safety issue with doing things in this conveyor-belt way.”

Letting patients directly access other NHS staff would improve their outcomes and reduce waits that can hit six weeks to see a family doctor, Nagpaul said.

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