Do GPs care whether their patients get back to work?

April 7, 2008

There was a flurry of activity at the Department of Health last month when the Health Secretary, Alan Johnson, announced plans to create a “well note” in place of a “sick note”. The aim was to get people off incapacity benefits and into work.

As expected, various elements of the health profession quickly tried to criticise the plans. A GP who was on the Government’s advisory panel said “independent occupational-health specialists should be introduced to adjudicate on sick notes instead of GPs”.

A member of the British Medical Association’s GPs Committee said: “Confirming that a patient is unwell is very different from making a judgment on whether someone is well enough to do their job.” Even the president of the Society of Occupational Medicine said that assessing a patient’s capacity for work was difficult for a GP.

These apparently professional opinions ignore two important points. First, if GPs cannot judge whether a patient is well enough to undertake his or her job, what judgment are they using when they sign a medical certificate to say a patient must refrain from work?

Clearly, some ailments prevent any work. Many ailments do not. So, what judgments are GPs making exactly? Employers are not impressed by their record on this issue: a recent Labour Market Outlook survey by the Chartered Institute of Personnel and Development found that almost 40 per cent of employers rate GPs as poor or very poor in helping patients with mental-health problems back to work.

Second, if a GP cannot do it, who should advise an employer on someone’s fitness to undertake work? Small employers cannot get easy access occupational-health advice. And those of us in medium to large organisations are unlikely to be impressed either if we are expected to use occupational-health specialists as our main source of advice on this.

The Society of Occupational Medicine should be taking a closer look at the standards of their professionals. Employers are increasingly hamstrung on health issues. When a pre-employment questionnaire is completed, it is confidential and managers are rarely consulted about how any condition might affect someone’s ability to do their job. Then we have the Disability Discrimination Act, and some occupational-health doctors seem to regard anyone with a long-term illness as falling within this legislation. Has anyone told them that the law requires an ailment to “substantially affect normal day-to-day activities” – not just the ability to do a job? Do occupational-health doctors think about the stresses on colleagues when they recommend long-term and unworkable phased return arrangements?

I do have sympathy for GPs – they do a difficult job. However, they clearly do not see their impact on employers. The occupational-health profession needs a shake-up, too. The needs of an employer still take too much of a back seat, and there is an overriding tendency simply to accept a patient’s view alone. This lets everyone down: the employer, the patient and the patient’s colleagues, who have to pick up the pieces.

Nick Rogers is director of human resources at Kingston University

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