The sick note or FMed3 (Med3) to give it its proper name,has existed in its current form for longer than the NHSitself. It dates back to a bygone era of heavy industry, nooccupational sick pay and GPs who made leisurely houserounds before retiringto the golf course each afternoon.At the start of the 21st century the Med3 is widely used tovalidate sicknessabsence, dictates a “black and white”approach of “fit or not fit” and generates significantworkload for GPs who stilltechnically must see a patientin person to sign the note.Proposals to replace the “sick note” with a “fit note”areintended to be part of a move away from a culturewhere work is seen as harmful for people with healthconditions toonewhich acknowledges that (good) workis good for us and that not working is as destructive asmany diseases themselves. Thenew FMed32010 willgive GPs more options than to say “at work or off work”.
So far so good.For this to work on a widerscaleit will be necessary tocreate Occupational Health (OH) capacity in the UK – andthis is the main challenge to the government’s proposals.At the moment only the minority of UK businesses haveaccess to Occupational Health provision and it is alreadya skill shortage speciality.
The concern has to be thatthere is a misperception that GPs will now take on an OH
role and directly advise employers.Dr Bill Gunyeon, Chief Medical Adviser at the Departmentfor Work and Pensions, explained that “the fit note simplyasks GPs to make a statement of a person’s function andthe employer then makes an assessment of how much of their job they can do based on this. GPs are not expectedto become Occupational Health specialists.” They are
also not required to have specific knowledge of a jobwhen they make their fitness statement.This is echoed by Professor Steve Field, Chairman of the Royal College of GPs, who explained that the fit noteallows GPs to say what a person can do and perhaps what adjustments need to be made. “If adjustments can’t bemade then the person is signed off as of now.” This isthe employer’s call. The new Med3 does not have a “fit for work” option but states that “you may be fit for worktaking account of the following advice.
“This is a serious concern for employers who may be
asked to make changes by GPswho have no knowledge of the job.The GP, as the patient’s advocatewill be under pressure to put the employee perspective. Managers and HR departmentscan presumably expect to see comments such as “shorthours”, “reduced stress” or “light dutues”.A recent survey of London GPs found that only 4% hadreceived any training around assessing fitness for work.Ninety-five percent of GPs do not feel that they are the appropriate person to complete fit notes with 81% stating
that occupational health doctors should take the role.This is alarmingly bad news with just a few weeks before the new fit note is introduced.The notes may work well in some situations where the new fit note might help to “unblock” situations where
employees currently delay their return to work on the basis that they are “signed off” opening the door forOccupational Health advice on duties.What this really means is that the need for an assessment of what an employee can actually do is being flagged by the GP and directed to the employer.
And in order to do that the employer will require expert advice. This is enforcing Occupational Health Provision on employerswithout legislating for it, and perhaps most worryingly
when it is not available on the scale to which it will be required. The government is aware of this movementin responsibility and says it is committed to a massive expansion of Occupational Health capacity but this isprobably years away. It iscertainly unlikely to be properly funded in the current economic climate. So the cost willalso fall to employers in the end. Our advice remains as always that clients should involveOccupational Health at an early stage and use the new fit
note to encourage employees to engage in rehabilitation. Early good quality Occupational Health advice reduces
absence and health related costs to business. Notproviding it will increasingly be a false
economy!
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