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From sick to fit: Can we create a ‘well note’ culture?


From sick to fit

With ill health costing the country £100 billion a year, the government has proposed the current sick note is replaced with ‘fit notes’ in an attempt to get people back to work as soon as possible. Lucie Benson finds out whether this plan will help solve the absence problem.

Last month, the national director for health and work Dame Carol Black unveiled her proposals for a healthier Britain, by publishing her review into the health of the working age population. The report, Working for a Healthier Tomorrow, called for a new approach to health and work in this country.

At the time of the report, Black said: “The aim of my review is not to offer a utopian solution for improved health in working life, but to identify factors that stand in the way and offer potential solutions.”

One factor that may be standing in the way of absence management is the current relationship between GPs and employers. Recent research by the Chartered Institute of Personnel and Development (CIPD) showed that 40% of employers feel the support they receive from GPs in helping individuals make a phased return to work is either poor or very poor, whilst 80% of CIPD members say there should be better collaboration between GPs and employers.

What’s more, the findings of Black’s review showed that ill health is costing Britain a whopping £100 billion a year; plus research by Norwich Union Healthcare in 2006 revealed that as many as 40% of organisations have no sickness absence management policy at all.

Well note culture

One of the ‘potential solutions’ offered by the government is to replace paper-based sick notes with electronic ‘fit notes’, stating what people can do, rather than what they can’t. But is this the right way to go? Can we really turn things around and create a well note culture in Britain?

Absenteeism: Fast facts

  • Everyday, around 1.5 million people fail to show up for work, whether it is for legitimate reasons or not. This costs businesses over £2 billion a month.
  • 25.3% of absences occur on a Monday, with the lowest number taking place on Saturdays and Sundays.
  • The worst calendar months for absenteeism (in order) are: January, October, February and November.
  • Age has an impact on the amount of days lost for each absence episode. The average time lost for the under 25s is 3.88 days, compared with 9.48 days for 55-64 year-olds.
  • Women take slightly longer time off per absence episode than men (0.2 days).
  • Source: Active Health Partners

    “Anything that can encourage GPs to support people to make phased returns to less demanding roles is good,” says Ben Willmott, employee relations advisor at the CIPD.

    “Too often at the moment, a GP will sign people off for quite long periods without even considering whether or not there is an opportunity for some form of phased return to work. But in many cases, there are employees who are looking for opportunities to get back to work, and if GPs can support that process, in collaboration with employers, through providing better information via the sick note, that has got to be a positive thing.”

    The government review emphasises that the current sick note system does not encourage GPs to explore the options for a prompt return to work, in collaboration with patients and employers. It also says that the sick note, in its current form, dates back to 1922 and reflects an age when an employee carried out a specific job, rather than today’s flexible workforce.

    Therefore, plans are afoot to radically overhaul the current system with a new approach that promises a more positive outlook; support for GPs, patients and employers; quicker and easier communication between GPs and employers; and practical advice as to how a return to work can be achieved.

    “If the sick note can be revised to provide a framework to aid better decisions amongst some GPs, that has got to be the way forward,” remarks Willmott.

    Professor Michael O’Donnell, chief medical officer at insurers Unum, also believes the new system has the potential to go some way in solving the absence problem. “The emphasis on what employees can do rather than what they can’t will help because it removes that false certainty; everybody has a feeling of certainty about the sick note – of having several weeks off work – so in that sense, if it focuses people’s minds and works as expected, I would think this will be a very good thing.”

    He adds: “GPs find it very uncomfortable challenging people about their fitness for work because they don’t know enough about what the person does at work, so they end up just giving sick notes on request. So I think employers ought to welcome this.”

    However, O’Donnell also says that many employers actually find it easier to just deal with it as either ‘fit’ or ‘unfit’ for work, and therefore may not welcome the new proposal.

    “There are some employers that say, ‘we don’t want you back until you are fully fit’, whereas I think what Dame Carol Black is saying, and many others including myself are saying, is that work is good for you, staying off work doesn’t help you recover, and that we should start being more practical about the whole thing.

    “I think more forward-thinking employers will be pleased with that, but we find that many employers are quite uncomfortable with any decision of whether to have a person back or not.”

    O’Donnell adds that the fit note proposal will put the onus on the employer and the employee to work together to keep the person in work. “I don’t know how enthusiastic employers will be about it, but it is going to be a major step for them, and all changes are difficult to promote.”

    Is it just a gimmick?

    Aside from a change in the present system, there is also the risk that this proposal is just another government initiative that sounds good on paper, but may not work well in practice. This is a thought shared by Allison Grant, a partner at law firm Davies Arnold Cooper.

    “Work is good for you, staying off work doesn’t help you recover, and we should start being more practical about the whole thing.”

    Professor Michael O’Donnell, Unum

    “Whilst the intention is to reduce workplace absenteeism, the likely impact in practice is highly questionable,” she remarks. “I do feel the notion of a ‘fit certificate’ sounds gimmicky.”

    She adds that fit notes are unlikely to be effective in cases of short-term absenteeism, although may work well for longer-term cases of absence. “However, we already have procedures in place to assess fitness, in consultation with the employer, who usually has access to the GP, under the employment contract, to secure information relevant to prognosis.”

    Grant goes further and points out that a fit note will be ineffective where the GP is faced with a psychological illness. “I do not see how the fit certificate is going to be appropriate in, for instance, work-related stress cases. If a patient has a psychological illness or is suffering from depression, the fit note is unlikely to be effective by changing or adding to our present system. The issue goes far wider than that and would ordinarily require occupational health to be involved.”

    However, from an HR point of view, the CIPD’s Willmott says that it is good that the government is examining the practical steps it can take to improve things for employers, employees and GPs: “If HR practitioners, who are very much at the sharp end of supporting employee wellbeing and managing absence, are saying that GPs aren’t supporting this process well, and they are not happy with the current sick note because it doesn’t encourage positive engagement, then it is good that the government is looking at that.”

    It remains to be seen how this initiative will pan out, and there may well be a few attempts at getting the form right before it is rolled out nationally, but, as O’Donnell says about the current problem of absenteeism: “It is time work was started on trying to find a different way.”

    One Response

      This will never work while GPs are legally able to mislead employers.

      Under the Social Security (Medical Evidence) Regulations 1976, which set out the format and rules for completion of medical statements of incapacity, GPs are required to ‘record on the statement an accurate diagnosis of the patient’s disorder which has led you to advise the patient to refrain from work or has caused the claimant’s absence from work’. However, they are also told ‘There are occasions when a doctor may feel that it could be prejudicial to their patient’s well being if they were to issue a certificate bearing the true diagnosis. This will usually be where the doctor feels the patient, and/or his employer, should not know that diagnosis’.

      If doctors, and they do, use this ‘opt out’, how can employers be sure that what is on the sick note is actually the true reason for the employee’s absence? Surely any system falls apart where the truth is withheld?

      The opt out, in my view, was not designed to mislead employers but it appears to have been adopted by some doctors as a way of protecting their patients from what they fear could be unscrupulous employers who may act negatively if the true reason was stated; surely the Employment Rights Act, DDA and other legislation is supposed to protect employees from these types of employers not doctors?

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