Report calls for shake up in management of sick notes

GPs would be able to refer patients who have been signed off sick to a “fit for work” multidisciplinary team, under radical new plans designed to overhaul attitudes to occupational health and reverse Britain’s “sick note culture.”

An estimated 175 million working days were lost to illness in the United Kingdom in 2006. In England, the annual cost of sick leave and worklessness added up to more than £100bn (€130bn; $200bn)―more than the current annual NHS budget for England and Wales.

Under the new plans, drawn up by Carol Black, the UK’s national director for health and work, occupational health would also be brought into mainstream health care and its academic base and profile bolstered.

The fit for work teams, based in primary care, would provide rapid early treatment in a bid to prevent the slide into long term sick leave and incapacity benefit. The teams would follow a “hub and spoke” model, with a case manager at the centre linked to an array of occupational, physical, and mental health practitioners, and advisers, such as debt counsellors.

These services could eventually be located in super-surgeries or polyclinics, if the pilots proved successful, said Professor Black.

Last month health secretary Alan Johnson sparked anger among GPs, who feared that they would be forced into a policing role, when he mooted the idea of “well notes,” ahead of Professor Black’s report (BMJ 2008;336:468; doi: 10.1136/bmj.39503.348032.DB).

“It’s a pity that GPs got this message without the teams,” Professor Black told the BMJ. The proposals, which also call for sick note certification to become electronic and to shift to a “fit note,” focusing on what patients are capable of doing, would “take the burden away from GPs,” she added.

But Hamish Meldrum, chairman of the BMA council, remained cautious. “The detail of how a ‘well note’ system would operate needs to be carefully examined, including the workload implications and the avoidance of any conflict of interest,” he said.

Earlier this month more than 30 organisations, including the BMA, signed a consensus statement pledging to do more to help people enter, stay, or return to work.

But the report says that healthcare professionals have been hampered by a lack of training on the health benefits of work. The Royal College of General Practitioners is set to roll out an online educational programme within the year, to boost GPs’ confidence in handling these issues, said Professor Black.

Employers’ attitudes also need to change, says the report. In particular, employers need to do more to help people with mental health problems, 200 000 of whom end up on incapacity benefit every year in Britain, the report says.

Paul Farmer, chief executive of the mental health charity Mind, said. “It’s not just employees who need support with sickness; employers need help too.” He added: “Many are simply confused about how they support their staff during sickness.”