GPs unwilling to mediate between patients and employers

Report on fit note underlines value of group risk rehabilitation services

GPs do not want to act as a go-between for patients and employers and believe that employers should pay for occupational health services to access advice on health and work, according to new research.

The report from the Department for Work and Pensions, based on 45 in-depth interviews with GPs, highlights the challenges of tackling sickness absence in the UK and lends weight to the business case for employers investing in access to expert advice.

It highlights a "consequence" vacuum, whereby GPs receive "very little or no feedback" from employers about how useful or feasible their guidance on patients' ability to return to work is or the extent to which their recommendations have been implemented.

It also underlines a series of barriers that exist to the successful implementation of the fit note, which replaced the traditional sick note last year, and is designed to help GPs support patients to return to work. These include GPs’ unwillingness to damage their relationship with their patients and the fact that GPs are less likely to push for a return to work if they think that the patient's job is contributing to their health condition.

The report’s exploration of GPs' experience of managing patients absent from work underlines the value of tools such as group income protection, which provide employers with an alternative source of advice on the problem.

Key findings of the report are:

GPs generally only hear the patient’s side of the story

GPs are aware that they are relying on the patient’s account of their employer’s attitude towards facilitating the return to work. For example, patients often describe their employer as inflexible when it comes to workplace adjustments, but this may be because the patient does not wish to return to work. 

GPs perceive their role as being the patient’s advocate

Although GPs are aware that work is good for health, they expressed concerns about recommending a return to work in some cases. For example, they reported that they may not perceive a return to work to be the best option if a relationship between the patient and their employer or colleagues has broken down or if they have work-related stress. They said that it would be beneficial if they could refer patients to agencies skilled in addressing "non-medical" barriers to work, such as lack of skills or problems with their employers.

GPs have concerns about employers' attitudes to absent employees

The report highlights that GPs have concerns about employers’ attitudes towards their staff. For example, they reported that patients were returning to work too quickly as a result of concern about not receiving sick pay. GPs also expressed scepticism about employers' attitudes to sick employees. Some thought that some employers do not take their employees' health seriously enough and may disregard the advice on the fit note and ask employees to complete tasks they aren't capable of doing.

GPs also perceived, sometimes from experience, that employers are inflexible when it comes to facilitating the return to work. Some had found that employers were sending employees back to them for an old sick note, in order to avoid the responsibility for an employee not yet fully fit. GPs also described situations where employers had put employees under pressure to ask for a fit note to return to work too early, because they wanted to reduce their sickness absence costs. They were aware of employers adopting strict sickness absence policies and taking disciplinary action against employees after just two or three individual sickness absence episodes.

GPs believe that other agencies need to be involved in the process

GPs suggested that occupational advice should be paid for by businesses. They feel that employers want much more specific advice about what duties employees are capable of performing. They also said that agencies with experience in tackling non-medical causes of absence should be involved.

Group risk providers argue that they are ideally placed to tackle long-term sickness absence because they can act as a mediator between the employer and employee and are able to investigate and tackle both medical and non-medical causes of absence. They are also able to help employers exercise their duty of care to employees and advise employers on how best to facilitate the return to work.


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