More than half of Irish GPs are in favour of issuing patients with UK-style “fit notes” instead of traditional sickness certificates because the current system focuses too much on disability, a study has revealed.
Fit notes replaced sick certs in the UK in 2010. Rather than simply stating that a patient is unfit for work and assessing how long they should remain on sick leave, GPs can also advise on when the patient can return to the workplace in a limited capacity, such as with reduced hours or fewer duties.
The study, run by the school of health science at University College Dublin and funded by the Irish College of General Practitioners, described the fit note as a potential replacement for the sickness certification system in Ireland.
For the survey, the first to quantify the challenges Irish GPs encounter with certifying sick leave, the researchers sent out a questionnaire and an example of a fit note.
Of the 196 GPs who took part, 53% preferred the fit note to the cert system, 36% were undecided, and 9% disagreed with the concept. The findings were published in the journal Occupational Medicine.
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The doctors who indicated a preference for fit notes were significantly more likely to view the existing sick-cert system as having “an excessive focus on disability” and to believe that GPs lacked training in sickness certification. The cost of illness-related benefits to the Irish taxpayer is in excess of €2.7bn, the study said, citing 2011 figures from the Department of Social Protection.
Romaine King, the Dublin GP who led the study, said that in her experience doctors “write sick notes multiple times a day and the certs really are focused on people’s inability to work — you either can or you cannot”.
She added: “Sometimes you come across people who could return to work in some capacity and this is not an option with the certs we have. There may be a way for them to go back to work in some form — like someone who has hurt their back could return to the workplace but not lift anything. It would then be on the employer to try to find a role for that person. Right now, it’s an all-or-nothing approach.”
The researchers said there was “compelling evidence” for the positive effects of remaining at work on people’s mental and physical well-being, and that, conversely, unemployment was associated with poorer physical and mental health, as well as a higher mortality rate.
A Fit for Work coalition, set up by healthcare professionals, insurers, business umbrella organisation Ibec and bodies such as Arthritis Ireland, has long called for a national programme to enable people with musculoskeletal disorders, such as arthritis, to stay at work. However, 90% of GPs in the study said there was a dearth of resources to rehabilitate patients on sick leave.
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Two-thirds believe issuing sick certs affects relationships with patients. The data echoes anecdotal evidence suggesting that some doctors agree to patient demands for a sick note to avoid any potential conflict.
King said she did not feel “under pressure” to write sick certs but, when doing so, “you are not really just acting as a doctor, but acting on behalf of the Department of Social Protection so they can receive sickness benefit”. She added: “You’re the patient’s advocate and having the option of a fit note would open up dialogue with a patient.”
Some claims for illness-related payments are referred to the department’s medical review and assessment section, which provides a second medical opinion on cases and checks if people with sick certs are truly unfit for work.
A report released last year by the Comptroller and Auditor General indicated that the department was struggling to hire additional medical assessors to determine whether excessive illness-related payments were being made. In the UK, claimants of employment and support allowance, the welfare benefit designed to give financial support to people who are unemployed because of a long-term illness or disability, are issued fit notes by their GP but they also face work capability assessments, dubbed “fit for work tests”. The assessors are guided by a computer program to determine if the claimant is capable of working, and some testing has been contracted out to private firms by the British government.
The tests have been criticised in some quarters for flaws that force vulnerable people back to work when it is against the best interests of their health and for stopping their benefits. In 2013, MPs revealed that 1,300 people had died after being told they should start preparing to go back to work.
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In November, research found that harsher “fit for work” tests in the UK were linked to 590 extra suicides and hundreds of thousands of additional antidepressant prescriptions. The research has been contested by the Department for Work and Pensions.
King said that the Irish study only investigated GPs’ attitudes to enabling patients returning to work through fit notes and did not examine the impact of any “punitive” benefits sanctions for long-term disability claimants.