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Time to revamp the 'sick note'

I am always amazed to hear of air crash victims so badly mutilated that they have to be identified by their dental records. What I cannot understand is if they don’t know who you are, how do they know who your dentist is?

 

This analysis is rather tentatively linked to the issue of health, in particular why small businesses are affected more than others when staff go sick.

 

For labour-intensive small businesses, the biggest single efficiency improvement available is likely to be the reduction of sickness absence. Yet many small firms overlook its importance and fail to put in place sufficiently robust systems to reduce ill health absenteeism.

 

The vast majority of sickness absence – 80 per cent of it – relates to short-term episodes, caused by such things as colds, coughs, flu and minor back pains. The cost of illness absenteeism averages £476 per employee, or a loss of £12 billion to the national economy.

 

At present, the provision of sickness certification for illness lasting more than a week remains part of a GP’s contractual duties. But research just published by the British Medical Journal shows just how halfheartedly and inaccurately GPs fulfill the task.

 

Key research conclusions show that GPs have a conflict of interest between their roles as patient advocate and benefits gatekeeper, that different doctors adopt greatly varying approaches to their role.

 

Almost all doctors interviewed in the study spoke of the underlying conflict of interest, with most believing that their patient loyalty outweighs any responsibility for reliable certification.

 

Many suggested that refusing to provide a sickness certificate to a patient would put them in a very difficult position. One GP, not unique, spoke of adopting ‘no discrimination at all’, providing certificates to anyone who wanted one.

 

These findings were backed by the editor of Doctor magazine, who was quoted by the BBC as saying that he knew of one surgery which had a pile of signed sickness certificates waiting on the reception desk to be handed out to any patient who wanted one.

 

The approach of doctors is underpinned by a common resentment at having to do the job of sickness certification at all. Their representative body, the British Medical Association, has long campaigned for the task to be moved away from GPs, enabling them to be freed up to see and treat those patients who genuinely need help.

 

The act of seeing a GP when a patient has merely a bad cold or the flu can be counter-productive – they may just need to stay in bed for a day, but struggling into a doctor’s practice may make them more ill, or spread the virus.

 

From the employer’s point of view, the current process might be considered worse than useless. It provides them with often false information on the health of an employee, while perhaps encouraging staff not to return quickly simply because they have, in effect, a doctor’s permission to take a week or two off work.

In future, sickness certification could form part of the role of occupational health centres, many of which could be based within larger workplaces.

 

Employers such as Peugeot and Coca Cola have already expressed interest in hosting centres with certification responsibilities, in which company doctors will decide whether an employee is fit to work. Small firms might join independent services, some of which may even operate within existing GP practices – but run by nurses who are occupational health specialists. Some £10 million is being set aside to finance pilot occupational health centres.

 

Such a change would not only provide employers with more accurate information, but would also improve communication between the certificate issuer and employer.

 

 

 

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