Experts share commentary on the PM’s plans to review fit notes

LONDON- SEPTEMBER, 18, 2023: Downing Street sign, location of 10 Downing Street, official residence and office for the Prime Minister of the UK

Last week, Prime Minister Rishi Sunak announced plans to combat ‘sick note culture’ by reviewing the fit note system for people who aren’t well enough to work.

Part of the plan is more “objective assessment” by unspecified “specialist work and health professionals” rather than GPs. 

Commenting yesterday, at our sister event, The Watercooler, on the PM’s speech, Rosena Allin-Khan, Labour MP for Tooting and former shadow cabinet minister for mental health said: “This is why the public don’t have any trust in politicians – they seem to be out of touch, they don’t seem to come from our world [or] be relatable in any way. They don’t seem to be people who get what it’s like not to be able to get out of your bed, put your clothes on, brush your teeth and go to work because you are struggling, because you’ve been on that waiting list for three years, because you can’t get the help that you need”.

Mr Sunak’s argument is that his plans would not lack compassion as there would still be a safety net for those who genuinely need it.

Here two experts share their feedback to the PM’s plans.

Nick Pahl, CEO, Society of Occupational Medicine (SOM)

The Society of Occupational Medicine (SOM) is calling for a review of fit notes by health professionals that are also trained in occupational health. Nick Pahl, SOM’s CEO, said:

“As the PM states, the fit note is not used to its full potential, and SOM would like to see a number of actions taken”. These are:

  1. Comprehensive training in fit note use, combined with occupational health training, in clinial and medical curricula.
  2. Fit note certification acting as a triaged referral point to an occupational health professional to support return to work. Lack of skills in occupational health (OH), are barriers to using the fit note to its full potential in general practice.
  3. Only 50% of UK employees have access to OH and the Government needs to fund OH to support people with health issues to stay and return to work.

He added: “Fit notes generally focus on the ‘not fit’ for work option, rather than the ‘maybe fit for work’ section. Statistics show that over a third of fit notes are issued for five weeks or longer, by which time around 20% of people will never return to work”.

“Through no fault of their own, people seeing their GP team often expect an all or nothing ‘sick note’. This makes it harder to manage expectations and come to a shared decision about using the ‘may be fit for work’ option.

Discussing the merits of the ‘may be fit for work’ section, or a shorter review period before reassessment can be perceived as punitive by patients who expect to get ‘signed off’ and find it difficult to understand why their GP team would challenge this. That is why SOM is calling for tailored occupational health advice to be made available to patients who receive the fit note – with better use of the ‘maybe fit’ for work section.”

Karl Bennett, Wellbeing Director, Vivup and Chair of the EAPA

Taking a different perspective, Karl Bennett, Wellbeing Director of Vivup and Chair of the EAPA said:

“It’s incredibly insulting to assume that people are visiting their GP to be signed off with mental health issues, and that this is taking time away from GPs doing other work”.

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“The issue is not having the capacity to issue ‘fit notes’, it’s having the resources available within the NHS to support those people when they are at their most vulnerable”. 

“It takes courage to ask for help if you are struggling with mental health issues. Visiting a GP may be a last resort for some, so investment is needed to support people, rather than increase access to fit notes”.

“When will the government recognise that support is available through Employee Assistance Programme services? EAP’s offer everything that is needed to support people to remain at, or return to work quickly. All employees should have access to the services offered by an EAP, while employers should have funding made available to them to ensure they are not choosing between their employees’ mental health and paying a fair wage”.

“This also demonstrates the support needed by employers to help employees recognise when they are feeling low, and have in place the tools needed to support mental health issues. This includes regular training for managers around the services available to their teams and focus on organisational culture – which needs to be one of inclusiveness without fear of consequence when asking for help”.

You can view the PM’s speech in this BBC report and the full Government press release can be viewed here.

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