Paper-based sick notes should be replaced with electronic ‘fit notes’ according to the first ever review of the health of Britain’s working age population.
The recommendation to implement an electronic system of ‘fit notes’, which would switch the focus to what people can do and improve communications between employers, employees and GPs, is made in a report from Dame Carol Black, national director of health and work, published today.
Working for a Healthier Tomorrow found that 175 million working days were lost to illness in 2006 at a cost of more than £100 billion.
Dame Carol said: “For most people their work is a key factor in their self-worth, family esteem and identity. So if they become sick and are not helped quickly enough, they can all too easily find themselves on a downward spiral into long-term sickness and a life on benefits. This is not only devastating for them, but also for their families. Their children suffer financially, emotionally and it can affect their long-term futures.
‘The aim of my review is not to offer a utopian solution for improved health in working life, but to identify factors that stand in the way and offer potential solutions.”
The report calls for more work-based support for those with health conditions but also says this should be underpinned by “a fundamental change in the widespread perception around fitness for work.”
Further, the report says health professionals need more support in providing fitness-for-work advice.
“Replacing the paper-based sick note with an electronic fit note would support this, switching the focus to what people can do instead of what they cannot, and potentially improving communications between employers and GPs.”
According to the report, the current paper-based sickness certification scheme fails to provide robust information on how many sick notes are issued and what they are used for. It says improved recording and analysis would enable GPs to compare practice with their peers as well enabling easier identification of regional and local issues and public health issues.
“Data collection would be improved by the introduction of an electronic certification system across Britain, linked to GP computing systems. Such a system could also be used to promote quicker and easier communication between GPs and employers – with the potential for ‘fit notes’ to be passed between them electronically if patients agrees.”
Other recommendations in the report include a call for a major drive to promote the positive relationship between health and work, greater support for GPs to help people stay in or return to work and the recognition of retention or return to work as an indicator of the successful treatment of working age people.
Dame Carol Black also called for the creation of a Fit to Work service to provide case-managed, multidisciplinary support for patients in the early stages of sickness absence. GPs could refer to the service through the electronic fit note system, says the report.
In response to the report, the BMA said it had been calling for an overhaul of the sickness scheme and sick note system for years, as it believes the current arrangements do not serve the best interests of patients, doctors or employers.
Dr Hamish Meldrum, chairman of the BMA Council said: “The BMA has long called for the sick note system to be reviewed. GPs are often placed in a difficult position when issuing sick notes to patients in the early stages of their illness and it is not always possible for them to confirm whether a patient is well enough to do their job.”
He said the success of Fit for Work pilots would dependent on the government providing adequate resources to meet demand for the services and the completion of a thorough and transparent evaluation of the pilots.
He added: “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. The GP must continue to act as the patient’s advocate, not a policing arm of the Department for Work and Pensions.”
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Working for a Healthier Tomorrow