GPs may no longer be responsible for fit notes as they struggle to be ‘objective’ and sign them ‘by default’, the Prime Minister announced.
Today, in a speech outlining reforms to the welfare system, Prime Minister Rishi Sunak said the ‘sick note culture’ needs to change, so that the system ‘recognises’ and ‘encourages’ the benefits of work.
He said ‘there is an argument’ for ‘moving away’ from GPs having responsibility for fit notes, saying the Government will test shifting this work to ‘specialist work and health professionals’.
A consultation will be published later today outlining the proposed fit note reforms and seeking views on how the system can ‘better support people to start, stay, and succeed in work’.
Ahead of Mr Sunak’s speech today, the Government said: ‘The Prime Minister has… announced a review of the fit note system to stop people being written off as “not fit for work” by default and instead design a new system where each fit note conversation focuses on what people can do with the right support in place, rather than what they can’t do.’
The Prime Minister highlighted that shifting responsibility for issuing fit notes away from primary care would ‘free up valuable time for GPs’.
He said: ‘GPs have a quite special relationship with their patients, and inserting this into it puts them sometimes in a difficult position, because they don’t want to damage that relationship with their patient, and it may be harder for them to be as objective.’
The Prime Minister also argued that the aims of the fit note system have failed, citing figures showing that 94% of the 11 million fit notes last year were signed off as ‘not fit for work’.
‘When we went from a “sick note” to a “fit note”, the whole point was we were trying to say, hang on, there’s lots of work people may be able to do, and we need flexibility in this gateway to focus on what people can do, not what they can’t – but that hasn’t happened,’ Mr Sunak said.
The Government has been testing out different models of issuing fit notes in pilots across the country, which the consultation will seek to build on.
BMA GP Committee England chair Dr Katie Bramall-Stainer said a review of the fit note system ‘may relieve the administrative burden’ on GPs, but she highlighted long hospital waiting lists as the main issue.
‘So rather than pushing a hostile rhetoric on “sicknote culture”, perhaps the Prime Minister should focus on removing what is stopping patients from receiving the physical and mental healthcare they need, which in turn prevents them from going back to work,’ she added.
Dr Bramall-Stainer also said: ‘Fit notes are carefully considered before they are written, and a GP will sign their patient off work only if they are not well enough to undertake their duties.
‘We do recognise the health benefits of good work, and that most people do want to work. But when they are unwell, people need access to prompt care.’
RCGP chair Professor Kamila Hawthorne said the college is ‘supportive’ of, and intends to respond to, the consultation on who is best placed to issue fit notes, given the ‘workforce and workload pressures’ GPs currently face.
She said: ‘We know that in the main working can be beneficial for patients’ health, and GPs and our teams will already encourage people to work, or to return to work if they have been off sick, where it is safe and appropriate for them to do so.
‘When making a decision to issue a fit note, the health and wellbeing of an individual patient must always be a GP or other healthcare professional’s principal concern.’
Professor Hawthorne highlighted that if others take on responsibility for fit notes, the ‘best interests of the patient’ must remain the ‘priority’ in assessing ability to work.
‘Any initiative should be piloted, and subject to rigorous evaluation in terms of its benefit for patients, especially the most vulnerable, and identifying unintended consequences, before any wider roll out is considered,’ she added.
Health secretary Victoria Atkins said the Government’s ‘ambitious reforms’ will help people to return to and stay in work.
She added: ‘We know that people in work often lead happier, healthier lives which is why it’s fundamental to shift attitudes away from sicknotes towards fit notes.
‘We are seeking the advice of those who understand the system best so we can break down these unnecessary barriers to work. Through tailored care and reasonable adjustments, we can build a healthier workforce for a healthier economy.’
The Prime Minister also announced a raft of other measures to ‘significantly transform and control welfare’, including tightening up the work capability assessment and the eligibility for Personal Independence Payments (PIP), as well as a crackdown on benefits fraud.
Last year, following a consultation on expanding the pool of professionals who can sign fit notes, the Government set out its intention to reform the system, announcing the ‘trailblazer trials’ in a small number of ICBs.
At the time, GPs were still expected to ‘play an important role’ in supporting people to get back to work.
The RCGP also urged the Government last year to involve GPs in discussions around plans for the future of fit notes, which included possible automatic referrals to ‘life coaches’.
In 2022, new legislation allowed a wider range of health professionals to legally certify fit notes to ease pressure on GPs – this included nurses, occupational therapists, pharmacists, and physiotherapists.
Well I think there’s something in the idea that under current conditions GPs may not be best placed to make work decisions. I absolutely do not have the time / capacity to properly assess every request that I get.
But the devil will be in the detail. Either we are responsible or we are not. The worst of all worlds would be endless GP consultations asking for letters of support to challenge a decision made by someone else.
PIP doesn’t present a great precedent. The government website is clear that evidence from GPs is not required, yet so many patients claim they have been advised to get a GP letter. Are they all being economical with the truth or are they being directed to us by people who should know better?
Will the same happen for sicknotes?
This would be brilliant!! It would free up capacity in general practice. We did nearly 6000 sick notes last and due to the increase in volume have had to take online requests to free up capacity.
Taking responsibility completely away would be great
Good move. I agree that removing this completely from us is a healthy decision.
Preparing a practice policy and message to the patients advising we are not going to write letters about patients capabilities to work if asked for by patients.
I agree with Dylan. The GP is best placed to issue Fit Notes IF they are the ‘TREATING DOCTOR’.
It would help if the administrative burden of issuing repeated notes on behalf of others were taken away from GPs, by enforcing compliance with the ‘Communication Standards’ and actual regulations, instead of hospital staff and specialists refusing.
I do not think it would help to stop GPs issung sick notes if we had to supply letters challenging DWP and bAMS decisions instead. Here it would help if DWP staff were able to actually read and understand what we put on Med3 forms – as many do not. It would also help if they would look sensibly at the case, rather than uncaringly cancelling patients’ benefits and subjecting people who are NOT capable of work, to repeated, stressful (to patient, sometimes only to their carers and GPs!), compulsion to obtain repeated evidence of something that will not and has not changed, and attend yet again at an assessment which they cannot even physically get to.
There might be some lazy workshy patients, but the current system appears unable to catch them, but causes distress to many others who are trying to work.
Employers who do not understand the system – and again, some who are not able to read and understand what is written on notes – also does not help. Please can we blacklist managers who are stupid?
This will require the facility for individuals to self certify for very much longer than the current 1 working week. That would be fine. It would then become a conversation between the individual and their employer/benefits agency as to fitness to work and in what capacity and what reasonable adjustments might need to be made.
it makes sense in some circumstances but in areas of high deprivation a high level of ‘sickness’ is usually multifactorial and the most deprived parts of society (and their children) will be the losers.. We hear though that 90% of fit notes are written as not fit rather than maybe fit and plainly (to me anyway) this is not the case except perhaps in the very short term. Off for 12 weeks with a bunion? when you need perhaps to have your foot up in many jobs but not if you are an airline pilot but your employer should find alternative work. I wonder if anyone can quote accurate dr specific sign of rates We know referral rates vary by a factor of 10 and is this the case also for sick notes? Once a diagnosis (very subjective ) has been offered that someone has ‘fibro’ or ‘ED’ syndrome the door to saying fit for work seems pretty firmly shut sometimes
Hmmmmm…..I’m afraid patients will retain the right to appeal, resulting in a deluge of requests for supportive letters and a flurry of extra appointments for those looking to justify their refused absence from work.
In 20 years I have come across one patient who asked what effect, in my opinion, going back to work would have on their mental health. Thousands of others entered consultations knowing what they wanted.
Independent assessor need gps input. One can’t rely on f to f one consultation With them. They need to verify from gp if what individual says is what it is. We have independent assessors for attendance allowance and mobility. They all ask gp to give report . Same thing will happen with med3.
I’m all up for it… one less job – and not a particularly rewarding one.
Initially it might seem a good idea but as Subhash Bhatt points out where will these independent assessors get their information from? Either they simply believe the patient as regards their medical history (unlikely) or they will be asking for information from the GP which is likely to take more time than the GP actually doing the note in the first place
Will go the same way as the medical examiner bs.Non event.Will it happen before a change of government I doubt it there will be a lot of Tory MPs with mental health issues after the next el;ection.
As if the GP s are responsible for sick note culture. This seem like another way of undermining GPs .
Isn’t taking away this traditional role from GPs another instance of further fragmentation? And I agree that paperwork will not diminish as the independent assessors will seek clarifying information from GPs. There’s little this “nasty” Govt is doing which doesn’t have hidden ulterior motives, so why now? I don’t particularly like their ready use of the trope of “sick note culture” stigmatising everybody on med3s.
By all means reform the fit note system, but if the government thinks the reason the treasury has no money is all the fault of the “poorly skilled work-shy” they’re focusing their attention in the wrong direction. Amazon paid no tax in 2022-23, instead getting a £7 million rebate for costs associated with investments. Rishi Sunak (our multimillionaire prime minister) needs to look into why so much of our country’s wealth is concentrated in the hands of so few people and so many people/organisations contribute so little tax and then DO SOMETHING ABOUT IT. Whipping a bunch of folk who may or may not be depressed or suffer back pain might make him and his friends feel better but this isn’t anywhere near the route cause of our country’s problems. He doesnt know it because people like him ARE the problem
Just like the ME/MCCD plans
It will simultaneously increase GP workload, cost more, further diminish the role and standing of GP, attract more ire from our patients…
Part of the gravely misguided de-professionalisation of GPs
And there’s more than a whiff of gaslighting here too. GPs aren’t to blame for this Government’s piss-poor record on the economy, productivity, long term sickness and welfare – they alone own that legacy
Sick notes put us in conflict with patients and so GPs were never best placed. I gave up on assessing for them and just give what the patient wishes so as not to harm the relationship. With any new system GPs should refuse to get involved beyond a factual summary of problems. The only people in a position to provide the service would those trained on OH.
So we can either improve the NHS waiting lists and mental health services or just punch down on those people who are in the main, genuinely afflicted and can’t hit back.
I’ve had a look at the monies ‘wasted’ on benefits annually versus the monies avoided in paying tax- legally or otherwise. Given the latter it is a much larger number it is a little strange that the Tories are not going after tax dodgers first. Perhaps it’s because they are not very good with numbers. Or anything for that matter.
Cowardice, corruption, conservatism.
It is unlikely this will come into being by the time we have an election, but I would expect the labour party to continue with it as they have shown that they wish to continue with almost all conservative policies concerning health so far.
The next thing will be the right to die. We apear to be following the Canadian model, make all your disabled people so miserable and without hope, (stop benefits then no money, no food, no medications, unable to leave the house, or just made homeless) that they want to chose death. Then introduce a law like MAID (medical assistance in dying) and then every time someone asks for a sick note ask them , wouldn’t they be better off dead? Best to have that DNAR on your notes? (oh and also , try to reduce the number of unpaid carers by charging them with fraud, fining them or sending them to prison, remove as much hope and support as possible- already being done here, as you know). Thats where we are going with this.
You think its just a bit less work for you (which it won’t be of course) but its actually a continuing part of the slide towards full on eugenics (see what the Nazi part did in the 1930ies).
Disabled people are uneconomic, less of them would mean more money for you and more houses and an efficient health service – we’ve already been taught to think that ‘they are going to die anyway’, better sooner rather then later, when they waste all that lovely money, right?
That pesky Overton window just keeps on moving more and more , until it all seems acceptable….
Be careful what you wish for, you are only temporarily healthly, one day this could be you, or the people you love.
About time. You cannot be your patient’s advocate , while at the same time policing their access to benefits. I am pretty sure that quite a few of my patients are “swinging the lead” but it is not my job to investigate their fraudulent claims or block their benefits – but I will be happy to contribute objective evidence to an enquiry.