Exclusive GPs will vote on issuing patients ‘indefinite’ fit notes on first presentation, as part potential future collective action being debated at the special LMC conference next week.
The proposal would see GPs passing all further fitness-for-work assessment to the Department for Work and Pensions (DWP).
This is because of the ‘huge number’ of appointments used ‘purely’ for fit notes, the motion added, and the fact that general practice ‘lacks the resources’ to do its job fully, ‘let alone that of DWP’.
However, legal advice published by the BMA as part of the conference agenda said that if the union called on GPs to only provide ‘indefinite’ fit notes, it would be ‘inducing doctors to breach their contracts’ and act in breach of their professional obligations, and this would ‘carry significant risk’ for the BMA, as well as for doctors individually.
In May last year, the previous Conservative government announced a £64m pilot for a new work and health service across 15 ICB areas which would test changes to how fit notes are issued.
This was part of a package of welfare reforms aiming to tackle the country’s ‘sick note culture’, which could include removing fit note responsibility from GPs. However, it is unclear where the plans stand currently as the current Labour Government has not announced any next steps on fit note reform.
The special LMC conference will see GP leader vote on escalating collective action in England, including ‘coordinated’ practice closures for an agreed period of time and ‘collective walkouts’.
Fit notes motion in full
GATESHEAD AND SOUTH TYNESIDE: That conference, noting the contractual duty of GPs to provide Med3s / fit notes, the huge number of appointments used purely for this purpose and the fact that general practice lacks the resources to do its own job fully, let alone that of the DWP, suggests that all practices now issue an ‘indefinite’ Med3 / fit note on the first presentation, passing all further fitness-for-work assessment to the DWP
Source: LMC conference agenda
The agenda for the conference taking place in London next Wednesday also contains a motion proposing GPs should not adhere to NHS England guidance on weight-loss drug prescribing.
The motion notes that GPs have ‘a right to prescribe as they see clinically fit’, regardless of cost implications.
And it calls on the BMA to support practices to prescribe, after ‘appropriate clinical assessment’, GLP-1s to ‘any and all patients who fit NICE guidance’, regardless of whether their ICB has agreed to this.
GP leaders told Pulse that the prescribing motion refers GLP-1 agonists for weight loss, and that it is about ramping up costs for ICBs as a form of collective action.
The motion also encourages GPs to decline to engage with Pharmacy First or ICB directives to direct patients to buy medications available over the counter and instead offer FP10s to all who wish for them.
Earlier this year, GPs were told by NHS England that they should not prescribe tirzepatide for weight loss until advised to do so by their local ICB.
NICE previously accepted a request from NHS England to slow down the rollout of the drug due to workforce and cost concerns, reserving eligibility for those with the highest clinical need at first.
NHS England clarified that ICBs will be designing their own models in line with the requirements of the NICE technology appraisal, which was published in December, and that GPs should therefore wait for ICB guidance before prescribing.
NICE’s final draft guidance on use of the weekly injection means that around a quarter of a million people could gain access to tirzepatide over the next three years.
Under NICE recommendations, tirzepatide is recommended as an option for managing overweight and obesity, alongside a reduced-calorie diet and increased physical activity, in adults, with a BMI of at least 35 kg/m2 and at least one weight-related comorbidity.
Lower BMI thresholds (usually reduced by 2.5 kg/m2) should be used for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds, NICE said.
GLP-1 motion in full
GATESHEAD AND SOUTH TYNESIDE: That conference, noting GPs have a right to prescribe as they see clinically fit, regardless of cost implications, requires GPCE support for practices to:
(i) actively switch medications from generic to branded where the cost of the latter to NHSE is greater
(ii) prescribe, after appropriate clinical assessment, GLP1s to any and all patients who fit NICE guidance, regardless of whether their ICB has agreed
(iii) offer to all patients who would prefer dosette / medibox provision by their pharmacist, seven day eRD prescriptions
(iv) decline to engage with Pharmacy First or ICB directives to direct patients to buy medications available OTC and instead offer FP10s to all who wish for them.
Source: LMC conference agenda
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READERS' COMMENTS [2]
Please note, only GPs are permitted to add comments to articles
Prescribing safely and responsibly weight loss injections would bring a huge workload onto GPs, so may be not worth it.
Indefinite sick notes do not help working people, but when we get ridiculous demands for sick notes on patients who have never worked, but are being denied benefiits pending a ‘review’ by DWP at indefinite date, then an indefinite sick note is entirely appropriate. Same applies to newly registered patients from elsewhere being told to make a ‘new’ application for benefit. It is not new if they have been off for over a month, so indefinite notes is appropriate.
Do not forget that you can add to the note an instruction, which appears to be legally binding too, for DWP to arrange a BAMS medical assessment within a stated period – please do so, it will put pressure on BAMS, but shift it from GPs.
funny that PCN partners are crying about work load on £200k salary but multiple locum GPs are sitting unemployed, looking to sign fit note but there is no job for them !!