More meaningful occupational health interventions will be necessary to make government’s plan to shift responsibility for issuing fit notes from GPs, towards specialist work and health professionals workable.
This is according to occupational health professionals Health & Protection spoke to in the wake of a speech by Prime Minister Rishi Sunak late last week where he committed to changes that would see more “objective assessment” by unspecified “specialist work and health professionals” rather than GPs.
Sunak also said that were the Conservatives to win the general election, those who were still out of work after 12 months after support from a work coach will have their benefits taken away completely.
The PM’s speech coincided with government issuing a call for evidence to inform a programme of work announced at the Autumn Statement in 2023.
It is part of a wider suite of activity to reform the fit note and will act as a prelude to a full consultation on specific policy proposals which will be launched later this year.
The call for evidence runs until 8 July 2024.
Occupational health needs to change
Pamela Gellatly, strategic development director, HCML, maintained government’s occupational health tsar, Dame Carol Black, wanted to take responsibility for issuing of fit notes away from GPs “many years ago”.
“If done correctly it could work as GPs do not have the time or capacity, nor do they understand work, job types etc., and when work is good,” Gellatly said.
But Gellatly added the occupational sector on its own, as we know it today, could not take this responsibility on from GPs.
“Occupational health needs to change and organisations now need a very different type of support,” Gellatly continued.
“Illness and absence from work is often not work-related and the time is now right to change workforce health management.
“An integrated approach across health and safety, health benefits (including absence) and wellbeing is now needed.
“This would encompass a multidisciplinary service which is experienced in the biopsychosocial aspect of health which also means such practitioners would incorporate the management of clinical symptoms with the range of underlying risk factors.
“This approach would reduce the burden of relying on clinical solutions and increase the focus on self-help through activity, weight management, good nutrition, good sleep and healthy behaviours.”
Work is a health outcome
But as Dr Julie Denning, managing director of Working to Wellbeing, pointed out a key factor is government has not yet specified yet which specialist work and health professionals will issue the fit notes.
“The fit note is already issued by a wider group of health professionals than just GPs and this clinical input mustn’t be underestimated in understanding someone’s capability to return to their roles, as well as the steps needed to rehabilitate them back into work,” Denning said.
“This rehabilitation needs to be implemented in order to help people back into work and can’t be ignored in favour of assessment and advice alone.”
Another key consideration not often discussed, Denning added, is that work is not universally considered a health outcome.
“It should be,” Denning continued. “Clinicians helping their patient to reflect on how to manage their condition and associated symptoms at work would be an extremely helpful step on the way to returning to work.
“Providing work focussed rehabilitation (vocational rehabilitation) as standard for those of working age should be an imperative, as well as seeing work as part of the rehabilitation process.
“Too often people are left struggling with symptoms that are challenging to manage and they don’t have any support to manage them in their personal lives, let alone their working lives.”
Meaningful investment in occupational health needed
For Jim Harris, managing director of HCB Group, proper investment in occupational health is needed to make the PM’s plans workable.
“Investment in employee health management which combines wellness at work, practical absence management, early intervention, rehabilitation and return to work support is, in the HCB view, the most meaningful solution to this,” Harris explained.
“The majority of employees would not need fit notes if practical support and return to work strategies were implemented early enough by the employer.
“A meaningful occupational health product designed specifically for the SME market that provides support in a practical and affordable way would also be a welcome addition.
“Traditional occupational health seems omni-focussed on large corporates.”
Unsustainable model of practice
For Brandon Collins, commercial director at HealthHero, GPs are working within an “unsustainable” model of practice and as a result long term sick notes tend to be issued quickly and often without seeing or even speaking to the patient.
“The medical risk and pressure of other critical workload is higher than that of reissuing a sick note to a patient on long term leave, therefore provision of sick notes is not given the attention it deserves,” Collins continued.
“A properly funded system better designed to identify patients who would benefit from support back to work would be welcomed. However in isolation this would not be sufficient.
“Underfunded mental health services, long waiting times for NHS hospital appointments or surgery leaving sick patients stuck in the community, and poor social care support of extended families would all need to be addressed.
“A hands on coaching/mentoring back to work system needs to be developed alongside any return to work project for appropriate patients.
“Identifying patients with chronic, irreversible or life limiting medical conditions and removing them entirely from the sick note pipeline could also be better managed.”
Employers have a key role to play
And according to Matt Liggins, head of wellbeing at Health Shield, employers have a key role to play in looking after their employees’ health.
“The research is showing the main reasons for long-term ill-health are chronic pain, type 2 diabetes and mental health problems,” Liggins said.
“The rise in the number of those experiencing chronic pain is potentially linked to an ageing workforce with more workers in their 50s and 60s, while the other conditions can be linked to almost 15 years of austerity and the impact this has on society.
“Financial challenges and restricted access to public services, particularly preventative services, contribute to deprivation and poorer health and we are seeing the impact of this now.
“In light of these challenges, employers have a key role to play in looking after their people, and crucially, this pays for itself with a strong return on investment.”
Steep hill to climb
Christine Husbands, commercial director at RedArc, said her firm sees first-hand the issues people with long-term health conditions face.
“Not only do they suffer from the symptoms of the illness itself but many other areas are impacted too,” Husbands said.
“Those with long-term physical illness often find their conditions deteriorating whilst waiting for surgery or treatment and in many cases also become mentally unwell, making recovery a very steep hill to climb.
“Holistic support from the earliest stage from an experienced professional can help people manage their symptoms, avoid mental illness and deal with all the implications of their illness. All this means that people often make a quicker recovery once surgery or treatment has taken place.”
