Should the ruling about GPs issuing sick notes be changed?


Rather embarrassingly, my average waiting time for a routine appointment to see me is now four weeks. However, I know I am not alone; the average waiting time to see your GP in England has increased over the past decade. There are so many reasons for this, but it is certainly not often because patients are coming to see me unnecessarily.

However, at least once a week I have a patient coming to see me asking for a sick note when they do not actually need one. I am constantly surprised how little employers know about the ruling regarding issuing sick notes.

The change from sick notes to 'fit notes'

The ruling regarding sick notes was changed in 2010. They are now actually referred to as "fit notes" and many people do not realise that since this time, assessment for a fit note can be conducted face-to-face, by telephone, or even issued after considering a written report from another doctor or healthcare professional.

This means that you do not always need an actual appointment with your GP for a fit note to be issued. They were changed from "sick notes" to "fit notes" to allow GPs to give more information to patients about the functional effects of their health conditions. This means that these notes do allow more flexibility for people who are fit for some work, but not necessarily their normal job.

Can patients self-certify and if so, for how long?

We do not need to issue a fit note for the first seven calendar days of sickness absence as patients can self-certify for this period. However, many of my patients still make appointments and are asking for a fit note to be issued because their employers are requesting one from a GP, even if they have only been off work with an illness for a few days.

The ruling is, that if a patient or employer requests certificates for periods of less than seven days, the GP is entitled to charge a fee (standard fit notes are issued free of charge). I find it very hard (actually impossible) to request money for this when the request is coming from the employer rather than from my patient. However, these unnecessary requests do frustrate me, as I count these as "wasted" appointments because I am not using my medical knowledge in any way.

The BMA's call for 14-day self-certification

I was interested to read therefore that The British Medical Association (BMA) has recently announced that employees should be allowed to sign themselves off for up to two weeks, in a move to free up some of our time to create more appointments. They also feel that other healthcare professionals (such as nurses and midwives) should be able to issue notes, because currently it is only doctors who can issues these notes.

The BMA have announced this as one way of trying to reduce the rate of unnecessary appointments so we can concentrate on seeing patients who are ill and need medical care and advice. GPs now carry out a staggering 70 million more appointments than we did a decade ago and some research has shown that up to a fifth of our consultations are not due to medical problems. Over the years I have been asked to write letters that state my patients are well enough to skydive, to go on school trips and even for one patient to state that she was not able to do her exams as her pet cat recently died!

It is unlikely that there will be an actual change to the way we issue fit notes in the near future, but I really feel it is important that both employers and employees are aware of the current rulings about this. Even freeing up one or two appointments with each GP every week will make a huge difference to our appointments!

Dr Louise R. Newson, BSc(Hons) MRChB(Hons) MRCP FRCGP, is a GP and menopause expert, based in Solihull, West Midlands, UK.
Follow her on twitter: @mymenopausedr