GPs like me know better than Rishi Sunak – his ‘sick note culture’ war hurts us all
Austerity has already made almost everyone’s life harder – let’s not add to the burden of practices and patients.
Nico* had been off sick for weeks with a bad back and depression.
Things were improving though, thanks to counselling I’d organised, and exercise for his back.
However, he wasn’t quite ready to go back to work full-time. So I issued a fit note to recommend that he go back part-time with no heavy lifting for three months – with my review in two months.
That suited him, his family and his workplace.
As a recently retired GP, I have been issuing or stopping fit notes tens of times a week for years. It takes seconds, but the discussion and the shared decision can take some time.
So I take issue with Prime Minister Rishi Sunak saying last week that Britain has a ‘sick note culture’ that needs to be tackled. He took aim particularly among people who are ‘parked on welfare’ to say that focus must shift to what work people ‘might’ be able to do rather than what they can’t.
He said ‘something has gone wrong’ since the pandemic to increase the number of people signing off work for long-term sickness, especially those with mental health conditions. So he wants to see specialist work and health professionals responsible for issuing or denying fit notes for patients rather than GPs.
Although some GPs may welcome the small reduction in workload, I think this is a very bad idea – for many reasons.
The PM’s initiative implies that a harsher regime will force people back to work, even if the rhetoric is that it will offer more support. It also implies that GPs allow people to stay off work for no good reason. Neither is true.
Around 60% of all fit notes are one-off, with the most common reasons for being off sick longer term are mental health, joint pain and respiratory diseases.
We know that good work is good for almost everyone and I always explained this to my patients. The GP can flex arrangements to suit both the patient, their family and their work. Our decisions try to balance out the illness, the personality and the work.
As far as I can see, there is no evidence that GPs keep people off work unnecessarily – the vast majority of people on fit notes really cannot work.
That hasn’t stopped the Government appearing to unnecessarily attack disabled people, particularly in recent months. Disabled people are being forced to repay unreasonable sums for ‘honest mistakes’ in their disability payments.
On top of that, there are huge barriers of care charges – getting worse all the time – with bailiffs knocking on doors.
This latest suggestion by the PM seems to me to be part of a narrative of blaming people for their illnesses rather than supporting them in their hour of need. The welfare state should be here to protect us, not blame us for being the ‘undeserving sick’.
So what will replace GPs? The exact details are still unclear, but private companies doing this kind of work have a bad reputation.
In 2010, a man with bipolar named Stephen Carré died by suicide after losing an appeal against the Department for Work and Pensions (DWP).
ATOS – a private company managing assessments for disability payments on the DWP’s behalf for almost two decades from 2004 – handled the case so poorly that a coroner at the inquest to Stephen’s death found that the rejection of his ‘fit to work’ appeal was a ‘trigger’ in his suicide.
Their services don’t come cheap either. According to The Mirror, ATOS have been paid more than £1.2billion of taxpayers’ money to carry out Personal Independent Payments assessments.
We don’t want to see incidents like Stephen again and I worry that hiring this process out will result in a similar outcome. Separating off this part of caring for the sick to another organisation means fracturing the all-round care that GPs can – and should – be providing.
Work, life, love and illness are part of a GP’s work with our patients. We can help provide support or tough love as needed. Austerity has already made almost everyone’s life harder – let’s not add to the burden of practices and patients.
This is a bad idea. It offers a quick, dirty and inappropriate fix.
The target should not be the sick. Instead, what we need from the Government is a commitment to properly funding the NHS so that GPs can do our jobs more easily and continue to provide a comprehensive service.
In parallel, we need a transformation of our social care that can support people with multiple conditions and disabilities, so that they can stay as active and independent as possible.
In addition, low wage rises and spiralling cost of living has meant that the poverty rate among working households reached a record high this century in 2021.
We know that deprivation and sickness go hand in hand. We need a deep, long term focus on rebuilding our broken civic society.
As for Nico, he was pleased to go back to work with the adaptations we set out and his work was happy to have him, even with those restrictions. Sure enough, in two months he was fit to return to full-time work.
It just goes to show that thoughtful shared decision-making based on an understanding of the person’s background and preferences makes for better, safer medical care.
Good work is good for us. But Sunak’s approach is not the prescription we need.
Dr Brian Fisher is a recently retired GP and a member of Keep Our NHS Public.
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