Friday, April 19, 2024
HomeCOVID-19‘Fit note’ Britain – a population groomed to stay at home

‘Fit note’ Britain – a population groomed to stay at home


STARTING this month, the government have slipped in a change in the process for obtaining a ‘fit note’ which employees must obtain if they are off work for longer than seven days. This has largely been missed by the media, despite the possibility of the unseen consequences which such changes are likely to generate.

A fit note used to be known as a sick note, and its purpose is still to declare that one is unfit (for work), which makes the name rather illogical. However this is the world we now live in where language and logic seem irrelevant.

If you are off work for seven days or less, on return you are required to self-certificate, and generally employees will not abuse this other than the usual suspects who will regularly pull a sickie. This more commonly happens on a Monday morning after a heavy weekend, if there is good weather or if there is a major sporting event.

(Hint: If you do pull a sickie, stay off your social media because suspicious employers will check up, and research shows that bosses think that 50 per cent of excuses are lies.)

If your period off work exceeds seven days, you are required to get a fit note from a health professional which states the reason for your absence. In the past this had to be signed by a doctor, usually your GP but also hospital doctors. The note would generally give a time limit after which it would need to be reviewed and re-issued if appropriate. The changes are that fit notes may now be issued by nurses, occupational therapists, physiotherapists and pharmacists, with no requirement to see or contact a doctor. The documents no longer require a physical signature, merely the printed name of the professional. The aim is to simplify and streamline the service, and to take pressure off overworked GPs.

Let’s give this a bit of context.

Although we are told by the government that unemployment is at its lowest for 40 years (3.8 per cent) this masks the true extent of the problem. In fact there are millions of those termed ‘economically inactive’, that is those of working age who are not in employment for a variety of reasons, and these numbers have burgeoned following lockdown and Covid, now estimated to be one in five working-age adults. Many millions are on a variety of unemployment benefits.

The problem this creates is that there is a dearth of applicants for jobs in virtually all sectors of the economy. Wherever you go there are adverts stating ‘recruiting now’ and obviously Brexit has made things worse. Some of the reasons for this may be understandable, for example child care or other care requirements. But a significant number, around 2.3million, are on long-term sick leave.

Of course ‘Long Covid’ is being blamed by some. I have grave reservations about this. Does Long Covid exist? Probably, but I suspect it is relatively uncommon. My suspicions are heightened by the huge number of symptoms included in the syndrome, which range from dandruff to ingrowing toe nails. But once you give a symptom a name it becomes a meal ticket for life.

I am a co-founder and trustee of a small but excellent mental health charity. A number of years ago we employed an admin assistant who had important functions in the office. One day she phoned in sick and duly provided a sick note after seven days, signed by her GP. It stated that she had a mild condition and we anticipated her return in a couple of weeks. However the sick notes kept coming for weeks, then months, on full pay, then half pay (naively we had a too-generous sickness policy). She would simply ring the surgery and another note would be provided. This was despite the fact that she was regularly seen out and about with her children.

When she finally condescended to return to work it was initially for half days. On day five she failed to turn up, and a subsequent sick note stated – you’ve guessed it – ‘work-related stress’. Being fully advised by our insurers and HR mentor it still took us a year, and lots of work, to get rid of her. More recently the charity has had similar problems with two fit young men, good at their jobs, but due to their complex personal lives they too were signed off by their GPs with ‘stress’ after short telephone consultations. Both are now unemployed and on benefits. I suspect that many readers who run businesses will have similar stories.

The vague terms of ‘stress’ or mental health problems are now the go-to condition if you want a quick sign-off. In these days when mental health is all the fashion, whether you are a prince or pauper, which GP would want to bother with a full clinical assessment (even if you could get an appointment)?

Most GPs I have spoken to believe rightly or wrongly that it is not their job to police the workplace. They do not have the time to see everyone and say that challenging a patient’s vague claims to illness or stress generates a huge amount of aggression (and they are already getting enough of that). It is easier to simply sign the chitty and get rid of the problem. Others are perfectly happy to shift fit note provision to other health professionals.

So what are the unintended consequences? After the last two years of insanity we now have a population who have been groomed to stay at home, and there is a clear unwillingness among many to return to meaningful work. The number stating that they are too ill to work has reportedly increased by 20 per cent since spring 2019. Making it easier to obtain a fit note on such grounds as stress or mental health issues will, in my view, simply compound the problem. Far easier to pop down to your local chemist and describe your symptoms to the friendly pharmacist who will, with a great sense of power and importance, be more than happy to sign you off without the messy business of actually having to make a diagnosis.

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Dr Tom Goodfellow
Dr Tom Goodfellow
Tom Goodfellow is a retired NHS consultant radiologist who had a specialist interest in paediatrics and cancer diagnosis.

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