GPs 'ignoring sick note advice'

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There is a large variation in how long patients are signed off work for by GPs for the same condition, despite clear national guidance, a study suggests.

Researchers studied 113 GPs in one English health trust and examined sickness certification practices after surgery or a heart attack.

Only one in 20 GPs surveyed followed government advice on sickness leave.

Occupational therapists said a "culture shift" was needed to get people back to work more quickly.

For the study published in Occupational Medicine, the researchers looked at hernia repair, hysterectomy and heart attack.

GPs questioned by the University of Manchester researchers differed widely in how long they thought patients should be signed off for.

We need to get across to GPs and patients alike that 'being signed off' may actually be bad for the health of the patient, their employer and the country as a whole Dr Richard Roope, study leader

For hernia operations some GPs recommended four to six weeks off work, compared with the recommended one to two weeks.

And for a hysterectomy, only a quarter of GPs suggested the appropriate seven weeks, with answers ranging from two to 13 weeks.

A third of those surveyed suggested heart attack patients should be off work for longer than the four to six weeks outlined on the Department of Work and Pensions website, the researchers said.

The study also showed that almost two-thirds of GPs had not received any training in sickness certification and the average amount of training for those who had was four hours.

Only a third of GPs were aware that the government had guidelines on sick leave.

'Fit notes'

The government is currently working to replace sick notes with "fit notes".

Under the new proposals, GPs would have to spell out what work the patient may be able to do.

Study leader Dr Richard Roope said the inconsistency seen in the study was unsurprising given the lack of training for GPs.

"There is good evidence to show that work is generally good for health," he said.

"We need to get across to GPs and patients alike that 'being signed off' may actually be bad for the health of the patient, their employer and the country as a whole."

Dr Tony Stevens, president of the Society of Occupational Medicine, said: "There needs to be culture shift amongst employers and patients and more support for GPs so that we can offer a more flexible approach that facilitates early rehabilitation to work.

"This can stop people being signed off unnecessarily."

The Royal College of GPs is running a training programme to help implement the fit notes programme.

Chairman Professor Steve Field said GPs also needed better access to specialist occupational health consultants.

"We would like to see some provision for occupational medicine in the GP training curriculum but feel this could only realistically be achieved if GP training were increased to five years as we have previously recommended."