Page last updated at 12:51 GMT, Monday, 22 December 2003

Sicknote system 'is a sham'

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Many GPs want to stop writing sicknotes

Many sicknotes are not worth the paper they are written on, GPs have admitted.

Doctors in Scotland have told researchers that they often write sicknotes for patients even when they are well enough to return to work.

GPs said they did not have the time or the desire to challenge patients and simply issued sicknotes "on demand".

Writing in the British Medical Journal, the researchers said many doctors were disillusioned with the current system

and wanted it changed.

At the moment, workers who get ill can self-certify for up to seven days.

This means that they do not have to provide employers with a medical sicknote from a doctor for up to a week.

I very rarely refuse to supply a certificate
Anonymous GP
However, this latest study from researchers at the University of Aberdeen suggests that even when workers get a sicknote from a doctor it cannot always be believed.

The researchers interviewed 67 GPs as part of their study. Most said they operated a "sick certificate on demand" system.

Almost all said they thought they would jeopardise their relationship with patients if they challenged their request for a sicknote.

"I very rarely refuse to supply a certificate," one GP told researchers.

"I am not going to allow a small issue like that to interfere with my relationship."

'Impossible position'

Some suggested they were in an impossible position and that the current system is seriously flawed.

"How can we act as policeman, friend, social worker and all the rest of it? We can't," said one GP.

And Dr Susan Hussey, who headed the research, said some GPs simply did not even bother to argue with patients.

"Some negotiated with patients, but most GPs acknowledge that if a patient is absolutely determined to get a sicknote they will eventually get it," she said.

If someone has a regular pattern of not turning up to work questions will be asked to try and find out the reasons that lie behind it
Alan Hogarth
CBI Scotland
"They can do it by going to see another GP, or producing a different condition and many of the conditions that are written on the sicknotes are impossible to prove."

She added that a lot of GPs saw themselves as patient advocates and resented having to be in a position to judge them.

But Alan Hogarth, from CBI Scotland, said there were systems in place to try and deal with people who were playing the system.

Mr Hogarth said: "If someone has a regular pattern of not turning up to work questions will be asked to try and find out the reasons that lie behind it.

"Counselling or occupational health services may be offered to them if they require it and finally if it is obvious the person is just isn't doing his or her job, they may be asked to leave."

Alternative system

The researchers said the government should consider an alternative system.

"An alternative system could include a self-certification system with spot checks akin to tax self assessment," they said.

Half of all GPs they talked to "wished their certification role removed".

"Many thought an extension of self certification the best alternative," they said.

Ben Wilmott, of the Chartered Institute of Personnel and Development, believes that GPs should not be responsible for the system.

Mr Wilmott said: "They don't have the objectivity because of the patient relationship they must maintain, they don't have the time and they don't have the expertise in fitness at work issues to administer the system effectively."


Do you think the current system for issuing sick notes should be changed. Send us your views on the form below.

Doesn't matter what system is in place, there will be people who abuse it
Robert Marshall, Carmarthen UK
Doesn't matter what system is in place, there will be people who abuse it. Most people, I suspect, would not be inclined to ask their GP to lie for them, so we're probably only discussing relatively few people. Sick notes or not, most employers are free to look askance at employees who take excessive amounts of sick leave, particularly for trivial reasons. Perhaps a useful improvement would be to have sick notes assessed by an independent GP - one with no relationship to either the employer or the patient - on demand by the employer after some additional period?
Robert Marshall, Carmarthen UK

I don't see why the system should be changed. Who else can tell whether someone is fit to work or not, except the doctor? How about a bit of courage and honesty for a change on the part of professionals?
Philip Lerman, Bradford, West Yorkshire.

I am a GP in an inner London borough where the demand for sick notes is high. I do regularly refuse sick notes if I think the request is inappropriate. One of my colleagues has been threatened with physical violence when she refused to issue a certificate.
CD, London

Sick notes are given out by GP's on demand and that has been the case for years. The patients are not to blame the doctors are. They are the ones that sign them. I work in a large office for a global company and we have lots of people off sick for weeks or even months on end when there is nothing wrong with them. Companies cannot challenge sick notes and they have damaging affects on staff morale and productivity because staff members who are at work all know these people are skiving. The buck stops with the GP as far as I am concerned.
Nicky Ellis, UK

So one GP thinks it's a 'small issue'. Not for employers considering that the average cost of sickness absence in the UK is 11.6 Billion (476 per employee per year). It is a huge issue and GPs cannot be allowed to hide behind the GP/patient relationship.
Bill Kinnear, Lundin Links, Fife, Scotland

No I do not think the present system should be changed. It is just another case of the government wanting to interfere in everything. Obviously there may be some GPs who feel pressurized into signing certificates but in those cases they should ask for the patient to be transferred to another doctor if possible. They could have members of staff in the practice if the doctors have not got time who's job would be to look up all long term sick patients, I think this happens anyway with any sick or disability benefits and arrange an appointment if necessary with a specialist to assess the patient's true condition.
Pat Noble, Bristol England

I can only dream of having more than a five minute emergency visit with my GP, let alone a relationship
Frederik B, London
"I am not going to allow a small issue like that to interfere with my relationship." They have to be kidding - I can only dream of having more than a five minute emergency visit with my GP, let alone a relationship. Sounds like they're just trying to work their way out of doing paperwork.
Frederik B, London

Another issue to be born in mind when GPs issue sickness notes is that these are not only used by employers when off work to justify the period of sickness. People's insurance companies use them for processing Illness Income Replacement Plans (of the short term variety - not long term illnesses). This is a very serious issue that GPs with the way the rules are should bear in mind.
Samantha Davison, UK

I don't think if you look at it a problem with the "sick note" system, a GP can refuse to give a sick note and I don't feel that a patient can bully or demand a sick note from a GP if so then we have a serious problem in society that goes far deeper than issuing sick notes.
Paul Moore, London, UK

Having been ill for 6 months last year with very bad depression I valued the fact that I could phone and ask for a repeat sick note. I did not want to have to speak to a different doctor every time to explain how I was feeling, as the one I wanted to see what not available. It relieved the pressure knowing that I could request this over the phone. This system may well be abused by a minority of people and these are the ones Doctors are probably aware of. For those that are genuinely ill you already have to deal with the guilt of being off sick without having to justify yourself to a doctor every month.
LP, Somerset

I've been signed off with work-related stress twice in the past eighteen months. The first time was at the urging of my GP herself, who'd recently put me on antidepressants; the second, my HR department ordered me to get myself signed off. The truth is that many workplaces don't take stress seriously until their employees are ill, and sometimes not even then. Self-certification is more likely to be taken as 'malingering', and could only make the problem worse.
SC, UK

Yes the current system of issuing sick notes should be changed. Sick note should have special codes written by the GP which would indicate that sick note has been issued on patient demand but the GP believes needs to be investigated by special inspectors without any come back to GP's.
Mr. J J Dhanani, Harrow

Abolish sick notes. Think of the saving in GP time. Self-certification is fine so long as employers are permitted the discretion to stop paying people whom they judge to be swinging the lead. If you want to get a real indication of how much sickness cheating there is, compare workforce absence levels with the absence levels of the self-employed - who don't get paid if they don't work.
Nigel Holder, Saffron Walden, UK

There may be some patients who abuse the system and try to stay off sick although they are perfectly well. But you also have to consider the opposite scenario: Work pressures may mean that you don't dare to call in sick when you rather should stay home. Call me too responsible, but I almost felt guilty when I had to self-certify for a couple of days recently. It would have made me feel better if a doctor confirmed my condition.
Holger, UK

The current system is a disaster. Unfortunately, managers aren't able to challenge workers who have too much time off sick for trivial issues because of workers rights. I would support the 'spot check' system - send round a private investigator to check up on the 'sick' employee. If the employee is genuinely ill, he won't be doing any more than going to the doctor/pharmacist. If the employee is out Christmas shopping, then issue a P45. I know, I'm just a big softie, full of festive goodwill towards my malingering colleagues.
Paul, Southampton, UK

Surely the problem is that often that certificates have to be produced retrospectively - i.e once you are well enough to drag yourself to the doctors. How is a doctor supposed to be able to ascertain how ill you actually were last week when you were unable to get out of bed and attend a surgery ?
Matt Mullen, Southampton

There will always be dishonest people who take advantage of whatever system is in place. Changing the system to make it easier for the doctors to do their job can only benefit the decaying health system.
Chris Hurst, Dartford, UK

I work for a recruitment agency and we supply temporary staff. Its amazing the amount of people that get signed off for "stress" - always a good line and you don't have to fake a cold. Unfortunately this discredits genuine sick notes. I can appreciate in today's rough society that Doctors do not want to say no and upset unruly patients, but they are going to have to make a judgement, that is what they are paid for isn't it? To diagnose sick people correctly.
Nadina, UK



SEE ALSO
Doctors under sicknote pressure
28 Oct 03 |  Health
Sicknote cutbacks urged
02 Jul 02 |  BMA Conference
Bid to curb sicknote demands
11 Jan 02 |  Health

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