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Last Updated: Monday, 18 February 2008, 13:44 GMT
Should doctors be 'agents of the state'?
By Nick Triggle
Health reporter, BBC News

GP completing paperwork
GPs are in charge of signing people off for the first six months
Fresh from its success in getting GPs to work longer hours, the government has its eyes on extending the remit of doctors.

Home Secretary Jacqui Smith wants A&E staff to start reporting stabbings and shootings in a bid to help police combat violent crime.

And later this week, Health Secretary Alan Johnson is expected to announce plans to get GPs to encourage patients back into work rather than falling back on the sick note system.

But the plans are being met with opposition.

The British Medical Association says it is against both schemes as it does not want doctors to become "agents of the state".


The idea of forcing doctors to report attacks is not new. Laws were introduced in Northern Ireland at the height of the troubles to compel doctors to report violence.

But Dr Tony Calland, chairman of the BMA's ethics committee, says: "Doctors are against this because they see it as a breach of confidentiality. What if a person has been caught up in a gang attack and you report it to police it could then put that person at risk.

"Obviously, there are cases where it might be in the wider public interest to report something, such as a rape where future attacks may be committed, but really doctors have to use their own judgement.

"That is what has happened in Northern Ireland in spite of the law."

We are not agents of the state, whether it is monitoring the social security system or helping police
Tony Calland, of the BMA

And this comes as plans are set to be unveiled later in the week to tackle the so-called sick note culture.

The Confederation of British Industry estimates 175m working days are lost to ill-health each year.

It means the UK has the highest proportion of people receiving incapacity benefit - 2.7m at a cost of 12.5bn a year.

Katja Hall, head of employment and employee relations at the CBI, says: "Sick notes are outdated, inflexible, and in need of an overhaul.

"They focus on symptoms instead of consequences, and sign patients off for rigid and often arbitrary stretches of time.

"The emphasis must move from what people cannot do to what they are able to do."

GPs are responsible for signing patients off work for the first six months after which they are passed on to the incapacity benefits system run by the Department of Work and Pensions.


The health secretary is expected to urge doctors to make more effort to encourage patients to get back to work.

This will include advice about what they need to do to get well enough to work as well as discussing whether they are able to return in a more flexible, less onerous capacity.

It is even being suggested GPs will be asked to note down what tasks patients are able to do in what are being dubbed "well notes".

Mr Johnson says: "The evidence shows that far from being bad for health, work is generally good for people's health.

"In fact, staying in work or returning to work is often in a patient's best interests. "We want to explore what else GPs can do to change our sick note culture into a well note culture."

We want to explore what else GPs can do to change our sick note culture into a well note culture
Alan Johnson, health secretary

But Mr Johnson will also stress that employers have a bigger role to play.

He will cite examples where leading firms such as British Gas and Parcelforce have set up health clinics to address mental health problems and back pain that have reduced staff sickness.

And the announcements will come ahead of a publication in March of a report by Dame Carol Black, the national director for health and work, who is looking at the issue.

Unison, the public sector union, welcomes the emphasis on health in the workplace. A spokeswoman says: "Unison has been campaigning for years to try to get employers to take the health and welfare of their workforce seriously.

Dr Calland agrees changes are needed, but is unsure whether GPs have a central role to play.

"The idea that you have lots of people trying it on is a myth. Most people are genuinely ill and I think government and businesses could do more to help people return to work.

"The system is all or nothing. There is nothing to help people return to gradually return to work. It is either eight hours a day or nothing."

However, he also points out that it is not the role of doctors to try to catch those cheating the system.

"Doctors can't spend time investigating cases. We are not agents of the state, whether it is monitoring the social security system or helping police. We are their to treat people and that requires a level of trust."

He has recieved support from the Lib Dems. The party's health spokesman, Norman Lamb, said: "We cannot have doctors policing the benefits system.

"They are already under huge administrative burden and need to be able to focus on providing a more flexible GP service."

Action plan targets knife crime
18 Feb 08 |  UK Politics
Doctors facing benefits dilemma
23 Jan 06 |  Health

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