Page last updated at 00:10 GMT, Monday, 2 November 2009

'Fit notes' for back pain concern

By Emma Wilkinson
Health reporter, BBC News

Back pain
Back pain is extremely common

Government plans to introduce GP "fit notes" instead of sick notes may be unrealistic, at least in the case of back pain, say researchers.

A survey of 440 GPs in Nottinghamshire found few currently took any responsibility for managing the work issues of patients with back problems.

Considerable training and a change in culture will be needed for GPs to take on this role, Family Practice reported.

The Royal College of GPs said the issues would be overcome.

An overhaul of the sick note system was announced in March last year by Dame Carol Black, the national director for health and work, who calculated that ill-health was costing the economy £100bn a year.

The current government expectation that GPs are able to successfully manage this to manage this role may be unrealisti
Carolyn Coole, study leader

She called for a new fit-note system as well as fit for work schemes embedded in the NHS to help people back to work.

The idea is that GPs spell out what work the patient may be able to do rather than what they cannot do so employers can support them to return to work.

In the latest study, researchers from Nottingham University, surveyed 440 GPs - just over half of whom responded to find out how much they currently help people with back pain to get back to work.

In all 77% said they did not take responsibility for getting patients back to work.

And only a third ever filled in the remarks section on sick notes to advise employers.

Two-thirds said therapy and rehabilitation to help patients with low back pain with work problems should be provided by local authorities.

Common condition

It is estimated that a third of the population are affected by back pain in any one year and 20% of those will go to the GP.

In 2007/08 it is thought four million working days were lost because of musculoskeletal conditions.

Carolyn Coole, study leader and research occupational therapist, said the results showed GPs did not "readily engage" with getting back pain sufferers to work.

"The current government expectation that GPs are able to successfully manage this to manage this role may be unrealistic."

She added that GPs would need a lot of training as advising on work fitness is not something they do much of at the moment.

"It is going to be difficult for them in terms of the amount of knowledge they will need about a person's job and to give advice that the employer understands."

Professor Steve Field, chairman of the Royal College of GPs, said he understood the concerns, but added they were not insurmountable.

"We have been commissioned by the Department of Health to roll out training programmes and these started six weeks ago.

"The feedback we've had has been excellent and part of our work will be to raise awareness of the what GPs are able to do."

A Department of Health spokesman said: "We recognise that GPs are not experts in occupational health, but they and their patients are experts in their patients' health.

"We believe that GPs are well placed to provide appropriate advice, which the employer, who understands the demands of their workplace, can then use to decide whether or not they can safely facilitate the employee's return to work."

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