Every morning when I log into my computer, I’m greeted with a familiar message. It reads something like this: ‘Depression, one month please.’
This terse message is a request for what we GPs call a fit note – which most people call a sick note. I receive four or five of them a day.
I check their notes to make sure that the symptoms they are describing are not new. If this is a recently developed condition, I will call them in to the practice for assessment.
However, this is rarely the case. The majority of people asking for sick notes have requested them in the past due to an existing health problem and will want one again in the future.
Dr Dean Eggitt, a Doncaster-based GP, says he doesn’t speak to every patient he signs off work
I pull up a pre-generated form, enter the patient’s personal details, their medical problem and how much time they want to take off work.
I click enter and it’s done. The patient has been emailed the document which they can give to their employer. It’ll allow them to take a month off work and still get paid.
I don’t speak to the patient. In many cases I haven’t seen them recently, and probably won’t for quite some time. But almost all fit notes I receive, I will approve this way.
Last week, Prime Minister Rishi Sunak announced plans to remove GPs of their power to sign people off work.
The move is in response to the record 2.8million who are ‘economically inactive’ due to ill health, the majority of whom are living with chronic pain or mental health issues.
Soon after, The Daily Mail revealed that many GPs were routinely writing fit notes for patients they have not seen, and the news was met with outrage. But it didn’t surprise me one bit.
The truth is, in my own experience and from speaking to colleagues, waving through requests in this way has been routine practice for years.
We rarely deny a request for a fit note for several reasons: GPs are heaving under the weight of unprecedented demand for appointments, a new digital system that allows patients to email medical questions and requests and a mountain of admin and paperwork.
Of course, it would be ideal to see or at least have a phone appointment with every person who requests sick leave, but given the sheer number of such requests we get, it just wouldn’t be physically possible.
Occasionally, if I suspect malingering and the sick note doesn’t match up to what I know about the patient’s health, I will follow up with them. But these cases are far and few between.
I just don’t have the time to investigate each one.
In addition, we don’t say no simply because we can’t face triggering a confrontational situation.
And so, unlike many of my colleagues who – I think bizarrely – rushed to claim that GPs were ‘best placed’ to issue fit notes, I am supportive of Mr Sunak’s plan.
I’m not alone. In fact, when the new policy was announced, my GP WhatsApp group chat lit up with messages from colleagues who were overjoyed to hear they would no longer have to fill in these forms.
Because while GPs endlessly approve fit notes, few are happy with the arrangement.
GPs may wave through sick notes because they don’t have the time to assess each patient
One of the main reasons for this is that they worry that patients will complain if they refuse to sign them off work.
Since 2013, GP performance has been based heavily on how well they do on what is called the friends and family test – an anonymous survey which patients are invited to fill out, to say whether or not they would recommend their GP to friends and family.
GPs live in fear of bad scores because it can influence how many patients register with the practice – and this impacts how much funding we get.
Upsetting patients by rejecting their request for a fit note could mean a negative friends and family score.
It can also damage the relationship between patient and doctor, meaning that, when they are severely unwell in the future, they do not want to talk about their problems until it is too late.
Many doctors also fear that denying sick leave can put them in physical danger.
I sometimes get fit note requests from patients trying to get out of court-ordered community service and I will always call them into the practice for assessment.
When they realise that I’m sceptical of their claim, these patients can get aggressive – raising their voice and squaring up to me.
In this situation, it’s hard not to think about the fact that this person knows where I work and that my children go to the local school just down the road.
Is taking the moral stand and rejecting their fit note worth putting yourself and your family at risk of harm?
However, perhaps the most simple reason GPs regularly wave through sick notes is because we just don’t have the time to assess each and every patient.
GPs are seeing more patients than ever. On average, there are four million more family doctor appointments a month than before the Covid pandemic.
It is a huge workload that we are struggling to keep up with.
And even after we have seen them, patients can still expect to wait months to get an appointment with a mental health worker or a pain specialist.
The uncomfortable reality is that simply approving fit notes on the spot reduces the workload of GP while also making the patient happy.
That’s why I – and the majority of my colleagues – think the decision to take fit notes away from GPs is a good move.
Of course, there are still unanswered questions about how the scheme will work.
Currently, we don’t know who will handle the requests. All the Government has said is that they will be the responsibility of ‘specialist work and health professionals’.
It’s also crucial that the move is accompanied with more funding for mental health and pain services to ensure that patients can get treatment that allows them to return to work in weeks not months.
But I’m hopeful that the change will free up GPs to help even more patients while also ensuring that patients who are well enough to keep working do so.