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Fit notes

Portfolio politics

Louise Newson

Tuesday, 12 July 2016

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doctor writing note_shutterstock_438295003.jpgI was interested to read that the British Medical Association (BMA) has recently announced that employees should be allowed to sign themselves off for up to two weeks, in a move to free up some of our time and create more appointment availability. They also feel that other healthcare professionals (such as nurses and midwives) should be able to issue notes as currently it is only doctors who can issues these notes.

The ruling regarding sick notes was changed in 2010 – they are now referred to as “fit notes” and many people do not realise that, since this time, assessment for a fit note can be conducted face to face, by telephone or even issued after considering a written report from another doctor or healthcare professional. They were changed from “sick notes” to “fit notes” to allow GPs to give more information to patients about the functional effects of their health conditions. This means that these notes do allow more flexibility for people who are fit for some work, but not necessarily their normal job.

A fit note does not need to be issued for the first seven calendar days of sickness absence as patients can self-certify for this period. However, many of my patients still make appointments asking for a fit note to be issued as their employers are requesting one from a GP, even if they have only been off work with an illness for a few days. The ruling is that if a patient or employer requests certificates for periods of less than seven days, the GP is entitled to charge a fee. I find it very hard (actually impossible) to request money for this when the request is coming from the employer rather than from my patient. However, these unnecessary requests do frustrate me as I count these as “wasted” appointments as I am not using my medical knowledge in any way.

The BMA have announced this as one way of trying to reduce the rate of unnecessary appointments so we can concentrate on seeing patients who are ill and need medical care and advice. GPs now carry out a staggering 70 million more appointments than we did a decade ago and some research has shown that up to a fifth of our consultations are not due to medical problems. Over the years, I have been asked to write letters to state my patients are well enough to sky dive, to go on school trips and even for one patient to state that she was not able to do her exams as her pet cat had recently died!

It is unlikely that there will be an actual change to the way GPs issue fit notes in the near future but I really feel it is important that both employers and employees are aware of the current rulings about this. Even freeing up one or two appointments with each GP every week will make a huge difference to our appointments.

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Louise Newson

Louise is a part-time GP in Solihull, as well as a writer for numerous medical publications, including She is an Editor and Reviewer for e-learning courses for the RCGP. She is an Editor for Geriatric Medicine journal and the British Journal of Family Medicine. Louise has contributed to various healthcare articles in many different newspapers and magazines and is the spokesperson for The Information Standard. She has also done television and radio work. Louise is a medical consultant for Maverick TV and has participated regularly in ‘Embarrassing Bodies Live from the Clinic’. Louise has three young children and is married to a consultant urological surgeon. Although her spare time is limited she enjoys practising ashtanga yoga regularly and loves road cycling – she has raised over £2K for a local charity, Molly Olly Wishes by competing in a 120km cycle ride!
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