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CORPORATEMEDICALGROUP

Website: www.dwp.gov.uk/medical

Fitness for work advice and certification

Dr Philip Sawney

AOHNP(UK) Symposium

13 May 2004



Fitness for work advice & certification

• DWP’s role

• Overview of current system

• Reform - Issues and challenges



DWP and People of working age

• DWP – Minister for Work – Jobcentre Plus – HSC/E– Strategy - To promote work as the best form of welfare whilst

protecting the position of those in greatest need– Policy lead on: ‘statutory certification’; incapacity benefits;

vocational rehabilitation• Working Age

– Sickness absence costs = £10 bn /year (CBI estimate);

– Expenditure on IB = £12 bn /year– 24% of GP consultations are work related



Fitness for work - Statutory framework

• Medical evidence regulations - DWP guidance– Forms Med 3; Med 5

• Social security regulations• NHS (GMS Contracts) regulations – including

new GP contract• DDA and H & S law



Fitness for work medical advice – underlying principles

• Integral part of clinical management of patients of working age

• Start from premise that return to work is optimal health outcome

• Recognise the link between clinical care and the patient’s work

• Appropriate diagnosis and management• Consider alternatives to ‘unfit for work’ • Avoid unnecessary medicalisation of ‘absence’ from

work• Support positive expectations re: working lives



Health benefits of working

Work :

• generates self esteem

• reduces dependency

• enhances social identity

Work environments:

• develop social networks

• acquire, retain and develop skills



Impact of being out of work: evidence

Patients:

• Have reduced confidence and self esteem• Have increased morbidity and mortality -

particularly mental health • Have disability greater than underlying

impairment

the effects begin at 6 - 12 weeks



Med 3 Warning: this form may seriously damage your health



Fitness for work advice and certification

“Absence from work attributed to a health condition, injury or disability”

• GP - patient axis• Issue with quality of advice• Knowledge of workplace• Shortfall in professional training • Lack of employer focus



GP views

• “Poor understanding and training; many GPs are ambivalent about this work” - Hitchcock & Ritchie 2001

• “Some dislike perceived ‘gatekeeper’ role and admit to poor practice” - Hussey et al BMJ 2004

• “Area of work which creates confrontation with patients”

• “GPs estimate that 30% of patients off sick could return to work” - Dr Foster April 04



Employer’s views

• “GPs tend to see ‘work’ as harmful” • “GPs are overprotective of patients and distrustful of

the motives of others”• “Need to end the so-called sicknote culture”• “Only 10% of employers think GPs provide effective

support” IRS employment review - March 04



Employee (patient) views

• Non-medical factors strongly influence ‘fitness’ and capacity for work

• Need for timely access to professional advice from trusted source

• “63% expect to turn to their GP for advice on fitness for work and rehabilitation” - ONS Omnibus Survey 2004



The GP as ‘advocate’

• Setting long term health beliefs and attitudes• Need to consider the longer term effects of

worklessness for the patient • Distinguish between ‘own occupation’ [which

GP certifies] and work in general• Advocacy can be used as a barrier to

communication• Need to more positive expectations about

patient’s working lives



Raising awareness

Doctors• Statutory guidance• Desk aids • DVD• Website / Online learning• Professional meetings• Direct case related feedback

Employers• HSE guidance on absence management• New website for employers



Guidance, advice & training for doctors

Guidance/advice: IB204 & Desk aids

IB204

‘A Guide for Registered

Medical Practitioners’

Contains the rules & background

information about sickness

certification & report writing for

certifying medical practitioners



Web site



Online learning



Reform of fitness for work advice and certification

• Need to balance:– Patient Access– Quality of advice– Cost/affordability

• Context – New NHS GP contract [‘quality targets’ ]– Pathways to Work strategy – find an approach

which better supports work retention / rehabilitation– Legislation and structure of UK ‘benefits’ system

(including Statutory Sick Pay)



A new model ?

• Based on employer-employee axis– Employee and management have the primary

responsibility to initiate a timely return to work • Role of healthcare professional confined to providing

patient with factual information on restrictions or limitations arising from the diagnosed condition and other supporting advice as appropriate

• Management control of sick leave is through workplace culture and timely return to work programs



Reform difficult !

• Would require a different approach by all stakeholders

• Major training requirement

• Fostering a greater awareness of rights and responsibilities including legal (eg DDA and Health & Safety Law)



Take GPs out of the loop ?

• Primary care remains point of clinical care/advice to people of working age

• Risk of setting up a dual system – supported by public funding

• Resource limitations not confined to GPs



Helping patients return to work after illness or injury.

Vision

General Practitioners, Hospital Specialists, Occupational Health specialists and Employers working together to facilitate optimal workplace rehabilitation for all ill or injured persons.

The key elements of a return to work plan • Communication• Recognition of obstacles to a return to work • Knowledge of support services • Active management (rather than a passive ‘wait and see’

approach)• A positive outlook• A patient centred approach



Advice on fitness for work by other healthcare professionals ?

• Joint research: – DWP [lead] – Dept of Health – Cabinet Office

• Steering group of key stakeholders• Fieldwork in progress• Report – 2004• Issues = roles; training; workload



Sickness Certification - the future ?

• Need for excellence in medical care and support/encouragement for rehabilitation

• A more rounded view of advocacy re: advice and communication with employers and OHPs

• Likely to be a ‘mixed economy’ of specialist advice provision

Driver for change should be improved health and work outcomes for patients



More information

www.dwp.gov.uk/medical

• Guides - IB 204, deskaids, Disability Handbook• updates and hot topics• on-line training material • information about medical aspects of UK benefits• research / literature reviews

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