EMPLOYERS, volunteer groups, sporting clubs, gyms — there is a host of organisations that rely on “sick notes” and may soon have to rely on “fit notes”.
Most GPs have encountered people who use sick notes to manipulate “illness” to absolve their responsibilities at work (sick days), in learning (university, school), in social activities (jury duty) or in contract commitments (airline bookings, gyms, etc).
Businesses are not entirely innocent here, with some using sick notes to transfer responsibility or protect themselves from medicolegal action in the workplace, gym or as a deterrent to the “sickie”.
Some businesses blatantly use sick certificates to absolve the workplace of providing a graduated return to work or “light duties”, by claiming they cannot provide that type of work.
The basic trust in the worker‒employer relationship seems to be increasingly replaced by an administrative arrangement that allows manipulation by both employees and employers, and continues to cost thousands of taxpayer dollars in Medicare rebates for doctors to write these certificates.
Perhaps a new approach is in order.
I am no fan of many UK “health solutions”, which are often based on simplistic assumptions about general practice, and am yet to be convinced of the benefits of the “fit note” instead of a “sick note”.
The UK’s National Health Service first introduced the fit note
(officially called a Statement of Fitness for Work) in 2010. Doctors or other health care professionals provide information on how a patient’s condition will affect their ability to work. It is claimed that it helps employers understand how they can help employees return to work sooner or stay in work.
Although the Royal Australian College of General Practitioners has offered some support
to plans for the introduction of the fit note system in Australia, a trial planned among Canberra’s GPs has hit a legal snag
Recent UK research
showed that while the fit note could be useful in helping workers return to work, that option is infrequently used, and the completion and content of many fit notes did not meet employers’ needs.
There is evidence in favour of an early return to work, which is actively encouraged by WorkCover organisations
in most states, but there are also often situations where workers should stay clear of the work environment.
But should it be up to GPs to fix this problem?
Instead of GPs changing their work practices around sick notes or fit notes, perhaps it’s time for employers and employees to constructively resolve this issue by restoring trust in the workplace.
Surely, the impact of minor health problems can be managed with workplace agreements that build on employer‒employee dependence.
Doctors’ involvement in illness verification should not include minor cases, but should concentrate on illness where significant absences or workplace rehabilitation is required.
The UK system has this right — a fit note from a GP is required only when an employee is off work for more than 7 days
. If an employee is sick for less than 7 days, employers can ask employees to complete forms to confirm they have been ill.
If employers and employees can sort this out, the reliance on certificates can decrease, workplace harmony can replace distrust, injured workers can be supported in their return to work and the health system can save a lot of money on unnecessary GP visits.
Dr Evan Ackermann is a GP at the University Medical Centre, Southern Cross University, Gold Coast, Queensland, and the chair of the Royal Australian College of General Practitioners National Standing Committee – Quality Care.