Presentation on theme: "Sickness Certification David Stout. Aims Learn about Fit notes Introduce some ideas to help manage sickness in your surgery."— Presentation transcript:
Sickness Certification David Stout
Aims Learn about Fit notes Introduce some ideas to help manage sickness in your surgery
Objectives Learn how to fill in a fit note Learn the rules associated with fit notes Understand the impact of worklessness Understand your role in managing sickness Introduce some simple ways of assessing fitness to work Introduce some ideas about how you can manage patients asking for time off work
A simple consultation? What is your reaction when some requests a sicknote? Think about the last few you have done Were they easy to complete? Were they easy to complete? What sort of questions did you ask? What sort of questions did you ask? How good do you think you are at judging fitness to work? How good do you think you are at judging fitness to work? What are the challenges in these consultations? What are the challenges in these consultations?
Challenges The management of less clear-cut medical diagnoses Certification for common health problems The pressure from patients to issue fit notes Feeling uncomfortable when a decision has financial implications for the patient
Why does sickness matter?
Worklessness Worklessness 99% of patients return to work quickly but….
Work and Health – The Evidence Common Health Problems 66% of all sickness absence is due to common health problems: 66% of all sickness absence is due to common health problems: Less severe mental health disorders Less severe mental health disorders Musculoskeletal disorders Musculoskeletal disorders Cardio respiratory disorders Cardio respiratory disorders
Facts and figures (data 2008) Based on figures before introduction of ESA On average, 1 million people report sick each week On average, 1 million people report sick each week After 6 months, 3,000 of these are still not back at work After 6 months, 3,000 of these are still not back at work Five years on, 2,500 of them will still be claiming Incapacity Benefit Five years on, 2,500 of them will still be claiming Incapacity Benefit Over 2.7 million people claim Incapacity Benefit every year, which equates to 1 in 13 of the working age population Over 2.7 million people claim Incapacity Benefit every year, which equates to 1 in 13 of the working age population
Length of absence is a risk Window of opportunity (1- 6 months) Window of opportunity (1- 6 months) Worker off for 4 – 12 weeks: 10-40% chance of being off work at one year Worker off for 4 – 12 weeks: 10-40% chance of being off work at one year Worker off months: 90% chance of never returning to any form of work in the foreseeable future Worker off months: 90% chance of never returning to any form of work in the foreseeable future Waddell and Burton
Risks and harm of being out of work Loss of fitness Loss of fitness Physical and mental deterioration Physical and mental deterioration Increased risk of poor health x 2-3 Social exclusion Social exclusion Poverty Poverty Waddell and Burton, 2006
Risk and harm – mental health risks Psychological distress and depression Psychological distress and depression Increased x 2-3 Increased suicide and mortality 20% excess deaths Two-fifths of sickness absence in the UK is caused by anxiety and depression Two-fifths of sickness absence in the UK is caused by anxiety and depression
Families and work Children in workless households: have a higher prevalence of recurrent health conditions and lower well-being have a higher prevalence of recurrent health conditions and lower well-being suffer higher rates of psychiatric disorders suffer higher rates of psychiatric disorders are more likely to experience worklessness themselves during adult life are more likely to experience worklessness themselves during adult life
Fact about people being out of work The risk of being out of work in the longer term is greater than the risk of other killer diseases such as coronary heart disease Waddell & Aylward, 2005
Is Work good for your health and wellbeing? Strong evidence exists that unemployment is harmful to health. The unemployed have higher mortality, poorer general health, poorer mental health and higher medical consultation, medication consumption, and hospital admission rates. (Waddell & Burton) (Waddell & Burton)
Is work good for your health and wellbeing? Overall beneficial effects of work outweigh the risks Overall beneficial effects of work outweigh the risks Work can be therapeutic and can reverse the adverse health effects Work can be therapeutic and can reverse the adverse health effects Waddell and Burton
Shifting attitudes to health & work Current: Shift to: Work is a risk and (potentially) harmful to physical and mental health. Work is generally good for physical and mental health thereforeand Sickness absence/certification protects the worker/patient from work Recognise the risks and harm of long term worklessness
When does an illness require time off work? And How could I assess this? Discuss
You could assess effect of health on work SMARTIES
Fitness for work: health on work Stamina Stamina Mobility: walking, bending, stooping Mobility: walking, bending, stooping Agility: dexterity, posture, co-ordination Agility: dexterity, posture, co-ordination Rational: mental state, mood Rational: mental state, mood Treatment: side-effects, duration of Treatment: side-effects, duration of Intellectual: cognitive abilities Intellectual: cognitive abilities Essential for job: food handlers, driving Essential for job: food handlers, driving Sensory aspects: safety – self and others Sensory aspects: safety – self and others
You could assess effect of work on health DETTOL
Fitness for work: work on health Demands of the job: physical, intellectual Demands of the job: physical, intellectual Environment: shop floor/office, risk factors Environment: shop floor/office, risk factors (e.g. dusts, chemicals) (e.g. dusts, chemicals) Temporal: shift working, early start Temporal: shift working, early start Travel: business travel – between sites, overseas Travel: business travel – between sites, overseas Organisational: lone-working, customers Organisational: lone-working, customers Layout: ergonomic aspects of workstation, work equipment Layout: ergonomic aspects of workstation, work equipment
How can you help patients?
Rehabilitation Aims Bio – psycho – social approach Restore function Restore function Restore confidence Restore confidence Social integration Social integration
Key interventions Early intervention Communicate with line manager Recognise what patient can do, rather than not do Consider simple alterations to support early return TOP TIP…..Go back part way through week TOP TIP…..Go back part way through week
Integrating rehabilitation into the patients management plan Consider functional limitations Review effect of work on health and health on work Consider workplace, social and medical factors Consider what would support patient back to full function Appropriate advice, treatment and support services
How might you do this in reality? What sort of consultation methods will help
Changing behaviour Ambivalence is common and normal Confrontational interviewing = resistance Shift style - resistance diminishes, change talk increases Collaboration, honour autonomy Rollnick and Miller
Method Importance Importance Confidence Confidence Importance + Confidence = Readiness Rollnick and Miller
Importance and confidence How important is it for you to get back to work? So how confident do you feel about getting back to work? Agenda setting- device to hang a constructive consultation onto – what might help increase….. Rollnick and Miller
Support and resources What's out there?
Sources of support OH services in the workplace OH services in the workplace Disability Employment Advisers Disability Employment Advisers Access to Work Scheme Access to Work Scheme Fit for work services Fit for work services
Key messages Work is good for your health and well being Effective negotiation Effective negotiation Early intervention Early intervention Rehabilitation as part of the clinical management plan Rehabilitation as part of the clinical management plan
Fit notes The nuts and bolts
Changes from the old days Telephone consultation allowed Removed option to say fit for work New option may be fit for work…. In the first 6 months limited to 3 month duration
Other stuff Only a Doctor to complete Remains advice to your patient Complete free of charge Not until 7 days off work Issued on Day you assessed Day you assessed A date after you assessed if reasonable A date after you assessed if reasonable Report from another doctor Report from another doctor
If you give advice The employer is not bound by it If still unable to work does not have to return to see you Mythical fit notes Diagnosis can still be vague if harmful
Some testing questions
Am I legally liable if something goes wrong with the patient at their workplace?
Some testing questions Do I have to write a comment if I tick may be fit for work?
Some testing questions I still find employers wanting a fitness for work certificate
Some testing questions Should hospital doctors be sending patients to me for fit notes?
Some testing questions Do I need to issue a fit note not fit for work if the employer can not accommodate my suggestions?
Some testing questions Can I put bereavement as a reason for being unfit for work
Some testing questions Do I have to see / speak to a patient before issuing a fit note if they have seen a physiotherapist and been advised no lifting and carrying for 2 weeks?
Some testing questions Should I issue a fit note to someone who is at university?
Other sickness certification Holiday insurance Private sick notes Fitness to travel Gym notes
Fitness for work: prognosis ( see also OUP Handbook of General Practice) Source: