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Sickness Certification David Stout. Aims Learn about Fit notes Introduce some ideas to help manage sickness in your surgery.

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Presentation on theme: "Sickness Certification David Stout. Aims Learn about Fit notes Introduce some ideas to help manage sickness in your surgery."— Presentation transcript:

1 Sickness Certification David Stout

2 Aims Learn about Fit notes Introduce some ideas to help manage sickness in your surgery

3 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

4 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?

5 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

6 Why does sickness matter?

7 Worklessness Worklessness 99% of patients return to work quickly but….

8 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

9 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

10 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 6 - 12 months: 90% chance of never returning to any form of work in the foreseeable future Worker off 6 - 12 months: 90% chance of never returning to any form of work in the foreseeable future Waddell and Burton

11 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

12 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

13 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

14 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

15 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)

16 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

17 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

18 When does an illness require time off work? And How could I assess this? Discuss

19 You could assess effect of health on work SMARTIES

20 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

21 You could assess effect of work on health DETTOL

22 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

23 How can you help patients?

24 Rehabilitation Aims Bio – psycho – social approach Restore function Restore function Restore confidence Restore confidence Social integration Social integration

25 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

26 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

27 How might you do this in reality? What sort of consultation methods will help

28 Changing Behaviour

29 Changing behaviour Ambivalence is common and normal Confrontational interviewing = resistance Shift style - resistance diminishes, change talk increases Collaboration, honour autonomy Rollnick and Miller

30 Method Importance Importance Confidence Confidence Importance + Confidence = Readiness Rollnick and Miller

31 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

32 Support and resources What's out there?

33 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

34 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

35 Fit notes The nuts and bolts

36 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

37 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

38 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

39 Some testing questions

40 Am I legally liable if something goes wrong with the patient at their workplace?

41 Some testing questions Do I have to write a comment if I tick may be fit for work?

42 Some testing questions I still find employers wanting a fitness for work certificate

43 Some testing questions Should hospital doctors be sending patients to me for fit notes?

44 Some testing questions Do I need to issue a fit note not fit for work if the employer can not accommodate my suggestions?

45 Some testing questions Can I put bereavement as a reason for being unfit for work

46 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?

47 Some testing questions Should I issue a fit note to someone who is at university?

48 Other sickness certification Holiday insurance Private sick notes Fitness to travel Gym notes

49 Fitness for work: prognosis ( see also OUP Handbook of General Practice) Source: www.workingfit.com


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