1. Sick certification + Benefits
Jo Swallow

2. T/F Quiz! A med 3 can only be issued by the GP
A med 3 can be based on a phone conversation
A med 3 can usually be backdated
A med 3 can not be issued by a nurse
A patient who is appealing their ESA allowance must be issued a Med 3
A patient needs to be signed back fit to work after a certification expires

3. A patient can have 2 med 3s issued if they have 2 jobs.
SMP is paid for how many weeks?
ESA pays more than job seekers allowance?

4. Hidden slide – only to be shown if delegates express interest

5. Case 1 –Mr palmer
Mr palmer attends your surgery with pain in his lower back.
He works as a builder and this pain is preventing him from being able to work. He has already been off for 6 days and comes asking for help.
In pairs-
What issues might you consider? What action would you take?

6. Writing a sick certificate: Liaising with employers
Consider issuing a Med 3:
“You need NOT refrain from work” with specific advice to employers about adjustments to duties or hours in the remarks section.
Example of specific advice to employers:
" This woman is fit to return to work but is not fit to carry out manual handling tasks for the next two weeks”.
Consider returning the individual to work in the middle of the week rather than a Monday
Paying for treatment / investigations
Using the sicknote to communicate with the employer
Look at what the patient needs clinically to get better.
Be positive - look at what patients can do, not what they can’t.
Like any therapeutic interventions, sicknotes can produce side-effects and adverse reactions – use them with caution
Early intervention to help in returning to normal activity (including work) is crucial to prevent chronicity, dependency and job loss.
Earlier treatment for the patient - many employers will pay for private treatment if the GP identifies what treatments/interventions are necessary and there is prolonged NHS waiting time for them.
The onus is passed to employers to see if they can find work that is suitable for patients/employees.
List of commonly available workplace modifications e.g. reduced hours 6

7. Mr Palmer 2,
Mr palmer reattends 2 weeks later stating that his pain is still present and requesting a further month off work,
Thoughts, issues,
Plan?

8. Length of absence is a risk
Window of opportunity (1- 6 months)
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
Like any therapeutic interventions, sicknotes can produce side-effects and adverse reactions – use them with caution
Waddell and Burton 8

9. Risks and harm of being out of work
Loss of fitness
Physical and mental deterioration
Increased risk of poor health x 2-3
Social exclusion
Poverty
Waddell and Burton, 2006

10. Risk and harm – mental health risks
Psychological distress and depression
Increased x 2-3
Increased suicide and mortality
20% excess deaths

11. Families and work Children in workless households:
have a higher prevalence of recurrent health conditions and lower well-being
suffer higher rates of psychiatric disorders
are more likely to experience worklessness themselves during adult life

12. 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)

13. Case 3
56yr old michael thomas attends 7 days after undergoing a TURP for benign prostatic disease.
He works as a painter and decorator,
How long until he can commence work?
Any guides?
Other thoughts?

14. Fitness for work: prognosis
Source:
( see also OUP Handbook of General Practice) 14

15. Other resources…
The Royal College of Surgeons website 15

17. Driving and regulations