Dr Teck Khong: The "Fit Note" is symptomatic of the Labour Government - unfit for purpose

Dr Teck Khong is a Leicester GP and a forensic physician for Northamptonshire Police who contested Bradford North at the 2005 General Election and remains on the Approved Candidates' List. Here he critiques the drive by the Department for Work and Pensions to reduce absenteeism and sickness benefit claims with the "Fit Note".

No one would deny that we need to tackle abuse of the benefit system; but the Labour Government's strategy to deal with the economic impact of unwarranted sickness leave with the "Fit Note" - due to be implemented today - looks set to create a huge range of difficulties and hit the vulnerable in our society.

Although sound clinical judgement is made in estimating the most likely time for sufficient recovery from a condition to enable a return to work, the reality is not so straightforward. Even clear-cut cases of specific illnesses have variations in recovery times depending on the severity of the condition in each case, the ability of the individual to recover, any associated complications and any unexpected interceding event. There are, of course, the more nebulous conditions without objective and demonstrable pathologies that vex both GPs and the Department for Work and Pensions and cost the country heavily with dubious validity of the claims.

With the Fit Note, a new feature not found in the sick note is the option of graded return to work. The difficulty then arises regarding what constitutes an appropriate gradation of workload increase. What are the implications of omitting a phased return to work or advising a phased return that is too rapid and an accident happens or health deteriorates as a result? I was medical officer to a major bus company that operated an all-or-none policy – either a bus driver was fit for work or was unfit; the manager informed me he was not prepared to take risks with partial working with the connotations of incomplete recovery. With the launch of the Fit Note, it is inevitable that the GP will be drawn into a legal minefield.

Dr Teck Khong is a Leicester GP and a forensic physician for Northamptonshire Police who contested Bradford North at the 2005 General Election and remains on the Approved Candidates' List. Here he critiques the drive by the Department for Work and Pensions to reduce absenteeism and sickness benefit claims with the "Fit Note".

No one would deny that we need to tackle abuse of the benefit system; but the Labour Government's strategy to deal with the economic impact of unwarranted sickness leave with the "Fit Note" - due to be implemented today - looks set to create a huge range of difficulties and hit the vulnerable in our society.

Although sound clinical judgement is made in estimating the most likely time for sufficient recovery from a condition to enable a return to work, the reality is not so straightforward. Even clear-cut cases of specific illnesses have variations in recovery times depending on the severity of the condition in each case, the ability of the individual to recover, any associated complications and any unexpected interceding event. There are, of course, the more nebulous conditions without objective and demonstrable pathologies that vex both GPs and the Department for Work and Pensions and cost the country heavily with dubious validity of the claims.

With the Fit Note, a new feature not found in the sick note is the option of graded return to work. The difficulty then arises regarding what constitutes an appropriate gradation of workload increase. What are the implications of omitting a phased return to work or advising a phased return that is too rapid and an accident happens or health deteriorates as a result? I was medical officer to a major bus company that operated an all-or-none policy – either a bus driver was fit for work or was unfit; the manager informed me he was not prepared to take risks with partial working with the connotations of incomplete recovery. With the launch of the Fit Note, it is inevitable that the GP will be drawn into a legal minefield.

Two distinguishing features of the Fit Note are recommendation for amended duties and altered hours. With the former, colleagues are uneasy about advising amended duties as they are not trained in occupational medicine or fully cognisant of the situation at work. On the latter, a GP could not refuse a request by a night shift worker to undertake only daylight duties to help with sleep disturbance and depression and that could involve a discussion with the employer. The employer might then have to make adjustments to his workforce planning and productivity. But what if other employees similarly claim that night shift also causes them to feel unwell?

Perhaps the most controversial element of the Fit Note is workplace adaptation. Most GPs are not qualified to recommend employers workplace adaptations, and apart from safety issues, GP involvement in deciding changes in the workplace could lead to conflict with employers over legal and financial implications. Already, many firms are struggling to survive in the present economic crisis and making modifications however minor may ruin their viability.

Unless new jobs come on stream, the loss of income for many people will be ‘medicalised’ adding to the economic burden. We have seen how communities were affected with the decline of the steel and coal industries. This single-parent 45-year-old ex-food factory packer who requested a sick note epitomises the flaws of the benefit system:

“Doctor, the lady at the Benefit Office advised me to see you for a further sick note to continue receiving payments as I haven’t found a job in six months. There aren’t many jobs around and no one would employ me with a past history of backache. I know what you say about my condition and I admit I feel a lot better but I will lose my benefits, my house will be repossessed and my family will suffer. I am now getting depressed and if you don’t give me a sick note to say I have backache or depression, I will have to find another GP.”

There has to be a sea change of social values, particularly with regard to the work ethic, and the sick note should be strictly that and not used as a financial security net. The next government, hopefully a Conservative one, should not only be careful in refloating our economy but it must also introduce policies that influence a shift away from a culture of dependency; it must show courage to change for the better.

The inculcation of moral and civic responsibility is long overdue.