Guest blog by Dr Lara Shemtob
I work across occupational health (OH) and general practice and have an interest in the role of the fit note where most workers do not have access to OH. I find it can be challenging to have productive conversations around work and health in a GP setting. I am not the only one. Almost 95% of fit notes are signed as ‘not fit’ without suggesting any adjustments or advice that could help keep patients working when living through a period of ill health. Time and skills in OH are barriers to using the fit note to its full potential in general practice. But I am beginning to think the biggest barrier is poor public messaging on work and health.
Most patients have not heard of the fit note. People come to see their GP team expecting an all or nothing ‘sick note’. This makes it harder to manage expectations and come to a shared decision about using the ‘may be fit for work’ options in 10 minutes. Discussing the merits of the ‘may be fit for work’ section, or a shorter review period before reassessment can be perceived as punitive by patients who expect to get ‘signed off’ and find it difficult to understand why their GP team would challenge this.
The GP consultation is all about the balance between the patient’s agenda and the doctor’s agenda. Finding a middle ground on conversations around work and health feels consistently difficult. This is ironic as we know that the incentives around work and health so often align. Somehow, getting this across in a fit note consultation can seem like an uphill struggle.
The media narrative certainly does not help. Most media outlets continue to refer to the ‘sick note’. Last summer the legislative change to broaden the range of healthcare professionals able to authorise fit notes was widely portrayed as ‘slashing bureaucracy’ with connotations to the public that fit notes are a low-priority administrative task for GP teams. More recently, there have been headlines that a change in government policy on sick notes could be used as a tool to claw back benefits and force people back to work despite being unfit.
‘Sick notes’ are portrayed as binary. Increasingly, the narrative is that the patient is pitted against ‘the system,’ a barrier they must battle with to get the ‘sick note’ they need. Meanwhile, the evidence on issues critical to conversations around the fit note including on the benefits of work for health and not needing to be 100% well to undertake some work rarely get any airtime at all.
How can we improve public health messaging on the relationship between work and health?
Public health communications campaigns can be successful at aligning public and health policy maker agendas. One example is the campaign around the dangers of antimicrobial resistance. I have seen this filter down to general practice - increasingly clinicians and patients are on the same page around good antimicrobial stewardship.
Now that long term ill health is the biggest factor pushing up the rate of economic inactivity, the fit note is rising on the policy agenda. I am concerned that we are not communicating messages around work and health effectively to stakeholders outside the OH community, and that policy changes will be limited, therefore. In order to shift the dialogue, we need a national communications strategy with government and media buy-in promoting the evidence base around work and health.
Dr Lara Shemtob
First published in the work and health Substack to reach a wider audience on how the incentives around work and health can align.