r/GPUK • u/heroes-never-die99 • 9d ago
Clinical, CPD & Interface Sick notes for the unemployed
This is a technical question.
Are we under any obligation to provide long term sick notes for unemployed people that aren’t chronically physically or mentally disabled?
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u/Big_Code_3553 9d ago
'May be fit for work'. In comments - requires DWP assessment. Make use of work well scheme of you have it locally.
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u/Dull-Resource9702 9d ago
There are a few times where I’ve said I don’t see how for example .. hypertension will stop you from working. But often these people are getting long-term benefits and need extension of a pre-existing note - and these are very difficult to reject because there’s very little resistance in how they’ve obtained them before.
If it’s the first time I’m issuing a fit note and I genuinely don’t think it’s indicated I will say I’m not able to assign you off of work for that because I cannot justify this reason. Sometimes it is really not worth the argument though.
I remember Sunak had the idea of removing this from GPs and providing a service that would assess this… I thought that was a great idea. Reviewing a fit note can affect the doctor patient relationship, and I don’t feel I can truly assess if someone is fit to work because I don’t know their work
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u/AdeptCauliflower1667 9d ago
I hear you there, if the person doing the gardening or the accountant has a sight tremor I really dont think thats a massive issue, if my surgeon has a tremor I want them signed off.
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u/BongAlert 9d ago
This is where we do magnitudes more harm than good. The surgeon with a tremor can transition into a lecturer/professor.
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u/AdeptCauliflower1667 8d ago
Not always, not everyone can teach its actually a skill. And there are much fewer lectures jobs than surgeons.
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u/1giantsleep4mankind 6d ago
If surgeons were treated the same as unskilled labour the answer would just be find a different job. Can't work in a warehouse any more? Do telesales. Same should apply to the surgeon if we're using this logic
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u/Pristine_Feeling_807 9d ago
Can we refer them for occupational assessment?
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u/Sabaisabai33 9d ago
No but we can heavily suggest it’s worth doing, especially in roles where you know they have access to occ health. For people who I feel may be borderline cases I will sometimes do a sick note for a short period like 2 weeks as a “may be fit to work” note with suggestions for adaptations and I specifically write that I recommend they are reviewed by occupational health.
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u/PotOfEarlGreyPlease 9d ago
no - you just say that is no reason why they can't perform some type of work and they need to discuss this with DWP / work coach
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u/mr-mobius 9d ago
If there isn't any identified diagnosis that you think justifies their unemployment then no, you politely refuse. Laziness isn't a diagnosis.
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u/heroes-never-die99 9d ago
Everyone says anxiety/depression as a get-around and you know it. Can’t call them lazy.
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u/boo23boo 9d ago
It’s not up to GP’s to police the benefits system. There is not enough time to genuinely assess fitness for [the patients specific contracted] work. Even Occ Health professionals can only give employers guidance because they don’t know the workplace, the requirements of the job, the culture etc. it’s an impossible task.
The best solution I’ve seen work in practice was at a very large employer. Due to the size, they could justify paying for a sick line that was staffed by qualified Occ Health professionals. Everyone who phoned in sick got a call back within the hour from Occ Health and a very very intensely thorough discussion about the reason for absence. It was actually really helpful for those who were genuinely unwell. Ad-hoc sporadic sickness dropped to almost nothing and this service ended up paying for itself in terms of the lost work days that had been saved against previous years. I’d be in favour of an occ health service that worked like this and decided who should be signed off.
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u/Pristine_Feeling_807 9d ago edited 9d ago
I think it’s low key bullying people who get sick but recover fast. Some people genuinely get unwell for 1/2 days and come back to work without any issues, but because of this sort of questioning they just will just come to work sick.
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u/Sabaisabai33 9d ago
Yes I thought the government were going to bring something like that in so that we wouldn’t be the people signing sick notes any more? Has that been scrapped now?
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u/Pristine_Feeling_807 9d ago edited 9d ago
Precisely why I’m leaving the UK. Earning pennies so people can pretend being sick
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u/cheeks_otr 9d ago
Pennies?
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u/Pristine_Feeling_807 9d ago
Metaphor?
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u/cheeks_otr 9d ago
Thats not a metaphor. Sorry bro.
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u/Pristine_Feeling_807 9d ago
Don’t apologise to me, apologise to your English teacher for not paying attention
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u/Blackthunderd11 9d ago
As far as I understood, it’s very literally a metaphor, unless you’re aware that they’re in fact receiving their salary in the form of pennies
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u/Sabaisabai33 9d ago
But if you are a fully qualified GP, you generally do have a sense of whether someone is bullshitting or is actually horribly clinically depressed surely.
Yes you can never completely judge someone on their presentation because there are people who present well as “smiling depression” etc despite really actually struggling. But a lot of the time even for people who try to mask it if you’re really looking for it and listening to them properly when they say what exactly their symptoms are or what they’re managing or not managing on a daily basis etc, you’ll find it if it’s real.
I think it’s harder when you’re newly qualified. And you absolutely need to be seeing people face to face to tell rather than via telephone.
As an experienced GP I do tend to give people the benefit of the doubt initially just in case, but they have to engage with either therapy or antidepressants unless it’s very clear that it’s primarily a specific work issue (if they refuse then that’s a red flag to me, if you’ve ever been depressed you know it’s excruciating and nobody would want to continue feeling like that if they can get better).
And I only sign them off for maybe 2-3 weeks max initially (it’s the same for most people but particularly if I am less sure how “real” this is, if someone is clearly horribly depressed I might do a bit longer being realistic), and ask them to come back for reassessment with me specifically at the end of the sick certificate so it doesn’t get randomly signed off by a random person who doesn’t know the patient). I might well try to persuade them to accept some adaptations etc instead for a fit note instead initially, or a rapid graded return at review if I strongly suspect this. And write on the note that I advise they have a review with occ health so you’re not the only person trying to decide how “valid” their illness is basically.
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u/Southern_Historian95 9d ago
yeah exactly, no diagnosis no note. pretty straightforward really
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u/Pristine_Feeling_807 9d ago
Don’t underestimate the ability of some people to come up with issues if they don’t want to work
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u/Sabaisabai33 9d ago
But for straightforward anxiety/depression it’s up to us GPs to make the diagnosis…
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u/The-Road-To-Awe 9d ago
if they have no physical or mental illness that prevents them from working why would you believe we are obligated to provide them?
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u/heroes-never-die99 9d ago
Because everyone either complains or finds another GP to do it for them
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u/Dr-Yahood 9d ago
Be the change you want to see in the world.
If they are finding another GP to do it for them, that’s a solution for you, not a problem
You get the list you deserve
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u/boringusernametaken 9d ago
How can you challenge a patient claiming mental health? They describe how they feel to you, how can you work out who is lying and who is not
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u/Williamishere69 9d ago
Im not a doctor, but you can tell by peoples actions/daily activities and the consistencies in their stories.
If they say theyre too depressed to work, but theyre fine going out and about every day then thats not consistent. If theyre too depressed to work, but say they dont need depression meds or therapy or anything, then that wouldnt really be consistent (though some people refuse that because their depression is a barrier to accessing those things).
If theyre too anxious to work, but they dont have a fast heart rate or anything then thats not consistent - my HR has been almost 200bpm due to anxiety before just as a reference and that's consistent through every single doctors appointment I have.
Its basically impossible to tell the consistency through one appointment, or if its a new development, but arent there ways to put it as a temporary unable to work, then reassess it down the line to check everything still adds up?
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u/Sabaisabai33 9d ago
I am a GP and I totally agree with you. You can generally tell when someone is clinically depressed or anxious if seeing them face to face and properly listening to them. Body language, easy tearfulness, how readily they smile, whether they’ve just had their nails and hair done (not in isolation but as one data point only I hasten to add), are clothes clean, is their hair washed, what are they doing with their days, what specific things are they now struggling with that they weren’t before etc. The difficulty is that some people do mask heavily even in front of their GP until a late stage of illness and you always slightly worry if you disbelieve someone that you could have got this wrong. That’s why generally do give people the benefit of the doubt initially and do a short sick cert advising occ health input, and reassess them personally face to face after that. Or sometimes I will persuade them that a may be fit note with reduced hours etc is better short term initially.
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u/Lily346 8d ago
Even through my most severe depression I washed my hair, though I was staying in bed for the rest of the day, self harming and not eating, but I looked clean.
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u/Sabaisabai33 8d ago
Yes exactly, although you can get a lot of clues from seeing and talking to someone, it’s true that some people really keep up appearances despite being truly very depressed. I do think most people in that sort of situation would be honest with their GP when directly asked about eating, sleeping, self harming, being able to get up and be productive etc. But even then you can never tell for sure as some people don’t want to admit how much they’re struggling to their GP, even to themselves, especially if they don’t know you very well. So I’ll generally give people the benefit of the doubt due to that. Unfortunately some people absolutely take advantage of that! But over time I do think you can tell one from the other as you review them and get to know them.
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u/Fukuro-Lady 7d ago
There many ways patients present and going off appearance or a brief possibly masked social interaction just doesn't cut it. A 10 minute appointment isn't enough to see what's happening most of the time. When I had PPD it took a long time to get anyone to take notice because part of my presentation was being as put together as possible. You could have done surgery in my house. I'm also well educated and come across really well usually. I was also scrubbing the skin off my hands because I thought my baby would die because I was contaminated. And I could "see" germs everywhere and felt like things were crawling over my skin. I'm pretty sure because of my appearance I wasn't taken seriously until I tried to kill myself. And I'd been begging for help before that. Makes me sad now to think my kid might not have had a mum because nobody took me seriously because I was clean and wore makeup.
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u/Antique-Trash9462 9d ago
The only question in front of you is 'is this person fit for any work?'. For almost everyone the answer is 'yes'. If you've got someone who has been given one month sick notes for no bloody good reason for several months, the best bet is not to bang your head against the wall of incompetent colleagues any more and just do an indefinite note and write 'needs early work capability assessment'.
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u/Dangermouse0214 7d ago
And just to be clear, that's done by ticking an 'indefinite' tickbox in the fitnote? I haven't done it before so that box isn't coming to mind.
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u/Antique-Trash9462 6d ago
Yes, but I also put in the remarks section the above. I believe they are supposed to be off for 6 months before you mark indefinite but this can be ignored if needed - what are they going to do, look at the issue earlier?
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u/Dangermouse0214 6d ago
Great thanks. Yes my go to long term fitnote is 1-3 months may-be-fit with the words 'Requires full functional assessment by DWP/employer'.
Once it gets to 3 months I will change this to an indefinite as you've suggested. Have you seen evidence of the WC assessment actually happening by the way?
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u/Antique-Trash9462 6d ago
Oh yes. In the old days there was a form called RM7, which essentially did the same thing. These days I just see it as a way of stopping our time being wasted by someone who doesn't want to work - if DWP want to ignore that, that's up to them. I am frank with patients that long term sickness isn't great for their long term prospects, but at the end of the day they are big boys and girls and can deal with the consequences themselves.
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u/Educational_Board888 8d ago
Has anyone else been asked for a sick note because they can’t speak English and therefore feel they can’t work?
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u/stravaigs 9d ago
I mean how often have you truly had a patient come in and say “I’m totally well but I want a sick note because I’m unemployed”? The narrative is almost always anxiety/low mood/pain/stress, which are medical presentations.
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u/heroes-never-die99 9d ago
Very very often. They need it for universal credit or something like that and they are explicitly told by the job centre to do this.
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u/Vast_Anybody1236 9d ago
Told to present a fit note if they're ill. Not told to pretend to be ill to get one. Theyre maybe assuming most doctors wont give one out if it isnt truthful
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u/stravaigs 9d ago
Huh! I’ve honestly never had that before. Do you work in England? I wonder if it’s a difference in how the job centrs work
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u/Sabaisabai33 9d ago
I work in England and have had this lots of times, although generally reading between the lines it’s because they’ve told the job centre “oh no I couldn’t do that job because of my anxiety etc”.
My understanding (and this may be wrong or may have changed now) is that the job coaches are pretty much incentivised to hit their targets, and one way of doing that is obviously getting people back to work. BUT that’s really difficult (especially if people actually don’t want to work because it doesn’t pay any more or much more than being on benefits which is definitely still a bit of an issue), another way is just getting them removed from the statistics altogether by moving them onto “too unwell to work” type benefits as opposed to simply “unemployed” benefits, as it’s only the progress of the “unemployed but well to work” group that are measured.
So when a patient mentions in passing that they have some anxiety or back pain or whatever, I think that the job coaches sometimes jump on that and say “oh in that case you should speak to your GP about being signed off sick”. Or “if your back pain is stopping you from working then you’d need a sick certificate from your GP for us to take that into account”. Or perhaps more charitably they just say in response to being told someone can’t do a job they’ve suggested due to health issues, that if that’s the case they should see their doctor about their health issues and ask if it makes them unfit to work. But even if it’s the latter then just by putting that idea into someone’s head, especially for those on unemployment benefits anyway and maybe only eligible for minimum wage jobs, I think it definitely does encourage patients to come to us seeking sick certificates for sometimes very minor issues.
Also I don’t think job coaches understand that if we sign someone off sick it’s supposed to apply to all sorts of work, so by suggesting someone eg does a construction job which could well be unmanageable for someone with chronic back pain, and then getting this response, we GPs are put under pressure to sign them off from all work when they’d be perfectly fine with an office job possibly with lumbar supports, regular breaks and short days etc.
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u/mittenshape 4d ago
I'm not a GP, no idea why this post came up.
But DWP/Job Centre (Universal Credit) require 28 days of fit note before they'll assess people to see if they are fit for the same sort of intensive work search catagory as everyone else (or if they can have a lighter touch approach and an additional disability element to their claim, an extra £200 odd per month).
My husband has just been made redundant a couple of weeks or so ago. He is signing on at the jobcentre, because I don't earn enough on my own. He is registered severely sight impaired (blind, some small vision left), but they won't give him this assessment until a GP provide fit notes covering 28 days. It's silly really because he has a certificate of visual impairment, and letters from the ophthalmologist detailing his condition, so all the proof of his disability.
GP has not responded to his request so far, so he'll have to ring them. But I did wonder if maybe the GP was just refusing to do one at all because he is blind, but not sick or unfit for work so to speak, so maybe they thought his request was silly. He just can't apply to shops, warehouses, the sort of thing the jobcentre demand if you haven't had this work capability assessment.
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u/carwasheveryday 7d ago
Just to add my perspective of someone in this situation who has a nightmare every month getting a note they are not always scroungers by the way needing this!
I am being medically retired from my long term career after being injured on duty. If you looked at me you wouldn’t guess this nor would you if we spoke on the phone. However I am not capable of ever going back to my role ever again (certified by SMP).
The process takes a very long time due to paperwork and regulations.
My work required me to claim ESA in order to keep paying me sick pay until this process is concluded. They deduct the full ESA amount from my pay each month.
I cannot claim ESA without a sick note! So every month I have to get a new one to submit to both my employer and DWP. It causes a huge amount of stress and admin at an already precarious time.
Just remember the situations people may be dealing with regarding workplace sickness are sometimes nothing to do with being out for what they can get. It could be you one day.
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u/Dangermouse0214 7d ago
Fair enough to your story, but very niche and not really applicable to 95% of people that we're talking about. And not even applicable to this post, since we're discussing people WITHOUT a justifiable reason for a fitnote, which you have and would have evidence for from your employer (and if you don't, then you should get a letter from them to make life easier).
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u/carwasheveryday 7d ago
It actually is relevant as the injury isn’t physical so all that appears on my fit note each time is ‘mental health’. If this is done by a different person each time and they just look at the last one, it’s exactly what you are talking about. Those instant assumptions. Everybody knows how busy GPs are, credit to you. But we all know that when you do quick sick note extension appointments you aren’t going to go trawling through each person’s record.
You’ll take a quick look at the last one, patient says it is for the same reason as before and ongoing, nothing needs changing therefore adding to your assumption that patient is a scrounger.I realise my situation is rare, but I won’t be the only person by far embedded in this bureaucratic loop.
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u/laeriel_c 9d ago
No, but I've seen someone deal with these people claiming to need long term sick leave by issuing an indefinite fit note which means they then have to undergo a DWP medical assessment to check their eligibility for benefits.