A new service that could lessen GPs role in managing long-term sick leave by placing patients in the hands of specialist advisers is now available across England, Wales and Scotland.
The Fit for Work scheme is designed to help employees on long-term sick leave stay in or return to work. But crucially it offers patients access to advice or assessment from occupational health advisers rather than placing further responsibility on family doctors.
The DWP-funded initiative describes itself as ‘free, expert and impartial advice’ to help GPs support their patients, but also employers and employees in managing sickness absence or a return to work.
The GP role in Fit for Work
For GPs, the support provided is two-pronged. GPs can access advice and assistance from specialist advisers online or by telephone or use the Fit For work website to find answers to questions.
A referral scheme is also being rolled out. Under this, GPs can refer patients who meet certain criteria and who have reached four weeks’ sickness absence to an occupational health professional who will carry out an assessment and draw up a tailored 'return to work plan'. The plan will replace the need for a GP to sign fit notes during that period.
The GP referral service went live in March in two areas in England and Wales – Sheffield and Betsi Cadwaladr – but it has now been extended to cover all of England and Wales.
Scotland has a separate service based on the same model, which is also now available across the whole country.
Though patients cannot self refer, employers will be able to if, after four weeks of absence, the employee has not been referred by their GP. The scheme is entirely voluntary – GPs are not compelled to refer, and patients have to consent to a referral.
What happens to patients referred to Fit for Work
The Fit for Work model doesn’t actually provide for treatment or interventions, explains Dr Rob Hampton, a portfolio GP and occupational physician who was involved in the Fit for Work pilots.
The scheme makes a series of recommendations for a return to work, which the employer may decide fund. Employers will be incentivised to do this through a £500 per head per year tax break on medical treatments to help an employee return to work.
Dr Hampton believes GPs should welcome the initiative because it offers patients an independent occupational health evaluation.
‘Only one in four patients have access to an occupational health department and only about one in every 250 GPs have an interest in this area so there is an unmet need,’ says Dr Hampton. ‘It is one of few areas in our work as GPs where if we feel we are not managing properly and need further expertise we haven’t been able to get it. We can now so this is a huge step forward.
‘GPs will be able to refer where they feel they don’t have access to the time, the services, or the employer support that might be needed to facilitate a return to work. Patients that engage with this will hopefully be given a lot more time and in depth exploration of their problems than can currently be given in a brief appointment with their GP.’
Impact on GP workload
While the expectation is that patients will benefit from the scheme, another advantage for GPs is that for a period of time someone else will be managing the patient’s return to work programme.
Dr Hampton says: ‘If the people delivering this get it right it shouldn’t increase workload for GPs. If the referral pathway is easy it should reduce consultations from people on long-term leave. This can only be a good thing. The service also stipulates that they shouldn’t be going back to the GP for more and more information once they have received the referral. It will be their job to gather the information required.’
GPs will have to bear in mind, however, that if patients don’t consent to a referral or if the return to work plan is unsuccessful the case will return to the GP to pick up.
‘We can’t say how much take up there will be yet or how effective it will be,’ says Dr Hampton. ‘But I would really encourage GPs to use the scheme and refer patients.’
A three-year pilot of the scheme in Leicestershire that began in 2010 (one of seven pilots), saw 94 per cent of practices make referrals. Around 70 per cent of the patients were returned to work or stayed at work, says Dr Hampton.
Fit for Work will also be available for practices to access at employer level to address sickness absence among their own employees.
Medical defence organisation the MDDUS says it regularly deals with calls from practices enquiring how to deal with the sensitive issue of long-term absence.
Liz Symon, employment law adviser at MDDUS says hopefully the new scheme will provide more transparency in the way this issue is managed.
Ms Symon says that practices should update their sickness absence policies to reflect the new service and ensure they communicate with employees of changes that will affect them via team meetings. She advises practices to include in their absence policies that employees are referred to the Fit for Work scheme if they are away for four weeks or more.
But she warns: ‘The employee has the right to refuse this request and any future decisions made by the practice will need to be based on available information.’