Wednesday, 22 June 2016

Thoughts on the #BMA16 plan for "two weeks self-cert".

Workers are well aware of the "self-cert" system when you are off sick.  It's supposed to be seven days, then you need a doctors note. In practice, it's often five days, and I've even seen some employers insist you go to the GP on day one of absence.

The BMA want this to be increased to two weeks.   They also say that GP's are spending 20% of time on non-medical work.

In a world of reasonable people, the government would want to listen.  Business would want to listen.

But no.

The government has already dismissed the idea.  This is despite the fact that the BMA has not even had the chance to raise the issue with them and present it's case.

I think this tells us a lot about the government.

But what about business?  The CBI have also dismissed the idea.

Neil Carberry, director of employment and skills at the CBI, said: “When someone is sick enough to be off work for a week, they should try to see a doctor. Self-certification is only appropriate for short-term absences, when a doctor’s visit may not be required.”

Has Neil tried to get into his GP surgery lately?  Perhaps he has.  Is this why he has carefully used the word "try" ?

After three days self-cert with a terrible throat (the type with horrible white spots!) you might ring the GP. Typically, the GP will say,  "These things often go away by themselves, and I'd rather that than prescribe anti-biotics.    If you are no better in a week, ring the surgery and we'll see you. If it gets worse in the meantime, ring us."

So that's ten days of absence before the GP will see you.   But the GP is still required to write a note for work after seven days.

There are two problems:

1.  Employers asking for the note earlier than seven days are placing unnecessary pressure on the GP, the worker, and the relationship between the GP and patient. This is a wholly avoidable cause of stress upon workers and GP's.  This could be resolved even if the period of self-cert isn't extended as suggested by the BMA.

2. Employers are bound to ask for a note after the self-cert expires, yet the GP may well not have wanted to see the worker yet.  It would be sensible to change that,

How is a GP supposed to assess "fit for work" for a patient they are not ready to see? Is this ethical?

In practice, a call to your surgery for a note for work does not get you an appointment. It may get you a "triage call back", or you may be told to come in to collect the note tomorrow.  Where the GP does the note the following day, it may not be back dated to when the request was made.  This can land workers on the wrong side of strict absence management policies, and often results in the worker making a further request for the surgery to correct it's note.

So let's go back to the words of Neil Carberry.  He is saying that self-cert is only appropriate when a GP visit is not required.  I agree with that.   However, I think Neil would really struggle if asked to justify his view that seven days self-cert is always adequate.

Clearly there is merit in the BMA plan. At the very least, I think workers should be able to extend the period of "self-cert" where they report that they have contacted the GP, but the GP has stipulated a time beyond seven days before they want to see them.

Perhaps the government and CBI could give listening a chance.

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