This week the BBC published findings from a survey of 5,000 GPs in England asked whether they had ever refused to issue a sick line to patients who felt unable to work due to mental health problems. Only 752 GPs responded, but the majority said that they had never refused to issue a sick line for mental health problems.
The issue was highlighted as there are increasing numbers of people being signed off work, with the main reason being mental health problems. There is a concern that if this continues to increase it will further damage the economy and could have other knock-on effects on society. In 2024 Prime Minister Rishi Sunak declared a war on the ‘sick note culture’ in the UK, with around 2.8 million people too ill too work.
Here in Guernsey, my experience as a GP has been that fewer people request sick notes from me than used to be the case in Scotland, where I worked as a GP for about 20 years. I have also noticed that people here are usually keen to be off work for as little time as necessary. Occasionally they have to be persuaded that it would be in the best interests of their employer, as well as their own, to take sick leave until they are well enough to return to work. However, as is the case with many trends in the UK, it can also be observed that numbers of people in Guernsey requesting a sick note from their GP is increasing, as are the numbers of people signed off work as long-term sick.
There is a growing body of opinion among GPs that sick notes, or sick leave, should not be the responsibility of GPs but would be best negotiated directly with employers or trained occupational health physicians. The Royal College of General Practitioners argues that while GPs could issue short term (up to three weeks) sick notes, longer term sickness absence should be managed away from the GP surgery. They argue that the doctor-patient relationship can be damaged by divided responsibilities of the GP – on the one hand toward their patient as a supporter, and on the other toward the employer, or States, to avoid what may be seen as unnecessary time off work which has a societal cost.
There has been much scientific study looking at this as many doctors find the discussion around sick note requests stressful and difficult. There is description of the dual role of GPs as patient supporter, but also as gatekeepers to time off work or benefits. This creates friction between doctors and patients at times and can interfere with the ‘healer’ role of GPs. Often the discussion can result in negotiation between the doctor and patient which may result in a sick line being issued for a shorter period than that requested, or agreeing target dates for return to work. An interesting finding from one research project in the UK found that patients did not mind being questioned by their GP about reasons preventing them from returning to work and in fact did not find it helpful if the sick note was simply issued without discussion.
A way around this problem in recent years has been the option of issuing a ‘fit note’ – stating that someone can continue to work so long as they have altered hours, amended duties, phased return after absence or changes to their workplace – which supports continued working without taking time off. Some employers recognise the value of preventing illness and health problems in reducing time lost due to sickness and may invest in annual health check-ups for their staff, and in the UK Jaguar Land Rover are experimenting with six ‘centres of wellbeing’ designed to provide exercise classes, health checks, physiotherapy, counselling and occupational health support, to assess whether this will reduce time off sick.
The really important message about all of this is that work is good for you. This has been scientifically proven, and as recently as 6 January this year, the Journal Of Occupational Rehabilitation published a systematic review of associations between employment and health outcomes. They had scoured the academic journals for reviews on this topic over a 12-year period between 2012 and 2024 and summarised the results of 49 reviews. In essence what they found was not new but despite the many changes in working practices in recent years with introduction of working from home, artificial intelligence and flexible shift working, these truths remained.
Being in work has a positive effect on the following:
1. Mental health: employment reduces the risk of depression, anxiety, stress, loneliness and even suicide.
2. General wellbeing: life satisfaction was reported as higher in people at work, and people felt they had better social support.
3. Physical health: being in work reduces the risks of developing heart and lung disease, diabetes, dementia, illness and even death. Workers were found to have better immunity to infection, and reduced levels of inflammation.
4. Alcohol and drug misuse are less likely in people who are in work.
5. Returning to work after prolonged absence is associated with improvements in physical and mental health.
The researchers did note however that not all work is good, as the importance of a stable secure job, in a workplace with supportive employers was very important.
So, it turns out that getting a sick note can be a complicated business, as doctors do not want to inadvertently do their patients harm by encouraging them to stay off work. People who have been off work for more than a month often have trouble returning to work especially if they have been unemployed for a while. In Guernsey we are lucky to have the Sohwell (supporting occupational health and wellbeing) team who your GP can ask to contact you to support a return to the workplace. Be open to discussing work with your GP, who is there to help and support you.
