GPs welcome fit note reform despite mental health charities concerns

GPs have welcomed Rishi Sunak’s plans to end their power to sign people off work, despite concerns from mental health charities.

The Prime Minister has promised to end the UK’s “sick note culture” and said the job of issuing sick notes in England would be transferred from GPs to “specialist work and health professionals”.

GPs said they have been forced to sign people off work following ten-minute assessments due to a growing number of cases and fears of repercussions if they fail to fulfil patients’ requests.

One GP from East Anglia told i: “We have an increasing number of patients demanding to be signed off for mental health problems. The problem we have is that it’s hard to gauge the impact of a mental health problem from a ten-minute appointment, but if we don’t sign someone off and something happens – that’s not a risk any GP is prepared to take.

“Whether a patient is anxious for entirely natural reasons or whether someone has clinical depression takes time and is a specialist area of medicine. The way funding in primary care works is that we get paid per patient per year and it’s a lot less than you’d think.

“There simply is no incentive, financially or time wise, for GPs to take three appointments for one patient to conduct a review because someone says they have ‘back pain’ or ‘mental health’ which will realistically benefit the DWP [Department for Work and Pensions]. So what do GPs do? Sign them off and save themselves the stress and the pushback.”

Dr Jay Verma, GP Partner at Shakespeare Health Centre in London and president of the GP section at the Royal Society of Medicine, told i: “The proposal for fit notes to be reallocated to other health care professions should be welcome news for GPs and patients.

“Occupational therapists in particular would be ideally placed to carry out proper assessments and provide advice as they have the perfect skill set including how to help people keep doing the things they need to do and enjoy doing. They could then have the ability to escalate to specialist doctors for complex matters.

“Often with long term conditions it’s not just about someone being off work, but about how they can be best helped and since GPs are now seeing about double the number of patients each day than they were a few years ago there isn’t always the time for an in-depth evaluation. The pressure is also applied from patients in some cases to sign them off.

“With issues like mental health it’s not just about signing someone off to sit at home as we know activity and socialising can really help with low mood and a sense of purpose. Of course there will be patients who simply cannot work, and GPs must be able to help those patients in an effective and timely manner without unnecessary bureaucracy.”

However, the chief executive of the mental health charity Mind criticised Mr Sunak over his “harmful and inaccurate” rhetoric.

Dr Sarah Hughes said: “We are deeply disappointed that the Prime Minister’s speech today continues a trend in recent rhetoric which conjures up the image of a ‘mental health culture’ that has ‘gone too far’. This is harmful, inaccurate and contrary to the reality for people up and down the country.

“The truth is that mental health services are at breaking point following years of under-investment with many people getting increasingly unwell while they wait to receive support. To imply that it is easy both to be signed-off work and then to access benefits is deeply damaging.

“It is insulting to the 1.9 million people on a waiting list to get mental health support and to the GPs whose expert judgment is being called into question.”

Iain Porter, senior policy adviser at the Joseph Rowntree Foundation, said: “This is an irresponsible war of words on people who already aren’t getting enough support, which the Government would rather not talk about.

“Any sensible aspects of the Government’s previously announced planned reforms like a better focus on occupational support have become overshadowed by damaging rhetoric about which illnesses are genuine or not. Many people want to work, as the Prime Minister says, but have their hopes dashed by woeful health and wellbeing support and jobcentres unfit for purpose.”

Fit claimants will have their benefits removed if they refuse to take a job after 12 months under Mr Sunak’s “new welfare settlement for Britain”.

Setting out his plans for reform he suggested that some people with mental health conditions who receive Personal Independence Payments (PIP) could be offered treatment instead of cash.

The Prime Minister warned against “over-medicalising the everyday challenges and worries of life” and said an expected rise in benefits spending in the coming years is “not sustainable”, citing a £69bn current spend on people of working age with a disability or health condition.

Mr Sunak insisted the changes are not solely about cutting costs, but spending on PIP alone is forecast to increase by more than 50 per cent over the next four years, he said.