Dame Carol Black urges GPs to stop issuing sick notes

GPs should stop issuing sick notes and refer patients to an early intervention work-related health service to tackle sickness absence and worklessness, Dame Carol Black proposed yesterday.

Black urged the government to pilot an early intervention, multidisciplinary service, Fit for Work, to prevent people falling out of employment and onto incapacity benefits, in her review of the health of the UK’s working age population.

The review identified that sickness absence and worklessness costs the economy £100bn a year – more than the current annual budget for the NHS – with common mental health problems and musculoskeletal disorders being the major causes.

The Fit for Work service would be case-managed, with individualised action plans for recovery, to ensure that people get a prompt and holistic assessment in the early stages of sickness and return to work.

The support could include talking therapies, exercise, occupational therapy or advice on personal concerns such as family or housing.

Pivotal role

Dr Bob Grove, employment programme director at Sainsbury Centre for Mental Health, said: “Family doctors play a pivotal role in people’s working lives. Issuing a sickness or ‘fitness’ certificate is as serious a step as issuing a prescription. The government should support GPs, employers and others…before time takes its toll and getting back starts to seem impossibly hard.”

Traditionally, occupational healthcare is not under the remit of the NHS but a responsibility of the employer. However, the review found that 40% of organisations failed to have a sickness absence management policy to support employees. In response, Black argued that the Fit for Work service would only be effective if it was based in or close to primary care services, such as in health centres.

In addition, Black said a business-led health and well-being consultancy service would provide employers with a tool to measure the benefits of investing in services to improve staff’s state of health.

Staff well-being

Paul Farmer, chief executive of the mental health charity, Mind, said: “Putting staff well-being on company balance sheets is an astute idea – giving employers the tools to measure and to improve their employees’ well-being will be crucial in moving to a healthier workforce.”

And for those living on incapacity benefits, of which over half have mental health conditions, the government should fully integrate specialist mental health provision into employment support programmes to help people return and stay in work, the review, Working for a Healthier Tomorrow, said.

Grove added: “Four-fifths of mental ill health at work is not caused by work. But being unemployed is as bad for your health as smoking or obesity. We need to stop people needlessly losing their jobs because of mental ill health.”

More information

Working for a healthier tomorrow

Related items

Essential information on mental health
Sainsbury Centre demands recovery revolution in mental health
Why incapacity benefit changes won’t work



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