Re: Helen Salisbury: Unfit fit note proposals

Dear Editor

In the BMJ of the 25th February 2023, Helen Salisbury, a practising GP in Oxford, writes, “we heard that GPs are to be encouraged to sign fewer fit notes as this will boost Britain’s flagging economy by getting people back to work.” Apparently the Treasury and the Department of Work and Pensions are responsible for this proposal.

Dr Salisbury is right when she states that this governmental encouragement “manages to insult doctors as well as patients, while totally ignoring the significant problem of worsening health in our country.” I recently overheard a comment uttered by a member of the general public that roughly translates to “Didn’t you know that GPs give out sick notes for fun and patients who ask for them are phoney.” This was actually said in a sarcastic tone with an intended meaning of the opposite of what was stated, unlike the Government proposal.

These days it appears to me that GP “bashing” is ripe in both governmental circles and the press. This pervasive, unfounded and constant demeaning of highly trained professionals and decent members of British Society is not only wrong, but highly destructive both of our NHS and by default the health of our nation. In this particular instance how can a bunch of pen pushers in Whitehall with presumably absolutely no experience of what it is like on the front line, dealing day in and day out with sick and suffering members of the British public, how can they be in a position to nonchalantly pressurize highly trained caring individuals to sign fewer fit notes? Each patient is an individual with different problems, needs, illnesses and working environments. How then can a broad edict from government sweep in and ‘advise’. They are talking of course nonsense, but it is a destructive, unhelpful and badly thought-out nonsense.

It is of course easy to criticize, but what suggestions are there regarding this issue. In this human being’s experience, let me say that I have never come across an employee who does not go the extra mile for an employer who treats them well. A duty of care to employees is so important – the looking after, nurturing, and kindness to the vast majority of employees will pay enormous dividends to any organisation. A corrupt, make as much money as you can and damn the consequences, non-caring, unethical employer will surely invite unhappiness and dissent, as well as encouraging absenteeism.

Governmental interest and investment in a well-resourced, professional, ethical and fair occupational health service in both the public and private sector is another potential route to reducing absenteeism, whether dealing with phased return, change in role and ongoing support to the employee and employer. Could this be improved and better resourced?

Instead of subterfuge with implied criticism, listen to the grass roots medical staff who actually do the work and the caring, and instead of undermining them, support them and their leaders to implement sensible and well thought out policies that can actually improve matters.

Over the last few weeks, I have for the first time in my life experienced quite a severe yet hopefully self-limiting illness. My general practitioner and thereafter hospital medical and nursing staff have been nothing short of the wonderful caring professionals they are. But wait ……my GP also has given me a sick note. Before it being accepted, should we perhaps ask a pen pusher in Whitehall whether my hugely competent GP needs to think again?

Sean Watermeyer
Consultant Obstetrician and Gynaecologist

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