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  • Dr Bernard Yew | Medical Director at PAM OH Solutions

Can planned changes to fit notes really reduce sickness absence?

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With record numbers of fit notes being used to sign people off sick, will stopping GPs from issuing them really help employers?


Record numbers of employees are no longer working due to sickness, with 94% of the 11 million ‘fit notes’ issued in the UK last year used to sign people off work. The economic cost is now so great that GPs may soon be stripped of their ability to issue fit notes at all.


This is in no way a negative reflection on GPs, who were never going to be able to fully understand how someone’s health might impact on their ability to do a particular job during a five-minute consultation. Let alone what adjustments an employer – they had never had the opportunity to talk to – might be able to make to keep them in work with while they recover.


But who will support the growing number of employees who are no longer fit to work at full capacity and will the reforms work? Plus, what more can employers be doing to stop people from getting to the point where they want to be signed off work in the first place?


Our medical director, Dr Bernard Yew, explores the implications of the new plan for welfare and shares three key take-aways for employers wanting to reduce sickness absence.

Three ways employers can reduce sickness absence

1. Stop people from going off sick in the first place


The biggest takeaway is that GP ‘fit notes’ failed to work because they excluded employers from the solution, when employers are part of the problem. The fact that employees were more likely to talk to their GP than their employer, about how they were struggling to work due to issues ranging from anxiety to backache, needs to be rectified.


The sooner someone can be supported to manage a physical or mental health problem, the more likely they are to remain in work. Our own research into the benefits of early intervention found that 91% of employees who felt able to ask for help while still in work, were expected to be in work a month later, compared to just 45% of those who were given support after 1-2 months of absence and 27% of those who had been off for over six months.


Critical to getting more people to come forward for support, before they start to struggle so much it’s affecting their work, is training managers to see beyond ‘I’m fine masks’ and getting them to have the courageous conversations needed to find out how employees really are, before they become too sick to work. Only then can work put in place the reasonable adjustments that our research found could prevent two thirds of people from going absent.



2. Use specialist ‘work and health’ professionals to identify reasonable adjustments


The new welfare reforms now being put forward acknowledge that specialist ‘work and health’ professionals, including occupational health experts, are now needed to identify in what capacity someone might still be able to stay in work. That’s because it’s no good looking at what medical adjustments someone might need, such as the opportunity to have more breaks, if they work on a production line that can’t be stopped.


Necessary to making the right adjustments is balancing the needs of the employee with the commercial ability of the organisation to deliver these adjustments and the motivation of the employees’ manager to support them. Put simply, if the organisation can’t afford to buy a piece of assistive technology, or the employee’s manager doesn’t understand the need for any adjustments, even the best-intentioned recommendations are unlikely to succeed.


For the most part however, work can support people to recover. Someone with a musculoskeletal issue can be helped to use work as a means of gradually rebuilding their physical strength to accelerate their recovery. While someone with depression can be supported to use the social interaction at work to rebuild their self-esteem and confidence, in a way that wouldn’t be possible if left isolated at home on sick leave. But if the right adjustments aren’t there to phase their recovery, they will simply get too sick to work.



3. Address organisational barriers


The sad reality is that the UK does indeed now have a ‘sicknote culture’ with more being spent to pay people not to work than is being spent on schools or policing. This is clearly unsustainable, with many employees also prepared to phone in sick rather than face toxic workplace issues, ranging from bullying to discrimination and sexual harassment.


Critical to reducing sickness absence is looking at the organisational issues that might be driving this. If the company sick leave is so generous that people can ‘afford’ to take six months leave, or everyone going into a certain department experiences burnout that needs to be addressed. At the same time, organisations with a high prevalence of workplace injuries must be encouraged to offer more risk assessments and education to mitigate this.


Occupational health professionals supporting individuals can also feedback organisational trends that are affecting employees as a whole. It’s therefore to be welcomed that the focus on reducing sickness absence is to be shifted from asking GPs to look at the medical factors in isolation, to asking health professionals to look at the problem in the round. In this sense, the new welfare reforms have a chance of succeeding, where other initiatives have failed.


Free training session: A framework for reducing sickness absence

10am Tuesday 4th June 2024

Join our clinical experts, led by our medical director, Dr Bernard Yew, for a free 45-minute training session on ‘a framework for reducing sickness absence’.

During this 45-minute session (with 15 mins of Q&A afterwards), you will learn:


- What’s driving the UK’s ‘sicknote culture’ and the importance of keeping people in work

- The role of managers for supporting people before they become too sick to work

- How to use reasonable adjustments to reduce sickness absence by two-thirds

- The value of biopsychosocial models for supporting people to return to full duties

- Ways to address organisational factors contributing to high levels of sickness absence


How PAM OH can help to reduce sickness absence


PAM OH can proactively help you to reduce sickness absence with proactive services designed to keep people in work and help them recover, or learn to manage longer-term conditions, as quickly as possible:


Seamless access to multi-disciplinary clinical teams to help employees address issues ranging from mental health to MSK before they become too sick to work


Onsite clinicians to drive wellbeing initiatives and the culture change needed to encourage employees to change lifestyle to prevent being signed off


HSE compliant risk assessments to meet your occupational health obligations and reduce the risk of employees working in ways that will harm their health


Day-one absence and triage service to help employees address any issue limiting their ability to attend work, in a way that has helped clients to more than halve absence


Manager-friendly return to work service to consult with managers before assessing the employee to deliver an actionable return-to-work plan that reduces the absence


Data-driven wellbeing strategies based on your occupational health data and automated live reporting to reduce wellbeing risks in the areas that most matter

For more information, please contact us via or 01925 227 000


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