The DWP is piloting radical changes to the current fit note system from July, which include GPs referring patients directly to medically unqualified support workers without issuing a fit note at all.
The pilots will run in four areas, with each location testing a different method:
Birmingham and Solihull - GPs issue the first fit note where needed, with all patients referred to a new support service led primarily by non-clinical staff, including social prescribers and work and health coaches
Coventry and Warwickshire - GPs issue the first fit note, with patients able to be referred to a support service made up of both clinical and non-clinical staff
Cornwall and the Isles of Scilly - GPs refer patients directly to a non-clinical support service, without issuing a fit note.
Lancashire and South Cumbria - GPs refer patients to a support service made up of both clinical and non-clinical staff, without issuing a fit note.
Social prescribers aim to support people with social issues that affect their health and can offer advice on such issues as debt, housing, loneliness, carers’ support, physical activity groups and local activities. They do not have any medical training.
According to the NHS health careers website “There are no set entry requirements for this role... Some employers may ask for basic numeracy and literacy plus some IT skills and relevant work experience”. Individuals can do an online Social Prescribing Essentials Course at the National Academy for Social Prescribing
According to the Working Well Trust the only qualification required to become a work and health coach is:
“Basic understanding of health conditions including mental and physical. Alongside this able to demonstrate a working knowledge of common treatment routeways and healthy lifestyle practices”.
Work and health coaches do not have any medical training.
Many readers may be alarmed at the prospect of being referred by your GP to medically unqualified staff who will make judgements about what work you are capable of doing.
However, it should be noted that these are just pilots which will run for up to a year to gather evidence on their effectiveness.
They are aimed at people who are currently employed by large firms in the pilot areas, with the aim of keeping them in work. Support will include “three-way conversations between patients, employers, and trained professionals - covering reasonable adjustments and keeping people connected to their workplace from the first day of absence”.
The proposals have received a lukewarm reception from actual health professionals.
The Royal college of GPs said:
“We are open to exploring evidence-based reforms that could help improve outcomes for patients. However, any reform of the fit note process must put the health and wellbeing of patients first, be fully resourced and avoid creating additional workload for general practice. As such we look forward to seeing a comprehensive evaluation of this pilot.”
Meanwhile, the BMA, which was involved in the design of the pilots, said:
“We will continue to input into the pilots to ensure they have appropriate occupational health support and do not inadvertently increase pressure on general practice or affect patient care. While we are supportive of this pilot, it must be underpinned by appropriate training, clinical oversight and clear governance.”
The announcement of the fit note reform last week came at the same time as the government published its Fit Note Reform: Call for Evidence results which claimed that just 29% of those from primary care settings thought that issuing fit notes was a good use of GPs time.
You can read the full DWP press release on the fit note pilots here.
