GP certificate alternative mooted

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The Department of Health has been looking at alternatives to the current GP certificate system for s...

The Department of Health has been looking at alternatives to the current GP certificate system for sickness absences.

Dr Barbara Kneale, consultant occupational health physician at Developing Patient Partnerships, said: "One of the problems with the current GP certificate is that diagnosis often relies on history only. The GP is also often ignorant of the work conditions."

Dr Kneale is the project manager of a Department of Health funded project looking at the alternatives to sickness certification in general practice. Starting her presentation, she cited the law, which states that a doctor's statement is strong evidence of sickness, unless there is evidence to the contrary. "Such alternative evidence could be provided by an occupational health professional with the appropriate skills," she said.

This evidence forms the basis of the alternative project Dr Kneale has been working on. The project is based on a remote call centre, remote case management and in-house occupational health advisers. "The overall aim was to look at what needs to happen within an organisation to introduce the alternative system. We also wanted to look at the impact on the GP's workload."

While the alternative system could reduce staff absence rates, the deployment of such a system ran through difficulties, according to Dr Kneale. "We underestimated the amount of change in implementing the new model. For the employees, visiting the GP is seen as an essential right. They were also concerned about confidentiality of their medical records. On the part of the managers, they lack knowledge in the issue of sickness absence and they misunderstood the purpose of the pilot."

Dr Kneale added that larger companies were prevented from taking place in the pilot project because of trade union concerns. However, "small organisations are more capable of introducing the new alternative," she said, calling for a change in the programme away from its "one-size-fits-all" current state. "Any alternative has to vary according to the size and model of the organisation. We also need to find a balance between administrative requirements and the medical requirements"

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