Alarm over proposals to scrap GPs’ ‘fit note’ duties

Proposals by two groups of English GPs that they and their colleagues should no longer be responsible for providing “fitness to work” certificates for their patients have alarmed disabled activists.

GPs from Kent’s local medical committee (LMC) have proposed in a conference motion to fellow doctors that they should no longer be responsible for filling in “fit notes” and that the Department for Work and Pensions (DWP) should “establish their own means for determining fitness for benefits”.

Another motion, from South Essex LMC, also proposes that fitness to work certificates “should no longer be issued by GPs”.   

Both motions have been included on the agenda for an emergency conference of GPs, to take place in London next week (30 January).  

GPs play a crucial role in the process of applying for employment and support allowance (ESA) – the out-of-work disability benefit – because claimants need to provide a fit note from their doctor in order to receive ESA while they are waiting to be put through the work capability assessment (WCA) process.

Campaigners fear that without the input of GPs, ESA claimants would lose a vital safeguard.

The two motions are on the agenda of the British Medical Association (BMA) emergency LMC conference in London next week (30 January), although BMA has reassured campaigners that they will not be voted on and have no prospect of becoming official policy for the doctors’ union.

Instead, a more general motion will be debated and voted on, calling for “separate contractual arrangements” for medical certification of illness, as well as home visits, care for residents of nursing and residential homes, and travel advice and immunisation.

The Special LMC Conference aims to address growing concerns among GPs about rising patient numbers, a lack of funding, and problems with recruitment in general practices across the country, and to “decide what actions are needed to ensure GPs can deliver a safe and sustainable service”.

Despite BMA’s assurance that the Kent and South Essex motions will not be voted on – or even debated – their presence on the agenda has startled activists.

They fear that dropping GPs’ duty to issue fit notes would risk further “avoidable harm” to sick and disabled people seeking vital financial support through the ESA system.

John McArdle (pictured), co-founder of Black Triangle, who first drew attention to Kent LMC’s motion, said such a move would mean patients being “thrown to the wolves of Maximus [the discredited US company that carries out the assessments] and DWP decision-makers”.

He said disabled people were “very sympathetic” to GPs’ concerns and frustration over workload and funding, but appealed to them “not to take it out on patients, who really need certification”.

He said: “We take on board their frustrations, but that is not a rational way of going about things.”

McArdle said GPs could ease their workload by making greater use of regulations that state that an ESA claimant should not be found fit for work (regulation 29), or placed in the ESA work-related activity group (regulation 35), if such a decision would pose “a substantial risk” to their “mental or physical health”.

In a draft letter to BMA, Black Triangle says: “It is the lack of a charging mechanism for benefits/appeals-related work that sits at the heart of this motion.

“GPs have neither the resources nor the willingness to continue to provide pro bono work due to the failings of the DWP.

“Despite this, many GPs feel compelled to help and it is well recognised that their support is often invaluable in overturning erroneous decisions.

“GPs must retain input into the process of entitlement to benefits and they must be appropriately remunerated to do so in the same manner as they would if they were completing an insurance report or other non-NHS work.”

BMA stressed that its policy had not changed, and was still that the WCA process should be scrapped and replaced with a “rigorous and safe system that does not cause avoidable harm”.

A BMA spokesman said: “This motion [from Kent LMC] will not be debated at the special conference and does not reflect current BMA policy.

“The BMA believes the certification for fitness to work process needs to be reformed and replaced with a system which works better for patients and puts less strain on overworked, overstretched GP practices.”