UK: Financial Times: NHS to trial GPs no longer handing out ‘sick notes’

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Felis Catus

Senior Member (Voting Rights)
[This is not ME/CFS specific but it will affect pwME/CFS who are still employed.


Some excerpts:
GPs in England will no longer issue “sick notes” as part of NHS trials designed to reduce the number of people signed off work because of health problems.

Sick workers will instead be sent to occupational therapists and “social prescribers” who recommend job coaching and therapy such as exercise or gardening in the hope that a personalised plan can help them stay in work, according to several people familiar with the government’s plan.
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Four alternative approaches will now be tested across four NHS integrated care boards. Two of these will see patients bypass GPs entirely when requesting fit notes and be sent either for treatment focused on staying in work or social support such as job advice and lifestyle coaching, according to people familiar with the plans. The other two will see GPs issue the initial fit note and send employees on to the other services if extensions are requested.

These services will be charged with helping employees stay in work or get back to work quickly. An existing scheme that gives people with health problems work coaching and advice on workplace adjustments, known as WorkWell, will be used to issue fit notes in some of the pilots. Other clinical and non-clinical support will also be tested, with plans for these services to issue about 100,000 fit notes during the trial period.
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So the way to reduce sick leave and "Get Britain Working" is to pretend that people are not sick and just need a bit of coaching and gardening.

Sounds like Get Britain More Sick...
 
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Well this guarantees people with new onset MECFS and MECFS type long covid will have worse outcomes and worse levels of disablity.

Never forget that PACE was sold as a way of getting people off benefits and back to work.

This is all so sinister.

The way everything is going it's like a breakthrough is the only thing can save us from a hostile state, a state that has been actively obstructing research that could lead to said breakthrough. It's enough to make one despair.
 
This seems to be a continuation of the pandemic policy that its good to be sick, you need to get sick to avoid getting sick...

There is a war on people being ill and resting at the moment, the situation is just getting worse. As we know that results in more Long Covid and more ME/CFS and then they are annoyed that so many are on PIP and LCWRA so they are seeking to reduced or even abolish both. I am really beginning to fear for our surivival in the UK.
 
Twitter - GP Dr Steve Taylor says the pilots are optional and that he "was in the discussions and forming of the pilots"





Dr Steve Taylor
"I have been in the discussions & forming of the pilotsIf those who are unable to work are forced to, I wouldn’t support it. Conversely this will help those who continue to work & shouldn’t work as there will be an option to use this to negotiate better conditions potentially"





"The pilots are optional. If you are unable to work you won’t work. If you need to be signed off in the pilots you still will. If you think it’s possible to do some work the scheme will liaise with your employer about options. The idea is to get better options & support"







"The pilot is looking at better options to help people to stay in work if possible. It is NOT about getting people to work who cannot work. The Pilots will see if it would work with people & employers. It’s NOT long term sick but aimed at preventing this"



There is a lot of worry about these proposals and the pilots. I can only repost here what Dr Taylor tweeted. I don't know how it will work out in practice.

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Lou B Lou said:
The pilot is looking at better options to help people to stay in work if possible.
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If that is social prescribing it is a straightforward con. There seems to be a delusion that you can 'prevent' long term sickness.

Ironically, it may be that OTs are even less keen then GPs to confront people who say they cannot work with 'why not?' and sign off more people, to go dancing or whatever. And very likely the pilot will 'fail'.
 
Jonathan Edwards said:
If that is social prescribing it is a straightforward con. There seems to be a delusion that you can 'prevent' long term sickness.

Ironically, it may be that OTs are even less keen then GPs to confront people who say they cannot work with 'why not?' and sign off more people, to go dancing or whatever. And very likely the pilot will 'fail'.
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There's appears to be so much desperation on the part of the government, who seem to be wildly thrashing around grabbing at useless 'get them back to work/keep them at work' project ideas. And whipping up hostility towards sick and disabled people, destroying empathy.

While the FT late last year told us that

"Total working-age benefits within the government’s welfare cap —including all out-of-work and health-related benefits — will be well below 2010s levels even after Labour’s U-turn on cuts to disability benefits"

Chris Giles in The Financial Times 15/10/25

https://www.ft.com/content/ee67c643-01bc-41f6-a4e2-c738deef129e

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The FT article mentions:
An existing scheme that gives people with health problems work coaching and advice on workplace adjustments, known as WorkWell, will be used to issue fit notes in some of the pilots.
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WorkWell programme started with a pilot in 2024 and was expanded to the whole England this year. Some quotes from a Pulse Today article published today:
Financial incentives for GPs referring patients to a scheme designed to reduce demand for fit notes could improve its chances of success, a new Government evaluation has found.
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Within that timeframe [October 2024, through to March last year], 5,661 individuals began receiving support through the scheme across 12 pilot sites, with the largest numbers of participants being from ICBs in Northwest London, Greater Manchester and North Central London.

They received ‘personalised one to one coaching’, signposting, and referrals to health, employment, and community and voluntary sector services as part of the scheme, and following an initial assessment, participants were expected to agree ‘return-to-work’ or ‘thrive-in-work’ action plans with WorkWell staff.
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I was offered a referral to them despite having severe ME/CFS. The article says that WorkWell provides ‘personalised’ and ‘early’ help for people struggling with their health. It wasn't early into my illness.
 
Jonathan Edwards said:
If that is social prescribing it is a straightforward con. There seems to be a delusion that you can 'prevent' long term sickness.

Ironically, it may be that OTs are even less keen then GPs to confront people who say they cannot work with 'why not?' and sign off more people, to go dancing or whatever. And very likely the pilot will 'fail'.
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I fear it won’t. At least not by the measures they will use.

This sounds very very similar to ICIT, the GP toolkit by Abrahamsen and Reme (OCFN) that’s about reducing sick leave by giving less sick leave. And some BPS babble and explanations of symptoms.

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ICIT has currently been taught to >40 % of GPs and the government very recently put out their plan to reduce sick leave that’s exactly the same - just hand out less sick leave.
 
Felis Catus said:
[This is not ME/CFS specific but it will affect pwME/CFS who are still employed.


Some excerpts:




So the way to reduce sick leave and "Get Britain Working" is to pretend that people are not sick and just need a bit of coaching and gardening.

Sounds like Get Britain More Sick...
Click to expand...
even more concerning is that fit notes are supposed to be about requiring employers to make changes quite often. Particularly if there is an unsafe situation going on. Because harm is being caused and will be if it continues when the person is being sent back.

They mention other professionals but really maybe if an OH person is a GP/medical service then that legally ticks the boxes, otherwise are people being also prevented from access to notes that make it clear the problem causing the harm isn't the person not doing gardening outside of the workplace but said employer not remedying whatever issue to make it a safe place for any person to return/go into - it doesn't exist anymore as a risk if you remove the people who could sign off the consequences of that?

I don't imagine social prescription would be allowed to write such notes 'to help them get back to work' and many might just be signposting. Now to a list with most of the important options removed? And if someone is asking for a fit note that doesn't mean that their health also needs to be checked on at the same time - so there is a huge liability/foreseeability of risk issue here surely. Which makes people harmed for the future whatever employment they might end up in.

Who becomes 'responsible' if someone would be 'at risk' but the policy is inferring to GP surgeries that if someone is working and might need a fit note they become barred from seeing the medical staff that might be able to assess a foreseeable risk and deterioratoin/harm to their health from being caused? Does it become the job coach or social prescriber if they end up being told - but its not their job so ignoring it is OK or are they responsible for that risk but without any control to do anything about it and what does that mean legally?

And if they are coaches in the GP surgery is it the GP surgery responsible if somone ends up with harm long-term or dies etc and it was plain as day it was preventable - has someone thought these things through? reframe it all they won't by suggesting those people make notes on 'telling them to get a job elsewhere' or 'gardening cures stress from bullying' but it surely doesn't actually make it true in the eyes of the legal system?
 
This isn't just impressively stupid, it's historically so. Just total reality avoidance and falling into delusional fantasies. This is the natural outcome of psychobehavioral models, things will only get worse from there.
Four alternative approaches will now be tested across four NHS integrated care boards. Two of these will see patients bypass GPs entirely when requesting fit notes and be sent either for treatment focused on staying in work or social support such as job advice and lifestyle coaching, according to people familiar with the plans. The other two will see GPs issue the initial fit note and send employees on to the other services if extensions are requested.
Click to expand...
So instead of taking a few minutes of GP time, they will pay people to do completely useless things, including hours of 1:1 "coaching", making the whole thing more expensive than the current approach of pretending those problems don't exist, which itself is massively more expensive than actually working to solve them.
Dr Steve Taylor said:
"The pilot is looking at better options to help people to stay in work if possible. It is NOT about getting people to work who cannot work. The Pilots will see if it would work with people & employers. It’s NOT long term sick but aimed at preventing this"
Click to expand...
Stunningly naive. Of course it will be used to do that, it's the whole point. They will simply declare that people who can't work actually can, they're just "insert bullshit excuses here". And like everything "biopsychosocial", it can't fail, it can only be failed.

But damn is this not "eating Tide Pods" (which never actually happened, obviously) level of dumb.
 
bobbler said:
Does it become the job coach or social prescriber if they end up being told - but its not their job so ignoring it is OK or are they responsible for that risk but without any control to do anything about it and what does that mean legally?
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The coaching industry is unregulated in the UK, so the fact that they're involved in this is insane.

I also think that gardening, dancing and similar are going to be a nice way for DWP to refuse PIP* even if people would be going beyond their limits to take part in those activities because they're good patients who trust professionals and want their health back.


*For our friends outside the UK: PIP
There are 2 parts to PIP:
  • a daily living part - if you need help with everyday tasks
  • a mobility part - if you need help with getting around
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Jonathan Edwards said:
If that is social prescribing it is a straightforward con. There seems to be a delusion that you can 'prevent' long term sickness.

Ironically, it may be that OTs are even less keen then GPs to confront people who say they cannot work with 'why not?' and sign off more people, to go dancing or whatever. And very likely the pilot will 'fail'.
Click to expand...
and one of the most important things a boss often needs is just that confirmation of the situation in order that they can tell their boss and the employer can plan. So good employers who might want to keep that employee even if it might be a big long thing they have wrong with them could end up finding they don't get what they need to make that possible either.

The more that gets muddied by roles that seem to have diverse people and approaches in them (I assume not all are just cheerleading signposters) where the employer doesn't know if that means their employee is getting referred to good treatment that they need to fix eg their bad leg rather than a positive spin on other things they've been offered the more it will cause frustration rather than clarity.

At least GPs would have some experience and knowledge to draw on of how the system is and how long things tend to take if someone is on a waiting list and how much use that might be from that point. What the person can't do in the mean time. It needs that qualification to ahve the bravery to sign someone off for that time - but sometimes if it is something bad that is what the employer needs, just plain honesty and realism so all know where they stand over being inadvertently strung along by false optimism?

And yes terrible for poorly understood illnesses because an employer might completely believe and get how ill someone with ME/CFS is until the wrong advice is given and then said employee gets surrounded by bps false positivity hell making them worse all because people assumed the straightforward options of time off or reductions or whatnot wouldn't go down well and/or thought 'these were worth a try first' because of nudges.

Suddenyl it ends up the sick person that trust gets lost in because a question mark gets put over their head that wasn't there before etc

They really want to know who and how good all the staff are that they are transferring this to and what they are like and how any 'pet interests' might get watched out for - ie they don't seem to be talking about what a varied lot they are suggesting instead of something quite specific (GP).

I'm also imagining said staff are probably busy as it is so it isn't like 'adding in a helping hand to look into options' but transferring the load so that another bunch of people have shorter amounts of time per person on their list but now with more time-sensitive complicated situations being added into it.
 
rvallee said:
This isn't just impressively stupid, it's historically so. Just total reality avoidance and falling into delusional fantasies. This is the natural outcome of psychobehavioral models, things will only get worse from there.

So instead of taking a few minutes of GP time, they will pay people to do completely useless things, including hours of 1:1 "coaching", making the whole thing more expensive than the current approach of pretending those problems don't exist, which itself is massively more expensive than actually working to solve them.

Stunningly naive. Of course it will be used to do that, it's the whole point. They will simply declare that people who can't work actually can, they're just "insert bullshit excuses here". And like everything "biopsychosocial", it can't fail, it can only be failed.

But damn is this not "eating Tide Pods" (which never actually happened, obviously) level of dumb.
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Is there even a particular problem that is real that this is addressing? have sicknotes suddenly rocketed for no reason etc?

or is it just politics etc and being seen to be hard on a problem that doesn't really exist ... yet?

Because without defining the issue I can see how depending on what that is a lot of these 'helps' will/could actually cause backfires depending on what it is to the aim which also I can only guess at of less people being sacked ?or more ill? or just less sickpay short term?.
 
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