Are GP health reports poor predictors of fitness for work?
Dr Charlie Vivian examines whether or not obtaining an employee health report from a GP - rather than an OH practitioner - is the best course of action, given that a GP will put the employee's needs first and may not give an accurate indication of their fitness to work.
When an employee has a health condition that affects their work, their manager will naturally want to clarify the medical picture. Shedding light on the medical facts allows decisive and focused decisions to be taken regarding ongoing employment.
The manager may seek advice from OH or they may go directly to the employee's GP. There are some apparent benefits from the latter. First, it is likely to be cheaper, and second, the manager is getting medical information direct from the treating doctor. But there are some potential pitfalls.
GP and patient priorities
GPs develop long-term relationships with their patients and, often, patients' family members. They will be reluctant to jeopardise this so they will look to put the concerns of their patients first.
This means that they may become the patient's advocate and their opinion could be one-sided, with no attempt to balance the advice being given.
GPs are also more likely to write a purely clinical report, with medical jargon, which will focus on the details of the condition, treatment and prognosis. But this focus may not clarify the impact of the condition on the employee's fitness to work.
The GP is unlikely to be aware of the details of the Equality Act 2010, leaving the manager in the dark about how to address this situation.
GPs are also usually under intense time pressure. In 2011, they dealt with 58% more consultations on average than in 1999. The much-publicised NHS crisis will only make their workloads more untenable, with the Royal College of General Practitioners stating that 10,000 more GPs are needed to cope with its increasing workload.
In summary, it is very likely that there may be a delay of weeks for the GP to write the report. Therefore, although seeking information directly from the GP may appear to be a cheaper option, the saying goes: "Cheap isn't cheap!"
Impartial advice
In contrast, OH practitioners aim to provide an independent assessment, without favouring either side. They will be aware that a medical diagnosis is normally a poor predictor of fitness to work and they will recognise that the employee's view of the situation is likely to be the key determinant of their fitness to work.
The OH practitioner will understand the need to calculate the situation using a bio-psychosocial approach. In other words, it is not enough to simply look at the medical diagnosis aspect. There is also a need to consider psychological factors and the social context. Unless these other factors are considered, the case could become stuck.
The OH report should be free from medical jargon and give clear advice about the employee's fitness to work. Contentious statements, such as causes of work stress, should be qualified with comments recognising that the advice may not be agreed by all sides. The focus will be on the obstacles that need to be overcome to ensure fitness to work is achieved. If legislation such as the Equality Act is applicable, the implications of this will need to be explained.
The OH report should clarify the employee's fitness to work, which will fit into one of four categories:
- The employee is fit to work and no restrictions are required.
- He/she is fit, but some adjustments are required (these should be outlined).
- The employee is currently unfit.
- The medical picture is unclear and further information is required, which may involve putting in place a discussion with a more senior OH colleague or seeking a report from the GP or treating specialist.
Relationship with occupational health
If further information is sought, it can then be translated from medical jargon into practical advice for the manager.
Ideally, the manager will have developed a relationship with the OH practitioner. This means that, if clarification is required or the manager feels the report is biased, he/she will feel confident about seeking clarification from OH. It may feel much more difficult to challenge a one-off medical report from the GP.
In summary, managers can seek advice about fitness to work directly from the GP or they can ask for an OH assessment. While the former is likely to be cheaper, there are a number of pitfalls involved that may make it poor value for money. On the other hand, OH can provide timely, unbiased and jargon-free advice on fitness to work.
The author: Dr Charlie Vivian MSc DMS MFOM is a consultant in occupational medicine and medical director of Corporate Health.
