The SOM Podcast: GP Essentials series

Over 6 million fit notes were issued by GPs last year – almost 95% of which were signed off as not fit for work without using the options for workplace adjustments and advice. Deciding whether someone is fit to work is a difficult decision that can have a huge impact on the individual and at the societal level, however this is not a topic emphasised in GP training and there are barriers to accessing CPD in this area.

In this series of three podcasts with experts in the field, guest host Dr Lara Shemtob finds out how to harness the potential of the fit note, why work-related mental ill health has been increasing in recent years, and why occupational health matters in primary care.

Fit note: guidance for occupational health professionals, updated on 17th December 2021 - https://www.gov.uk/government/publications/fit-note-guidance-for-occupational-health-professionals

Episode 1: How to get the most out of the fit note with Dr Jonathan Leach OBE

The transformation from sick note to fit note in 2010 meant that GPs were able to move from a binary decision of declaring a patient fit for work or not fit for work, to offering advice on amendments to duties that could enable an employee to continue working, or to facilitate a phased return to work.

In this episode, Dr Lara Shemtob speaks to Dr Jonathan Leach OBE about the barriers that may prevent GPs from using the advice section of the fit note and how to troubleshoot those barriers. They discuss the importance of using a person-centred approach, taking a basic occupational history, finding out what patients do in their job on a day-to-day basis to understand their functional limitations, tailoring advice accordingly, and understanding risk.

Also explored are the psychosocial factors that might be impeding a patient’s return to work and how referral to occupational health or mental health services at work can help, plus what to do when work is a contributing factor to a patient’s ill health.

NB: At the time of recording, Dr Jonathan Leach was Joint Honorary Secretary at the RCGP. His tenure ended 20th November 2021.

Dr Jonathan Leach OBE is a GP in Bromsgrove, Worcestershire. Jonathan originally pursued a military career, working around the world and achieving the rank of Colonel. Posts comprised clinical, managerial and academic roles, including Professor of General Practice and Director of GP Education. Returning to the NHS in 2008, he has held senior executive positions, including Medical Director and Director of Primary Care for Worcestershire and Associate Medical Director for NHS England. Jonathan is the NHS England Associate Medical Director for Armed Forces and Veterans Health, advising NHS in England on the NHS care of service personnel, their families and veterans. In this role he has been instrumental in the design and delivery of the new models of care for veterans and especially in the field of mental health. Jonathan is Medical Director for COVID-19 Vaccination for NHS England and was awarded the OBE for services to General Practice in the 2020 New Year’s Honours List.

Further reading: https://bjgp.org/content/71/712/525

About the host:

Dr Lara Shemtob in an Academic Clinical Fellow in General Practice and GPST3 at Imperial College London with an interest in occupational health. Lara works at Parkview Practice in White City and has recently undertaken the Diploma in Occupational Medicine.