The sick note crisis is the price of chasing quick-win GP stats

Reports of the crisis have been raging on for weeks. Reports revealed that hundreds of GPs have never refused a sick note. The Daily Mail declared 11 million were issued in England last year. The Mirror announced that patients will be sent to job coaches and gyms to curb the rise.

The common thread in all the furore is GPs, who are always left to shoulder the blame. The truth, though, is that they are doing the best they can in a broken system that strips away their time with patients and rushes them onto the next. In short, they’re being let completely down.

But how did we get to this point? Well, one particular binary choice sits at the heart of most primary care policy decisions: whether to prioritise GP access or continuity of care. Very rarely can policymakers do both.

And successive governments have taken the easy way out. They’ve shovelled resources into boosting GP access because it’s cheaper, easier to measure, and, frankly, makes for better NHS stats.

Health secretaries, from Matt Hancock all the way through to Wes Streeting, have shared a vision: GP practices working together to create economies of scale and drive up the number of appointments delivered.

In practice, though, that means fewer GPs work across larger geographic areas, leaving a capacity gap that has been filled by a broader range of healthcare professionals (in part because it’s often cheaper to pay these other professionals than GPs). When you book an appointment, you might now be seen by a clinical pharmacist, a physician associate, or a mental health practitioner.

And that's exactly the crux of the issue. If a GP is involved with only a few of a patient’s touchpoints with their local surgery – because other employees are treating them on other occasions – they cannot build a deeper understanding of their health, let alone a productive relationship.

They have very little context to work with and only ten minutes per appointment to assess what’s going on. Given they are normally under immense pressure to get to the next booking, it’s the perfect storm for sick note issuance. Signing a patient off work often becomes the only viable option when you do not have the time or relationship needed to delve deeper into the problem.

Given that it’s a more expensive and time-consuming issue to fix, the fact that continuity of care is at the nub of the sick note crisis is a tough reality for the Government to face. But it must.

The time for easy options is gone. James Murray, or whoever comes next, must commit to making hard choices and truly renew the focus on continuity of care that GPs have been demanding for years.

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Katie Collin is a partner at specialist medical accountancy firm Ramsay Brown.

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