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a stethoscope image cbSeptember 6 2017

Mental health and behavioural conditions account for nearly one-in-three known fit notes, NHS Digital statistics indicate.

New experimental figures analysing 12 million fit notes over a 28 month period have been analysed, of which around 5.8 million gave a known diagnosis. Mental health and behavioural conditions accounted for 31.3% of all fit notes (where the diagnosis was known), written in England between December 2014 and March 2017. Of these, around one in five (21.5%) were issued for a period of absence of more than 12 weeks.

The data also indicates that:

  • on average, GPs issued one fit note per 48 patients aged 18-65 years, each month;
  • 6.5% of fit notes reported were classified as ‘may be fit for work’, with 4 out of 5 of these recommending an adaptation in the workplace, working hours or duties;
  • 18.0% of fit notes with a known diagnosis were for diseases of the musculoskeletal system and connective tissue;
  • 58.% of episodes needed one fit note whilst 6.7% of episodes comprise five or more fit notes;
  • 2.8 per cent of fit notes for diseases of the respiratory system are for more than 12 weeks, whilst the proportion for all episodes was 14.7 per cent;
  • January 2017 saw the highest number of fit notes written from the included practices, with 556,000 issued during that month.

The Royal College of Psychiatrists called the rise in sick notes due to mental health “alarming.” Dr Jed Boardman, Lead for Social Inclusion at the RCPsych, said: “Mental health conditions are now a far more common reason for being signed off work; traditionally the leading cause was back pain.

“GPs and employers must do more to facilitate a person’s return to work. GPs will write suggestions on the Fit Note, such as staggered work days or agreeing specific goals for the returning employer – both parties need to be more active in tailoring these suggestions to that person.

“If anything, this new data may underestimate the scale of the problem. Almost half of benefits claimants of Employment and Support Allowance in England are receiving payments as the result of mental and behavioural disorders.

“Ultimately, it is discrimination which can act as the most significant barrier to those with mental health problems in work. The Government has committed to putting NHS mental healthcare on a par with physical healthcare - employers would do well to follow their example.”

Dr Steve Mowle, RCGP Honorary Treasurer, said: “Mental health related issues are making up an increasing amount of the GP caseload, so these figures are not surprising. They might possibly indicate a positive move towards greater awareness and reduced stigma of mental health in society – with people being more open and willing to discuss their mental health conditions.

“We know that working is beneficial for our patients’ long term physical and mental health and wellbeing, and we need a society-wide approach, including involvement from employers, to put measures in place to get people back into work, where possible, safely and appropriately.

“However, we still have a long way to go before mental health has parity of esteem with physical illness. Achieving this is a clinical priority for the RCGP, and we are pushing for GPs to have easier, better access to more, and a greater variety of, mental health therapies in the community for their patients to reduce waiting times and ensure they get the care they need.”

Links:
NHS Digital announcement         
NHS Digital: ‘Fit notes issued by GP practices, England. December 2014 - March 2017’. Published August 31 2017                    
NHS Digital Fit note statistics summary   
RCPsych comment         
RCGP comment                 

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