GPs have always had a high but maybe underestimated level of influence on the successful workings of an employer’s health and wellbeing strategy. With the implementation of the fit note and the Government’s proposals for GPs to take over the commissioning of NHS services, their influence is going to get even stronger and here’s why:
GPs are the gatekeepers to accessing most available healthcare. With very few exceptions, all NHS services need a GP referral. Even in private health, accessing the majority of treatments needs a GP referral although there is a trend away from this requirement for physiotherapy and counselling services.
So, even if they have occupational health support, employers are heavily reliant on GPs making the right decisions and referrals. With the fit note, they are being asked to make more considered decisions about signing off a length of absence and making recommendations on workplace adjustments enabling a quicker return. Whilst employers can choose to ignore their recommendations, they can’t ignore the length of time their employees have been signed off.
GPs are supposed to make these considered recommendations during a 10 minute patient consultation. Many have already complained that they are not occupational health experts and that they just don’t have the time to properly assess potential workplace adjustments.
Now they are being asked to commission NHS services through the setting up of GP consortia which if not managed effectively will take them away from their front line patient role, reducing further the time they have to evaluate return to work scenarios. This could well mean the dilution of the impact of the fit note as time poor GPs just sign employees off sick as before.
But it is not just decisions around referrals and fit notes where GPs can have either a positive or negative influence. They will now be running the budgets for commissioning NHS services and there is no guarantee that what they commission will match the needs of employees in their practice areas. It will very much depend on the demographics involved and how they choose to spend their funding.
One area where they will lose an element of control is the proposed abolition of practice boundaries which means that employees will be able to register with a GP that suits them. This could be closer to work than at home which might save lost time in attending appointments, but this is really at the margin as I don’t expect significant numbers to switch GP on this basis.
Recognising the level of influence they have, a large employer recently wrote to 2,000 GPs in areas where they had the highest concentration of employees to tell them about its business, help them understand its approach to occupational health and engage them in working more closely together. Only 5 GPs bothered to respond and I think this demonstrates the lack of influence and control that employers have over what is such a vital aspect of managing the health and wellbeing of their employees.
And there isn’t a great deal they can do about it other than buying private GP services which might begin to see an increased level of interest.