BMJ, doi: 10.1136/bmj.37949.656389.EE, (Published 22 December 2003)

PRIMARY CARE

Sickness certification system in the United Kingdom: qualitative study of views of general practitioners in Scotland

Susan Hussey ¹, Pat Hoddinott ², Phil Wilson ³, Jon Dowell ⁴, Rosaline Barbour ⁵

¹ Research and Development Office NHS Highland, The Greenhouse, Beechwood Business Park North, Inverness IV2 3ED
² Highlands and Islands Health Research Institute, The Greenhouse, Beechwood Business Park North
³ Department of General Practice, University of Glasgow, Glasgow G12 0RR
⁴ Tayside Centre for General Practice, Dundee DD2 4AD
⁵ School of Nursing and Midwifery, Dundee DD1 4HJ

Objectives To explore how general practitioners operate the sickness certification system, their views on the system, and suggestions for change.

Design Qualitative focus group study consisting of 11 focus groups with 67 participants.

Setting General practitioners in practices in Glasgow, Tayside, and Highland regions, Scotland.

Sample Purposive sample of general practitioners, with further theoretical sampling of key informant general practitioners to examine emerging themes.

Results General practitioners believed that the sickness certification system failed to address complex, chronic, or doubtful cases. They seemed to develop various operational strategies for its implementation. There appeared to be important deliberate misuse of the system by general practitioners, possibly related to conflicts about roles and incongruities in the system. The doctor-patient relationship was perceived to conflict with the current role of general practitioners in sickness certification. When making decisions about certification, the general practitioners considered a wide variety of factors. They experienced contradictory demands from other system stakeholders and felt blamed for failing to make impossible reconciliations. They clearly identified the difficulties of operating the system when there was no continuity of patient care. Many wished either to relinquish their gatekeeper role or to continue only with major changes.

Conclusions Policy makers need to recognise and accommodate the range and complexity of factors that influence the behaviour of general practitioners operating as gatekeepers to the sickness certification system, before making changes. Such changes are otherwise unlikely to result in improvement. Models other than the primary care gatekeeper model should be considered.

---

(Accepted 11 November 2003)
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Sickness certification system in the United Kingdom: Doctors are indeed agents of social control

James N Hardy
BMJ 2004 328: 461. [Extract] [Full Text] [PDF]

Sickness certification system in the United Kingdom: Maybe charging for certificates clarifies matters

Paul V Mackey
BMJ 2004 328: 461. [Extract] [Full Text]

Sickness certification system in the United Kingdom: Medical certificates are challenging but essential part of job

Graeme Mackenzie
BMJ 2004 328: 461. [Extract] [Full Text]

Sickness certification system in the United Kingdom: Department for Work and Pensions is trying to address challenges

Mansel Aylward
BMJ 2004 328: 461-462. [Extract] [Full Text]

Cure needed for sick certificates
BMJ 2004 328: 0. [Full Text]

Medicine's complexity: exhausting or inspiring?

Richard Smith
BMJ 2004 328: 0. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Roope, R., Parker, G., Turner, S. (2009). General practitioners' use of sickness certificates. Occup Med (Lond) 0: kqp147v1-kqp147 [Abstract] [Full text]  
• Cohen, D. A., Aylward, M., Rollnick, S. (2009). Inside the fitness for work consultation: a qualitative study. Occup Med (Lond) 59: 347-352 [Abstract] [Full text]  
• Gjesdal, S., Haug, K., Ringdal, P., Maeland, J. G., Hagberg, J., Roraas, T., Vollset, S. E., Alexanderson, K. (2009). Sickness absence with musculoskeletal or mental diagnoses, transition into disability pension and all-cause mortality: A 9-year prospective cohort study. Scand J Public Health 37: 387-394 [Abstract]  
• Hulshof, C. T J (2009). Working for a healthier tomorrow. Occup. Environ. Med. 66: 1-2 [Full text]  
• Gerner, U., Alexanderson, K. (2009). Issuing sickness certificates: A difficult task for physicians: A qualitative analysis of written statements in a Swedish survey. Scand J Public Health 37: 57-63 [Abstract]  
• Gjesdal, S., Ringdal, P. R., Haug, K., Maeland, J. G., Vollset, S. E., Alexanderson, K. (2008). Mortality after long-term sickness absence: prospective cohort study. Eur J Public Health 18: 517-521 [Abstract] [Full text]  
• Swartling, M. S., Alexanderson, K. A.E., Wahlstrom, R. A. (2008). Barriers to good sickness certification -- an interview study with Swedish general practitioners. Scand J Public Health 36: 408-414 [Abstract]  
• Kivisto, S., Verbeek, J. H., Hirvonen, M., Varonen, H. (2008). Return-to-work policies in Finnish occupational health services. Occup Med (Lond) 58: 88-93 [Abstract] [Full text]  
• O'Brien, K., Cadbury, N., Rollnick, S., Wood, F. (2008). Sickness certification in the general practice consultation: the patients' perspective, a qualitative study. Fam Pract 0: cmm076v1-cmm076 [Abstract] [Full text]  
• Upmark, M., Borg, K., Alexanderson, K. (2007). Gender differences in experiencing negative encounters with healthcare: A study of long-term sickness absentees. Scand J Public Health 35: 577-584 [Abstract]  
• Edwards, S., Gabbay, M. (2007). Living and working with sickness: a qualitative study. Chronic Illness 3: 155-166 [Abstract]  
• Osterkamp, R., Rohn, O. (2007). Being on Sick Leave: Possible Explanations for Differences of Sick-leave Days Across Countries. CESifo Economic Studies 53: 97-114 [Abstract] [Full text]  
• Hardy, J. N (2004). Sickness certification system in the United Kingdom: Doctors are indeed agents of social control. BMJ 328: 461-461 [Full text]  
• Mackey, P. V (2004). Sickness certification system in the United Kingdom: Maybe charging for certificates clarifies matters. BMJ 328: 461-461 [Full text]  
• Mackenzie, G. (2004). Sickness certification system in the United Kingdom: Medical certificates are challenging but essential part of job. BMJ 328: 461-461 [Full text]  
• Aylward, M. (2004). Sickness certification system in the United Kingdom: Department for Work and Pensions is trying to address challenges. BMJ 328: 461-462 [Full text]  

Rapid Responses:

Read all Rapid Responses

Qualitative study of certifying medical practitioners

Philip Sawney
bmj.com, 23 Dec 2003 [Full text]

Prostituting ourselves for certificates?

Paul V Mackey
bmj.com, 9 Jan 2004 [Full text]

Data Protection Act again?

David J Young
bmj.com, 11 Jan 2004 [Full text]

Military Doctors

Solomon MS Gruber
bmj.com, 11 Jan 2004 [Full text]

We ARE agents of social control

James N Hardy
bmj.com, 15 Jan 2004 [Full text]

Sick notes - what are the guidelines ?

susanne McCabe
bmj.com, 14 Jan 2004 [Full text]

Advice to patients on fitness for work - BMJ 2004; 328 (10Jan)

Mansel Aylward
bmj.com, 22 Jan 2004 [Full text]

Online poll

Find out more >>