Thursday, 2 February 2012

Doctors getting people back to work

The YouTube video above was shared by the GMC as part of their pre-consultation on updating the guidance on Good Medical Practice(GMP).

Reward to doctors for getting patients back to work is not mentioned in the draft version of Good Medical Practice.  However, for the first time the GMC guidance to doctors includes specific mention of encouraging patients to stay in or to return to employment. I am not aware of the reason why this has been included at this time. The wording is

"51 You must support patients in caring for themselves to empower them to improve and maintain their health. This may include encouraging patients, including those with long-term conditions, to stay in or return to employment or other purposeful activity. You may also advise patients on the effects of their life choices on their health and well-being and the possible outcomes of their treatments."
(my emphasis)

This is specifically raised in the consultation questionnaire:

"At paragraph 51 of this section, we advise doctors that they must support patients in caring for themselves to empower them to improve and maintain their health. This is essentially the same as GMP 2006. But we also now say that such support may include ‘encouraging patients, including those with long term conditions, to stay in or return to employment or other purposeful activity’. 
30 Do you agree this is a reasonable expectation of doctors "

What do you think of this guidance to doctors? The consultation closes on Friday 10th February 2012. Any member of the public can take part.  Find out more here including the link to the e-consultation.

"Doctors to encourage long-term sick to return to work" Daily Mail 1/11/2011
"Who is in charge of doctors and consultants- the DWP?" Twisted News 1/11/2011
"New section of the Department of Health" Jobbing Doctor 1/11/2011
"Work guidance for long-term sick" Guardian 1/11/2011 

EDIT Full GMC guidance published on 25/3/2013 The requirement to encourage patients back to work is absent. Full wording of para 51 is 
"51 You must support patients in caring for themselves to empower them to 
improve and maintain their health. This may, for example, include:
a advising patients on the effects of their life choices and lifestyle on 
their health and well-being 
b supporting patients to make lifestyle changes where appropriate."


  1. and become unethical like Atos ? I dont think so

  2. This is an incentive to possibly act against the wellbeing of the patient. As such I would say it breaches the hippocratic oath and would ruin the trust that patients have in their drs that they have their best interests at heart. It is imperative that patients have drs on their side when it is already happening that people are being declared fit for work by atos and then dieing within a few weeks. If we dont have our drs and consultants support and understanding when we are too sick to work with eg cancer etc. where are we supposed to turn!!

  3. Difficult one, I have a long term mental health problem that has meant I've been unemployed for 10 years. I would love to get "back to work", but the problem is not with the medical profession, it's with employers being reluctant to employ people like me. My doctor could give me all the "encouragement" in the world, but that won't magically change the wider problem which is societies attitude to mental illness and physical disability. They need to work on that before they start "encouraging" us back to work, the reforms are happening too quickly and in a society that is still not ready for thousands of mentally ill people to be thrown back into the employment market.
    If this is allowed to happen there will be real scenes like "Yozza" from "Boys from the black stuff" desperately mentally ill but forced to seek work, saying "giyuz a job" and nutting the foreman all over the country.

  4. I have been off sick from work for a long time and it is a very lonely place to be - continuous hospital appointments, tests, treatments, and it has been brilliant to know that during all of this that my GP has overseen all my care, and ensured that I am getting the best treatment. If during this period he was getting a 'bonus' to get me back to work, it would have been a huge conflict of interest and strained our professional relationship. I would have been reluctant to tell him about the extremes of my illness and this may have resulted in me not getting the best medical treatment. We've seen elsewhere how incentives are paid to companies to get people back to work, and they make poor decisions, based on monetary gain. Please don't let this happen to my GP - I need to be able to turn to someone during all this illness; I have no where else to go.

  5. 'Encourage' so quickly becomes 'compel' (aka 'beat with a large stick').

    Doctors: First do no harm.

  6. Writing as a recently retired GP my first concern was ALWAYS what was in the best interest of my patient. Often we acted as the patient's champion. Yes, in many situations returning to work was a part of the healing process and a perfectly proper objective for both doctor and patient. In a few it was clear that patients just could not cope with the working environment, and they needed to support of the doctor to protect them from officious pressure from other quarters to coerce them into doing so. Skivers? Oh yes, the creature exists but he is rare indeed. On the sparse occasions when I had to confront this I did so in an uncompromising manner, to protect my own integrity as a doctor and to avoid any taint upon the genuinely unable.


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