Tussles and Rollovers: Negotiating Sickness Certification in Primary Care

Abstract

Sickness certification in primary care is increasingly the focus of new policies, practices and politics which are associated with keeping people in work rather than moving on to sickness absence. However, there are considerable tensions for practitioners from their role in sickness certification. The decision to issue a sicknote is influenced by a number of factors including the needs of their patient, their own attitudes towards work, and their responsibility to the state or employer. Some patients, such as those with Medically Unexplained Symptoms (MUS), are particularly challenging for Practitioners, as they do not fit the “sick role” and are difficult to negotiate with. We present the first taxonomy from actual sicknote consultations between General Medical Practitioners (GPs) and their patients, classifying the types of requests and the associated responses. Although, most sicknote requests do result in a sicknote, GPs do gather information about the patient’s social, occupational, and family circumstances, negotiate absences from work, impose terms and conditions upon the patient, and challenge patients’ illness constructions. Our findings suggest that, despite the tensions for GPs in managing these patients, sicknote consultations can be an important juncture for the clinicians and patients, particularly in light of the move from an illness deficit model towards a health capacity model, where work is considered health-giving, and not a barrier to illness recovery. This resonates with the switch in the UK to a “fitnote” approach from the previous “sicknote” one.