Four-fold variation in fit note demand between CCGs hits GP workload

GPs in some CCG areas complete more than four times as many fit notes per working-age patient as their counterparts elsewhere in the country, analysis by GPonline reveals.

Demand for fit notes has risen sharply over the past two years, according to figures published by NHS Digital. In 2016/17 GPs issued 8.7m fit notes, compared with 9.5m in 2018/19 - an increase of almost 9%.

But demand varies sharply between CCG areas, analysis by GPonline shows. In some CCGs, GPs issued more than 3,500 fit notes per 100,000 patients per month on average in 2018/19, while in other areas less than 1,000 fit notes were issued per month for every 100,000 patients.

GP leaders said this regional variation had a significant impact on workload for GPs in areas of high demand, and urged NHS trusts not to dump responsibility for writing fit notes onto GPs after episodes of hospital treatment. The BMA has repeatedly called for the period of self-certification of illness for patients to be extended from seven to 14 days.

NHS Halton CCG, in Cheshire, issued 3,684 fit notes a month per 100,000 patients in 2018/19 - the highest rate in the country - compared with just 855 in NHS Central London (Westminster) CCG, which was the lowest.

Some CCG areas have seen demand for fit notes rise significantly faster than others over the past two years. Looking at 12-month average figures for the number of fit notes issued per 100,000 patients aged between 18 and 65 years old, some CCGs have seen a rise of 30% or more between 2016/17 and 2018/19 - while other areas have seen demand fall by as much as 15%.

GP workload

BMA GP committee chair Dr Richard Vautrey said regional variation in demand for fit notes was ' very much patient-dependent'. He said: 'It will be due to differences in deprivation, poverty, unemployment and other social determinants of health. It is a significant workload for GPs who are the main providers of fit notes.

'Many areas have tried to encourage secondary care services to issue fit notes after hospital procedures and other contacts but this is still not done consistently enough, which inconveniences patients as well as leading to unnecessary consultations in general practice.

'We have previously called for an extension of the period of self certification from seven days to 14 days, which could empower patients and help reduce unnecessary requests. This is still something the Department of Work and Pensions should consider as a way to improve access to overstretched GP services.'

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