Sickness absence management is a key component of any occupational health program and should be a key priority of all employers. Depending on the size and specific circumstances of the company this may be most appropriately dealt with on an individual case basis or through the development of an attendance management program.

Employers are frequently concerned with the validity of fit notes written by GP's but are unsure about what action they are able to take.

This position is confirmed in a research study of Scottish GP's published in the BMJ in 2003 (Sickness certification system in the United Kingdom: Qualitative study of views of general practitioners in Scotland. Susan Hussey et al). This indicated that a large proportion of GP's certificates are either inaccurate or unnecessary. Doctors taking part in the survey made comments such as "I've no discrimination at all, if a patient comes in and says 'I need to be off work for two weeks with a cold', I'll give him a MED 3 no questions asked". Another doctor commented "I think often what we write down is rubbish, there must be an epidemic of malaise", while another said "I very rarely refuse a certificate, I'm not going to allow a small issue like that interfere with my relationship (with the patient)". One doctor made a very telling comment regarding his attitude to issuing sick notes by saying "I sometimes write real crap on a MED 3, I write neurasthenia and scribble it so even I can't read it and they have never asked for a clarification, so they are obviously happy for you just to scrawl something totally illegible". The situation is succinctly summarized by one GP who simply stated "I will lie on the patient's behalf”.

There may be numerous reasons why an individual is unwilling to return to work including:

• Fear of further injury or making an illness worse
• Feeling that shouldn't be at work if not completely fit
• Lack of understanding of the illness and its implications
• Lack of social support mechanisms
• Misinformation
• Malingering

At RSOH we are skilled in determining the reasons for prolonged or frequent sickness absence. We can therefore provide detailed reports on an individual employee which will assist the employer in determine the most effective actions to take. Our aim is always to try to assist the employee in a full and early return to work, but if circumstances prevent this we will assist the employer in developing alternative strategies.

Employers are often concerned regarding their position should there be a difference of opinion between the employees GP and the company occupational health specialist. However, they can be reassured that the employer is perfectly entitled to take the occupational health specialist's opinion in preference to that of the GP and in cases which have reached an Industrial Tribunal, this position has been upheld by the courts.