Katie Collin, partner at Ramsay Brown, says that sacrificing continuity of care has compounded the sick note epidemic
Eleven million sick notes were issued in England last year, and it’s prompted outrage across the papers. So far, policymakers have pursued simplistic solutions but repeatedly failed to address the root cause of the issue – one that GPs have themselves been raising for years: continuity of care.
It’s very difficult to measure continuity of care, which, simply put, means how many people see the same doctor when they visit a practice. It sometimes seems a woolly concept, but by looking at the GP patient survey, The Health Foundation concludes it’s been stuck in a downward spiral ever since 2009.
Why is that relevant to sick note issuance? Because when you have a world where patients see a different healthcare professional each time they visit a practice, it becomes very difficult for the GP to understand the context behind that visit or build any sort of relationship with the patient. That, to be clear, is what GPs want to do with every patient. But they are often stripped of that choice.
Heavy workloads
In most circumstances, they’re left with about ten minutes to assess the situation and decide on the most beneficial course of action. Heavy workloads mean they’re rushing to the next patient, so signing them off sick becomes the most common outcome.
If, on the other hand, the government truly brought back the family doctor, and you saw the same GP every time you needed to visit your local practice, that doctor would have a far better understanding of the patient and their healthcare. They’d have so much more information that they could factor into the patient’s healthcare plan. And the relationship, in some cases, built up over decades, needs to help them navigate the way forward.
I truly believe that, if we cracked continuity of care in this country, the number of sick notes being issued by GPs would come down by some margin. Sadly, though, it’s been on the back burner for so long that serious damage has already been done.
How? Well, when civil servants and ministers weigh up what direction to take primary care, they have to choose between two routes. They can either prioritise GP access or continuity of care. Rarely can they do both.
The more attractive option for most governments has proven to be the former. And, in fairness, it makes sense when you’re looking at it from a public perception perspective. Boosting access is cheaper, faster, and crucially, makes for much better NHS statistics.
That’s an accusation that was laid at Wes Streeting’s door during his time as health secretary – that he was more focused on making the numbers look good than on whether those improvements were actually reflected in hospitals and GP practices across the country. I think the same has probably been true for every health secretary we’ve seen over the last decade or so, and it’s left its mark on primary care.
Don’t get me wrong, improving GP access isn’t bad in and of itself. It’s crucial that everyone can see a GP when they need to, and that they don’t have to wait around trying to get an appointment for days on end. It’s right that the government focuses energy on this part of the primary care puzzle – the issue is that it’s been the sole priority for far too long.
A perfect example was the decision to roll out primary care networks (PCNs) under Matt Hancock. This was a big move, all about grouping GP practices together to work at scale – sharing resources to provide more services across larger areas.
In the PCN push, many other healthcare professionals were recruited to deliver these economies of scale. That included physiotherapists, mental health practitioners and physician associates, to name a few.
Time to change tack
The drive to hire a more diverse range of healthcare professionals with their own areas of expertise obviously had its benefits. But there’s no denying it was a decision made entirely to improve primary care access, and that it came at the expense of GP recruitment. It made the workforce more fragmented, so that now, if you book an appointment at your local practice, you might be seen by one of these other professionals, rather than the same family doctor.
Countless similar decisions have been made over the last decade or so, and it’s clearly the mindset the current government has adopted, too. Starmer and Streeting’s neighbourhood health plan follows a very familiar pattern – better access to local health centres, more services provided, but no continuity.
For me, continuity – or lack thereof – is a massive contributing factor to the high levels of sick note issuance we’re currently seeing. Don’t get me wrong, it’s a difficult, costly and time-consuming issue to fix, but it’s one that must be placed at the top of the agenda in the years to come.
Without tackling the problem head-on and facing up to the decisions that have led us here, I fear the sick note epidemic will continue to rage on. It’s time to honour the calls of our GPs, change tack, and finally prioritise continuity of care.
