Stakeholder perspectives on the new sickness certificate in Victoria: results from a mixed-methods qualitative study
Bianca Brijnath A B , Nabita Singh A and Danielle Mazza AA Department of General Practice, Monash University, Building 1/270 Ferntree Gully Road, Notting Hill, Melbourne, Vic. 3168, Australia. Email: nabita.singh@monash.edu; danielle.mazza@monash.edu
B Corresponding author. Email: bianca.brijnath@monash.edu
Australian Health Review 40(1) 27-32 https://doi.org/10.1071/AH14136
Submitted: 12 August 2014 Accepted: 15 May 2015 Published: 27 July 2015
Abstract
Objective The aim of this study was to present the views of four stakeholder groups, namely general practitioners (GP), employers (EMP), injured workers (IW) and compensation agents (CA), about the content and usability of the draft of the new Victorian sickness certificate.
Methods A cross-sectional mixed-methods qualitative study was conducted in GP clinics and community settings in Melbourne, Australia. Interviews were conducted with GPs, EMPs and IWs and one focus group discussion was completed with CAs (n = 29). Data were collected between October and December 2013. Thematic analysis was performed.
Results All stakeholders viewed the new draft certificate as an improvement on the old one. GPs saw the certificate as a form of communication, whereas EMPs and CAs saw it as a therapeutic device. GPs continued to certify based on incapacity and provided little information about what IWs could do on return to work. All groups said that assessments for mental health needed more clarity and specificity. GPs, EMPs and CAs also said that the new certificates must be electronically available and integrated into existing medical software to streamline uptake.
Conclusions To ensure appropriate use of the new certificate, stakeholders must share a common understanding about its purpose and the certificate must be incorporated into existing medical software. Content on mental health assessment, an area of continued difficulty, needs additional refinement. The new certificate replaced the old certificate in March 2015; after it has been established in clinical practice, an impact evaluation should be completed to determine whether GPs are certifying capacity and earlier return to work.
What is known about the topic? When it comes to sickness certification, GPs tend to focus on what injured patients cannot do, rather than what they can do. The new sickness certificate aims to change GP behaviour by focusing the certificate more on capacity (i.e. what the injured patient can do).
What does this paper add? Four stakeholder groups agreed that the content and usability of the new certificate has improved. However, they agreed that the assessment of mental health capacity needs further specificity. Dissonances also remain between the stakeholders on the purpose of the certificate.
What are the implications for practitioners? Appropriate use of the new certificate requires a common understanding about the purpose of the certificate, training on its appropriate use, incorporation into existing medical software and clarity on mental health assessment.
Additional keywords: compensable injury, general practice, sickness certification.
References
[1] Dembe AE, Mastroberti MA, Fox SE, Bigelow C, Banks SM. Inpatient hospital care for work-related injuries and illnesses. Am J Ind Med 2003; 44 331–42.| Inpatient hospital care for work-related injuries and illnesses.Crossref | GoogleScholarGoogle Scholar | 14502760PubMed |
[2] Ruseckaite R, Gabbe B, Vogel AP, Collie A. Health care utilisation following hospitalisation for transport-related injury. Injury 2012; 43 1600–5.
| Health care utilisation following hospitalisation for transport-related injury.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC38zjvFOmtA%3D%3D&md5=1f158735f09df8a5d227a196412f9123CAS | 21466883PubMed |
[3] Collie A, Ruseckaite R, Brijnath B, Kosny AA, Mazza D. Sickness certification of workers compensation claimants by general practitioners in Victoria, 2003–2010. Med J Aust 2013; 199 480–3.
| Sickness certification of workers compensation claimants by general practitioners in Victoria, 2003–2010.Crossref | GoogleScholarGoogle Scholar | 24099209PubMed |
[4] Brijnath B, Mazza D, Singh N, Kosny A, Ruseckaite R, Collie A. Mental health claims management and return to work: qualitative insights from Melbourne, Australia. J Occup Rehabil 2014; 24 766–76.
| Mental health claims management and return to work: qualitative insights from Melbourne, Australia.Crossref | GoogleScholarGoogle Scholar | 24647855PubMed |
[5] Mazza D, Collie A, Brijnath B, Kosny A, Ruseckaite R, Singh N. FIT to work: general practitioners facilitating injured workers return to work. Melbourne: Institute for Safety Compensation and Recovery Research; 2013.
[6] Waddell G, Burton A. Is work good for heath and well being? London: The Stationery Office; 2006.
[7] Black C. Working for a healthier tomorrow: review of the health of Britain’s working age population. London: The Stationery Office; 2008.
[8] Welsh VK, Mallen CD, Wynne-Jones G, Jinks C. Exploration of GPs’ views and use of the fit note: a qualitative study in primary care. Br J Gen Pract 2012; 62 363–70.
| Exploration of GPs’ views and use of the fit note: a qualitative study in primary care.Crossref | GoogleScholarGoogle Scholar |
[9] Wainwright E, Wainwright D, Keogh E, Eccleston C. Fit for purpose? Using the fit note with patients with chronic pain: a qualitative study. Br J Gen Pract 2011; 61 794–800.
| Fit for purpose? Using the fit note with patients with chronic pain: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
[10] Hann M, Sibbald B. General practitioners’ attitudes towards patients’ health and work. 2011. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/197544/733summ.pdf [verified 13 December 2013].
[11] Coole C, Watson PJ, Thomson L, Hampton R. How do GPs complete fit note comments? Occup Med (Lond) 2013; 63 575–578.
| How do GPs complete fit note comments?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2c7kslKisA%3D%3D&md5=9a1877379e0673e6999f818c43fe2914CAS | 24213094PubMed |
[12] Ryan GW, Bernard HR. Techniques to identify themes. Field Methods 2003; 15 85–109.
| Techniques to identify themes.Crossref | GoogleScholarGoogle Scholar |
[13] Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3 77–101.
| Using thematic analysis in psychology.Crossref | GoogleScholarGoogle Scholar |
[14] Mays N, Pope C. Qualitative research: rigour and qualitative research. BMJ 1995; 311 109–112.
| Qualitative research: rigour and qualitative research.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2MzjvVSisA%3D%3D&md5=6728f57a8cc9e77f2dc81f6017b9a5a1CAS | 7613363PubMed |
[15] Roope R, Parker G, Turner S. General practitioners’ use of sickness certificates. Occup Med (Chic Ill) 2009; 59 580–5.
| General practitioners’ use of sickness certificates.Crossref | GoogleScholarGoogle Scholar |
[16] Cohen D, Khan S, Allen J, Sparrow N. Shifting attitudes: the national education programme for work and health. Occup Med (Lond) 2012; 62 371–4.
| Shifting attitudes: the national education programme for work and health.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC38jgtVKgtQ%3D%3D&md5=a222572e19d3d85a6c263817e0560bd8CAS | 22679210PubMed |
[17] Chang D, Irving A. Evaluation of the GP education pilot: health and work in general practice. London: Department for Work and Pensions; 2008.
[18] Wynne-Jones G, Mallen C, Main C, Dunn K. What do GPs feel about sickness certification? A systematic search and narrative review. Scand J Prim Health Care 2010; 28 67–75.
| What do GPs feel about sickness certification? A systematic search and narrative review.Crossref | GoogleScholarGoogle Scholar | 20334576PubMed |
[19] MacDonald S, Maxwell M, Wilson P, Smith M, Whittaker W, Sutton M, Morrison J. A powerful intervention: general practitioners’ use of sickness certification in depression. BMC Fam Pract 2012; 13 82
| A powerful intervention: general practitioners’ use of sickness certification in depression.Crossref | GoogleScholarGoogle Scholar | 22877237PubMed |
[20] Sallis A, Birkin R, Munir F. Working towards a ‘fit note’: an experimental vignette survey of GPs. Br J Gen Pract 2010; 60 245–50.
| Working towards a ‘fit note’: an experimental vignette survey of GPs.Crossref | GoogleScholarGoogle Scholar | 20353670PubMed |
[21] Black C, Frost D. Health at work: an independent review of sickness absence in Great Britain. London: UK Government Department for Work and Pensions; 2011.
