A common question in general practice: “Ms P’s fit note runs out on Monday – can you do her another one?” Your answer should be considered carefully as the following case illustrates, explains Dr Rachel Birch, GP and medicolegal adviser at MPS
Dr A, a GP registrar, received the message “Ms P’s fit note runs out on Monday – can you do her another one?” at 4pm on a busy Friday afternoon. Her GP trainer, Dr S, was doing the ‘duty doctor’ session at the main premises, but the request was passed to Dr A as Dr S was undertaking an urgent home visit.
Dr A was told that Ms P had been on the phone and had appeared worried – she had told the receptionist that she wasn’t sure if she should return to work or not, but that her fit note was due to run out on Monday and she would be in trouble with her boss if she did not hand another note in. She asked to pick up the fit note at 5.30pm.
Dr A had never met Ms P before. She looked in her medical record and noted that Ms P had been seeing Dr M, the senior partner, for depression and anxiety. She appeared to have had three fit notes issued in the last four months. The notes were fairly brief and although Dr M had documented that Ms P had “greatly improved” there was no clear advice regarding her job, or a return to work.
Dr A realised that she needed to make an assessment of Ms P before completing a fit note. Dr M was out of the practice for the day, so she could not obtain any further background information about the patient. She spoke with Dr S, but he had not previously met the patient.
Dr A tried to contact Ms P by telephone, but was unable to reach her. She asked the receptionist to keep trying to contact her to explain that Dr A was unable to issue a fit note without reviewing her and to organise for Ms P to come down to the practice that afternoon for a review appointment. The receptionist was unable to reach Ms P on the telephone.