Qualitative study of certifying medical practitioners
Hussey et al (BMJ 2003; 0: 379496563-0) provide some interesting new
data which builds upon previous research findings, including that
commissioned by the Department for Work and Pensions (DWP). The DWP has
responsibility for both the policy in the area of state sickness
certification and the official guidance to registered medical
practitioners throughout Great Britain. From this perspective I offer the
following comments on the paper.
The DWP in fact replaced the former Department of Social Security and
the Department for Employment in June 2001 and is not 'a branch of the
DSS' as stated in the Introduction. The DWP statistics quoted [4.9 million
/ 3 million people] are misleading since they refer to a range of benefits
claimed by people of working age including those where there is no link to
sickness certification. A more appropriate statistic would be the
2.7million people of working age in the UK currently in receipt of a state
incapacity benefit; almost all of these people will have received sick
notes at some point.
The paper does not make clear when the field research was carried
out. This is a relevant because, following previous research findings,
updated guidance was issued by the DWP to all general practitioners in
April 2000 and April 2002.
A number of the references cited (Ref 5,7,8,19) relate to Scandinavia
where important contextual differences make comparison with the UK
difficult - the text does not make this clear.
The researchers adopted an approach to qualitative research which was
intended to 'examine the more sensitive areas of the general
practitioner's perspective'. This resulted in focus groups where '..one
facillitator was personally known to many of the participants..' and
'..many of the participants knew each other...' The paper does not
discuss the possible effects this might might have had on the data nor was
there any attempt to conduct one-to-one interviews to verify whether
participants views were being influenced by the structure of the focus
groups.
Only 3 of the focus groups were devoted to discussing emergent
themes, there appears to have been no clarification of issues with the
original focus groups or apparently with experienced GP principals.
Looking at the examples of GPs views provided in the appendices some
clearly relate to state benefits, such as Disability Living Allowance
(DLA), which have no direct connection with sickness certification.
Unfortunatly it is not clear to what extent overall these findings
actually relate to a lack of awareness by the GPs of their role in the
current system for state sickness certification (which seems to be
suggested by many of the comments) or to perceived difficulties in
practice to follow the correct procedures and guidance.
Finally, I note in passing that the researchers did not share their
findings with us but they apparently did share them with the BMA. The BMA
Public Affairs Division issued a Press Notice ahead of publication on
BMJ.com which resulted in extensive media coverage of certain aspects of
the findings on Monday 22 December 2003.
Competing interests:
Principal Medical Adviser, Department for Work and Pensions
Rapid Response:
Qualitative study of certifying medical practitioners
Hussey et al (BMJ 2003; 0: 379496563-0) provide some interesting new
data which builds upon previous research findings, including that
commissioned by the Department for Work and Pensions (DWP). The DWP has
responsibility for both the policy in the area of state sickness
certification and the official guidance to registered medical
practitioners throughout Great Britain. From this perspective I offer the
following comments on the paper.
The DWP in fact replaced the former Department of Social Security and
the Department for Employment in June 2001 and is not 'a branch of the
DSS' as stated in the Introduction. The DWP statistics quoted [4.9 million
/ 3 million people] are misleading since they refer to a range of benefits
claimed by people of working age including those where there is no link to
sickness certification. A more appropriate statistic would be the
2.7million people of working age in the UK currently in receipt of a state
incapacity benefit; almost all of these people will have received sick
notes at some point.
The paper does not make clear when the field research was carried
out. This is a relevant because, following previous research findings,
updated guidance was issued by the DWP to all general practitioners in
April 2000 and April 2002.
A number of the references cited (Ref 5,7,8,19) relate to Scandinavia
where important contextual differences make comparison with the UK
difficult - the text does not make this clear.
The researchers adopted an approach to qualitative research which was
intended to 'examine the more sensitive areas of the general
practitioner's perspective'. This resulted in focus groups where '..one
facillitator was personally known to many of the participants..' and
'..many of the participants knew each other...' The paper does not
discuss the possible effects this might might have had on the data nor was
there any attempt to conduct one-to-one interviews to verify whether
participants views were being influenced by the structure of the focus
groups.
Only 3 of the focus groups were devoted to discussing emergent
themes, there appears to have been no clarification of issues with the
original focus groups or apparently with experienced GP principals.
Looking at the examples of GPs views provided in the appendices some
clearly relate to state benefits, such as Disability Living Allowance
(DLA), which have no direct connection with sickness certification.
Unfortunatly it is not clear to what extent overall these findings
actually relate to a lack of awareness by the GPs of their role in the
current system for state sickness certification (which seems to be
suggested by many of the comments) or to perceived difficulties in
practice to follow the correct procedures and guidance.
Finally, I note in passing that the researchers did not share their
findings with us but they apparently did share them with the BMA. The BMA
Public Affairs Division issued a Press Notice ahead of publication on
BMJ.com which resulted in extensive media coverage of certain aspects of
the findings on Monday 22 December 2003.
Competing interests:
Principal Medical Adviser, Department for Work and Pensions
Competing interests: No competing interests