How to respond to school sickness absence requests

Dr Elliott Singer, Medical Director lead for our GP State of Emergency campaign, explains how to push back against requests for school sickness absence letters in order to free up more time to see patients with greater health needs.

We’ve all been there.

A busy surgery on a Monday morning.

The waiting room is full.

Ahead of you this morning there is a hypertensive patient who needs a medication review, a teenager with acne who needs support and guidance, a patient with depression who needs referring for CBT, a long-term patient of the practice with a back complaint, a diabetic patient whose blood tests are back and you need that discussion about rising HbA1c, a whole host of discussions on referrals and the last minute request to provide a certificate for a child who has been off sick from school. You don’t need this one but you have to go through the procedure with the concerned parents.

GP: “How can I help you today?”

Patient: “Our child was unwell last week and had to miss school. The school has told us that we need a certificate from you to confirm our child’s illness.”

GP: “Ah, you’ve been misinformed by the school.”

Patient: “What do you mean, “misinformed”?”

GP: “You don’t need a certificate from me. GPs do not provide short term sickness certification for periods of less than 7 days.”

Patient: “But the school has requested a certificate!”

GP: “The school is obliged to accept a note from you, as the parent or guardian, as confirmation that your child was ill during the period of absence from school.”

Patient: “That’s not what the school said. You’re a GP anyway, you should just provide a sick certificate if we ask for one.”

GP: “Well I can only really issue a medical certificate if a patient is seen by me at the time of their illness.”

Patient: “So, what do we do then?”

GP: “You need to go back to the school, provide them with a note and tell them that your GP has advised you to do this because this is the correct procedure.”

Patient: “I’ve waited here for an hour because your surgery is running late, in a waiting room full of sick people, to be told this! What a waste of my time.”

Sound familiar?

This is exactly the type of thing that causes pressure for GPs and their practice teams, as well as patients. We need to get the message across that this type of work is not our responsibility. GPs are not contractually required to undertake this work and it is not part of our terms of service but telling patients this does not sit well with some of us.

We know that a large volume of these requests that present to us in practices are about illnesses that are, by and large, self-limiting and do not need any treatment at all. Making parents ask for a certificate encourages dependence on the health service. It also encourages sick certificate mentality in young children and it means that parents have to take time off work and attend the surgery. This means that an appointment is taken that could have been used for a more serious illness.

This is why at my practice we have adopted an approach that is recommended in Londonwide LMCs’ emergency guidance on school sickness absence requests. General practice is in a state of emergency. Patients are finding it harder to get appointments, practices are less able to meet patients’ needs, service fragmentation is causing confusion for patients, practices are closing and clinicians and their teams find themselves under more and more stress. This is why we need to push back on unnecessary work. Dealing with school absence sickness requests is one such thing we do not need to do.

If you start to use the proforma letter in Londonwide LMCs’ emergency guidance you will hopefully begin to get the message through to local schools and the parents themselves and relieve some of the pressure on your day.

Last updated : 22 Aug 2017

 

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