Profile of responders
Nine (five in England, three in Scotland, and one in Wales) of the 30 PCOs contacted participated (30%), generating 3184 GP contacts. Thirteen contacts were ineligible (absent from practice or invalid address); 583 valid questionnaires were returned (18%). Eight GPs returned incomplete forms and 48 wrote to decline participation (too busy/no time, no incentive payment, disagreement with government policies affecting GPs, a need to negotiate fitness for work decisions with the patient, and questionnaire length).
Fifty-three per cent (n = 309) of valid questionnaires were from GPs assigned the current Med 3, and 47% (n = 274) from those assigned the trial Med 3. There were no statistically significant differences in the demographic characteristics of GPs between the two Med 3 groups: average age 46 years, 51% male, 8% had an occupational health qualification, 32% were GPs for less than 10 years, 3% worked in a single-handed GP practice, 21% in a practice with two to three GPs, 30% in a practice with four to five GPs, and 46% in a practice with six or more GPs; 56% worked in an urban area, 20% in a rural area, and 22% in an inner city area.
Comparing fitness for work assessments
GPs using the trial Med 3 form were more likely to assess cases as ‘fit for work’. This applied across all three health conditions: back pain (OR) = 13.4; 95% CI = 8.9 to 20.2; P<0.001); depression (OR = 3.5; 95% CI = 2.1 to 5.8; P<0.001); and combined (OR = 5.5; 95% CI = 3.5 to 8.6; P<0.001).
GPs using the trial Med 3 assessed 70% of back pain cases as ‘fit for some work’ (), whereas 76% of the same back pain cases were advised by GPs using the current Med 3 to refrain from work. ‘Fit for some work’ was used least often in the depression case (19%). The majority of depression cases were considered ‘not fit for work’ using trial (74%) and current (91%) Med 3 forms. GPs using the current Med 3 form assessed 88% of cases with combined back pain and depression as ‘not fit for work’, compared to 58% of cases assessed this way by GPs using the trial Med 3.
Fitness for work assessments and written advice.
GPs using the trial Med 3 form were less likely to advise patients to refrain from work, although a small proportion of cases were deemed ‘fit for work’. Taking into account the reduction in cases that were ‘fit for work’ and the decrease in cases that were ‘not fit for work’, a net increase of 15 to 44 percentage points remained across the health conditions considered ‘fit for (some) work’.
Comparing fitness for work advice
Cases with written advice in the comments section were more likely to have been assessed by GPs using the trial Med 3 form. This applied across all three health conditions: back pain (OR = 9.3; 95% CI = 6.3 to 13.6; P<0.001); depression (OR = 8.1; 95% CI = 4.9 to13.6; P<0.001); combined health condition (OR = 12.7; 95% CI = 7.9 to 20.5; P<0.001). When written advice was compared between health conditions (across both current and trial Med 3 forms) it was found that GPs were more likely to provide written fitness for work advice in the back pain case (41%), compared to the combined (27%) and depression cases (20%). This may be related to the larger number of back pain cases assessed as ‘fit for (some) work’.
Use of trial Med 3 work solutions
Altogether, 796 work solutions were suggested by GPs using the trial Med 3 (back pain n = 349; combined n = 281; and depression n = 166). In the back pain case, a work solution was suggested most frequently when GPs made a ‘fit for some work’ assessment (n = 289). Amended duties were the most commonly used option for the back pain case. Altered hours were suggested least often, regardless of assessment outcome (). The guidance advised that work solutions are used in ‘fit for some work’ assessments; however, GPs used them for the other assessments.
Use of trial Med 3 work solutions.
Graded return was the most frequently suggested work solution for the depression case and this was used mostly when cases were ‘not fit to work’. This is the only circumstance where a work solution was used more often when a case was considered ‘not fit for work’(n = 49). In the combined health condition case, work solutions were used most frequently when the case was assessed as ‘fit for some work’. Amended duties was the most frequently suggested work solution (n = 115) and altered hours the least (n = 41).
Use of trial Med 3 date sections
Completion of sections (iv) and (v) was mandatory. GPs completed both sections in 68% of cases.
Eighty-eight per cent (of trial Med 3 GPs) thought using the trial Med 3 rather than the current Med 3 would take longer in live consultations.
GP experiences of using the trial Med 3 form
GPs reported that the trial Med 3 is missing a clear time period for which the fitness for work assessment applies. GPs used sections (iv) and (v) inconsistently and ambiguously; some GPs thought it was irrelevant to ask when they would like to see the patient again. GPs expressed uncertainty about when and under what circumstances an employee was expected to return to work if assessed as ‘you may be fit for some work’, and how this relates to employers' willingness to follow the Med 3 advice. GPs thought the space for diagnoses was insufficient and wanted an ‘occupational health assessment’ box.