Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Primary Care
Published in: BMC Primary Care 1/2014

Open Access 01-12-2014 | Research article

Extending the authority for sickness certification beyond the medical profession: the importance of ‘boundary work’

Authors: Victoria K Welsh, Tom Sanders, Jane C Richardson, Gwenllian Wynne-Jones, Clare Jinks, Christian D Mallen

Published in: BMC Primary Care | Issue 1/2014

Login to get access

Abstract

Background

The study aimed to explore the views of general practitioners (GPs), nurses and physiotherapists towards extending the role of sickness certification beyond the medical profession in primary care.

Methods

Fifteen GPs, seven nurses and six physiotherapists were selected to achieve varied respondent characteristics including sex, geographical location, service duration and post-graduate specialist training. Constant-comparative qualitative analysis of data from 28 semi-structured telephone interviews was undertaken.

Results

The majority of respondents supported the extended role concept; however members of each professional group also rejected the notion. Respondents employed four different legitimacy claims to justify their views and define their occupational boundaries in relation to sickness certification practice. Condition-specific legitimacy, the ability to adopt a holistic approach to sickness certification, system efficiency and control-related arguments were used to different degrees by each occupation. Practical suggestions for the extension of the sickness certification role beyond the medical profession are underpinned by the sociological theory of professional identity.

Conclusions

Extending the authority to certify sickness absence beyond the medical profession is not simply a matter of addressing practical and organisational obstacles. There is also a need to consider the impact on, and preferences of, the specific occupations and their respective boundary claims. This paper explores the implications of extending the sick certification role beyond general practice. We conclude that the main policy challenge of such a move is to a) persuade GPs to relinquish this role (or to share it with other professions), and b) to understand the ‘boundary work’ involved.
Appendix
Available only for authorised users
Literature
1.
Roland M: Linking physician pay to quality of care: a major experiment in the UK. N Engl J Med. 2004, 351: 1448-1454. 10.1056/NEJMhpr041294.CrossRefPubMed
2.
Department of Health, NHS Service Delivery and Organisation R&D Programme: Evaluating models of service delivery. Briefing paper: Extending the practice of allied health professionals in the NHS. 2006, London: National Coordinating Centre for the Service Delivery and Organisation
3.
Royal College of General Practitioners: Primary care practice and its team: RCGP information sheet. 2007, London: Royal College of General Practitioners
4.
Holdsworth LK, Webster VS, McFadyen AK: Physiotherapists’ and general practitioners’ views of self-referral and physiotherapy scope of practice: results from a national trial. Physiotherapy. 2008, 94 (3): 236-244. 10.1016/j.physio.2008.01.006.CrossRef
5.
Kelly A, Neale J, Rollings R: Barriers to extended nurse prescribing among practice nurses. Community Pract. 2010, 83 (1): 21-24.PubMed
6.
Laurant M, Reeves D, Hermens R, Braspenning J, Grol R, Sibbald B: Substitution of doctors by nurses in primary care. Cochrane Database Syst Rev. 2004, 4: CD001271-doi:10.1002/ 14651858.CD001271
7.
Allen D: The nursing-medical boundary: a negotiated order?. Sociol Health Illn. 1997, 19: 498-520. 10.1111/1467-9566.00065.CrossRef
8.
Svensson R: The interplay between doctors and nurses: a negotiated order perspective. Sociol Health Illn. 1996, 18: 379-398. 10.1111/1467-9566.ep10934735.CrossRef
9.
Gieryn TF: Boundary work and the demarcation of science from non-science: strains and interests in professional ideologies of scientists. Am Sociol Rev. 1983, 48: 781-795. 10.2307/2095325.CrossRef
10.
Abbott A: The System of Professions: An Essay on the Division of Expert Labour. 1988, Chicago. Chicago: University of Chicago Press
11.
Mizrachi N, Shuval JT, Gross S: Boundary at work: alternative medicine in biomedical settings. Sociol Health Illn. 2005, 27: 20-43. 10.1111/j.1467-9566.2005.00430.x.CrossRefPubMed
12.
Charles-Jones H, Latimer J, May C: Transforming general practice: the redistribution of medical work in primary care. Sociol Health Illn. 2003, 25: 71-92. 10.1111/1467-9566.t01-1-00325.CrossRefPubMed
13.
Tolliday H: Clinical autonomy. Health Services: Their nature and organization and the role of patients, doctors, nurses and the complementary professions. Edited by: Jacques E. 1978, London: Heinemann
14.
Timmons S, Tannner J: A disputed occupational boundary: operating theatre nurses and operating department practitioners. Sociol Health Illn. 2004, 26: 645-666. 10.1111/j.0141-9889.2004.00409.x.CrossRefPubMed
15.
Welsh S, Kelner M, Wellman B, Boon H: Moving forward? Complementary and alternative practitioners seeking self-regulation. Sociol Health Illn. 2004, 26: 216-241. 10.1111/j.1467-9566.2004.00387.x.CrossRefPubMed
16.
Fryer GE: The United States medical profession: an abnormal form of the division of labour. Sociol Health Illn. 1991, 13: 213-230. 10.1111/1467-9566.ep11340810.CrossRef
17.
Jeffery R: Normal rubbish: deviant patients in casualty departments. Sociol Health Illn. 1979, 1 (1): 91-98.CrossRef
18.
Dingwall R: The Social Organisation of Health Visitor Training. 1977, London: Croom Helm
19.
Scott WR: Organisations: Rational, Natural and Open Systems. 1992, New Jersey: Prentice Hall, 3
20.
Harrison S, Dowswell G, Wright J: Practice nurses and clinical guidelines in a changing primary care context: an empirical study. J Adv Nurs. 2002, 39 (3): 1-10.CrossRef
21.
Foley L, Faircloth CA: Medicine as discursive resource: legitimation in the work narratives of midwives. Sociol Health Illn. 2003, 25: 165-184. 10.1111/1467-9566.00330.CrossRefPubMed
22.
23.
24.
25.
26.
Department of Health: General Medical Services: standard contract, 2009. 2009, London: GMC
27.
Wynne-Jones G, Mallen CD, Main CJ, Dunn KM: Sickness certification and the general practitioner: what really happens in practice?. Fam Pract. 2010, 27 (3): 344-350. 10.1093/fampra/cmp096.CrossRefPubMed
28.
Hiscock J, Ritchie J: The role of GPs in sickness certification. (Research report No 148). 2001, London: Department of Work and Pensions
29.
Health, Work and Well-Being Directorate: Reforming the Medical Statement: Government response to the consultation on draft regulations: The Social Security (Medical Evidence) and the Statutory Sick Pay (Medical Evidence) (Amendment) Regulations, 2010. 2010, London: Department of Work and Pensions
30.
Black C: Review of the health of Britain's working age population: Working for a healthier tomorrow. 2008, London: The Stationary Office
31.
Department for Work and Pensions: Fitness for work: the Government response to ‘Health at work – an independent review of sickness absence’. 2013
32.
Aronsson G, Gustafsson K: Sickness presenteeism: prevalence, attendance-pressure factors, and an outline of a model for research. J Occup Env Med. 2005, 47 (9): 958-966. 10.1097/01.jom.0000177219.75677.17.CrossRef
33.
Barnes MC, Buck R, Williams G, Webb K, Aylward M: Beliefs about common health problems and work: a qualitative study. Soc Sci Med. 2008, 67 (4): 657-665. 10.1016/j.socscimed.2008.05.008.CrossRefPubMed
34.
Blaxter M: Health. 2004, California: Cambridge: Policy Press
35.
Johansson G, Lundberg I: Adjustment latitude and attendance requirements as determinants of sickness absence or attendance. Empirical tests of the illness flexibility model. Soc Sci Med. 2004, 58 (10): 1857-1868. 10.1016/S0277-9536(03)00407-6.CrossRefPubMed
36.
Nettleton S: ‘I just want permission to be ill’: towards a sociology of medically unexplained symptoms. Soc Sci Med. 2006, 62 (5): 1167-1178. 10.1016/j.socscimed.2005.07.030.CrossRefPubMed
37.
Pinder R: Bringing back the body without the blame? The experience of ill and disabled people at work. Sociol Health Illn. 1995, 17 (5): 605-631. 10.1111/1467-9566.ep10932129.CrossRef
38.
Williams GH: Chronic illness and the pursuits of virtue in everyday life. Worlds of Illness: Biographical and Cultural Perspectives of Health and Disease. Edited by: Radley A. 1993, London: Routledge
39.
Norrmén G, Svärdsudd K, Andersson DKG: How primary health care physicians make sick listing decisions: The impact of medical factors and functioning. BMC Fam Pract. 2008, 9: 3-10.1186/1471-2296-9-3.CrossRefPubMedPubMedCentral
40.
Krohne K, Brage S: How GPs in Norway conceptualise functional ability: a focus group study. Br J Gen Pract. 2008, 58 (557): 850-855. 10.3399/bjgp08X376131.CrossRefPubMedPubMedCentral
41.
Hussey S, Hoddinott P, Wilson P, Dowell J, Barbour R: Sickness certification system in the United Kingdom: qualitative study of views of general practitioners in Scotland. Br Med J. 2004, 328: 88-10.1136/bmj.37949.656389.EE. 10 JanuaryCrossRef
42.
Von Knorring M, Sundberg L, Lofgren A, Alexanderson K: Problems in sickness certification of patients: a qualitative study on views of 26 physicians in Sweden. Scan J Prim Health. 2008, 26: 22-28. 10.1080/02813430701747695.CrossRef
43.
Cohen D, Marfell N, Webb K, Robling M, Mansel A: Managing long-term worklessness in primary care: a focus group study. Occup Med. 2010, 60: 121-126. 10.1093/occmed/kqp169.CrossRef
44.
45.
Gulbrandsen P, Hofoss D, Nylenna M, Saltyte-Benth J, Aasland OG: General practitioners’ relationship to sickness certification. Scand J Prim Health. 2007, 25 (1): 20-26. 10.1080/02813430600879680.CrossRef
46.
Harvey S, Henderson M, Lelliott P, Hotopf M: Mental health and employment: much work still to be done. Br J Psychiat. 2009, 194: 201-203. 10.1192/bjp.bp.108.055111.CrossRef
47.
Vaez M, Rylander G, Nygren A, Asberg M, Alexanderson K: Sickness absence and disability pension in a cohort of employees initially on long term sick leave due to psychiatric disorders in Sweden. Soc Psych Psych Epid. 2007, 42: 381-388. 10.1007/s00127-007-0189-9.CrossRef
48.
Stansfield S, Feeney A, Head J, Canner R, North F, Marmot M: Sickness absence for psychiatric illness: the Whitehall II study. Soc Sci Med. 1995, 40 (2): 189-197. 10.1016/0277-9536(94)E0064-Y.CrossRef
49.
Munir F, Leka S, Griffiths A: Dealing with self management of chronic illness at work: predictors for self disclosure. Psychol Health. 2005, 13 (4): 717-733.
50.
Munir F, Yarker J, Haslam C, Long H, Leka S, Griffiths A, Cox S: Work factors related to psychological and health-related distress among employees with chronic illnesses. J Occup Rehabil. 2007, 17 (2): 259-277. 10.1007/s10926-007-9074-3.CrossRefPubMed
51.
Munir F, Yarket J, Haslam C: Sickness absence management: encouraging attendance or ‘risk-taking’ presenteeism in employees with chronic illness?. Disabil Rehabil. 2008, 30 (19): 1461-1472. 10.1080/09638280701637380.CrossRefPubMed
52.
Sanders T, Ong BN, Sowden G, Foster N: Implementing change in physiotherapy: professions, contexts and interventions. J Health Organisat Manag. 2014, 28 (1): 96-114. 10.1108/JHOM-10-2011-0102.CrossRef
53.
Sanders T, Harrison S: Professional legitimacy claims in the multidisciplinary workplace: the case of heart failure care. Sociol Health Illn. 2008, 30 (2): 289-308. 10.1111/j.1467-9566.2007.01052.x.CrossRefPubMed
54.
Hughes EC EC: Men and their Work. Toronto: Free Press of Glencoe, 1958. Quoted by Nancarrow SA, Borthwich AM. Dynamic professional boundaries in the healthcare workforce. Sociol Health Illn. 2005, 27 (7): 897-919. 10.1111/j.1467-9566.2005.00463.x.CrossRef
55.
Wynne-Jones G, Mallen CD, Mottram S, Main CJ, Dunn KM: The identification of UK sickness certification rates, standardised for age and sex. Br J Gen Pract. 2009, 59 (564): 510-515. 10.3399/bjgp09X453431.CrossRefPubMedPubMedCentral
56.
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 (598): e363-e370. 10.3399/bjgp12X641483.CrossRefPubMedPubMedCentral
Metadata
Title
Extending the authority for sickness certification beyond the medical profession: the importance of ‘boundary work’
Authors
Victoria K Welsh
Tom Sanders
Jane C Richardson
Gwenllian Wynne-Jones
Clare Jinks
Christian D Mallen
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2014
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-15-100

Other articles of this Issue 1/2014

BMC Primary Care 1/2014 Go to the issue

Research article

Chest pain out-of-hours – an interview study of primary care physicians’ diagnostic approach, tolerance of risk and attitudes to hospital admission

Research article

A practice-based analysis of combinations of diseases in patients aged 65 or older in primary care

Research article

Interventions aimed at increasing the level of physical activity by including organised follow-up: a systematic review of effect

Research article

A qualitative study on clinicians’ perceptions about the implementation of a population risk stratification tool in primary care practice of the Basque Health Service

Research article

Awareness, agreement, adoption and adherence to type 2 diabetes mellitus guidelines: a survey of Indonesian primary care physicians

Research article

Health coaching in primary care: a feasibility model for diabetes care