Getting a sick note isn’t as easy as it used to be

What happens when you are too sick to make it into work? As we all fall ill from time to time, it seems like it should be straightforward enough. Different companies, however, can have very different sick-leave entitlements.

Into the mix is a new problem. The majority of absences from work are for colds and flus, where it’s best to stay in bed and get better rather than spread it around the office. But while employers may still ask for a doctor’s certificate to cover an absence, the ongoing shortage of GPs means workers can struggle to get an appointment.

An employee at a public-sector body says a sick note is required when an employee is absent on a Friday or Monday. But this staff member says getting a GP appointment for a simple cold is a massive headache, with many GP surgeries declining new patients and waiting lists of over a week for a routine doctor’s visit in some parts of the country.

So, just what rights do employees have, and can a generous employer find that staff take advantage?

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Regan O’Driscoll is a partner at CC Solicitors and one of the country’s leading employment law experts. The firm’s clients include both employers and employees. “Any sickness absence policy that I draft – and most I’ve seen – will say you need a sick cert from the third day of illness,” she says. “This used to tie in nicely with illness benefit, which kicked in after three days. That changed in 2014, so now it only kicks in after six days. Some employers will pay nothing, some up to 10 days a year, some will offer three months on full-pay and three on half-pay before the employee can go on disability insurance at six months. It varies enormously.”

There is no legal obligation on any employer to provide for sick pay, but, with employers increasingly battling to recruit and retain the best staff, the best companies to work for will make at least some provision.

Generous sick pay policies can occasionally be subject to abuse, says O’Driscoll. But sick leave, pay and entitlements can fairly often become a flash point. “A sloppily drafted contract can lead to disputes concerning the nature and limitations of the entitlement. From an employer’s perspective, an inability to vary the policy at their discretion can be issue. Excessive absenteeism can arise. Employees can and do get into trouble for not notifying their employer in accordance with the specific policy, and/or not remaining in contact as required.”

‘A vicious circle’

Margaret Furlong says she waited more than three weeks for a doctor's appointment in New Ross. "You can't even get an emergency appointment without booking before 9am. They tell you to wait until after 6pm and go to Caredoc, who are usually extremely busy and can't see you, so they tell you to go to A&E where you get an earful for wasting their time on something your GP could easily have handled. It's a vicious circle."

Similar difficulties have been reported throughout the country.

"Outside Dublin, 70 per cent of GPs are not taking on new or additional public or private patients," says GP Dr Maitiú Ó Tuathail. "They are at capacity in towns around Ireland, including Naas, Navan, Dungarvan and Ashbourne. The problem is getting worse and will get worse – in the next five years, we expect 700 GPs to retire. Ireland trains around 190 GPs a year, but around 40-50 per cent are emigrating."

Ó Tuathail says the crisis began in 2011, when cuts under the financial emergency measures in the public interest (Fempi) legislation saw a severe cut in income for GPs who struggled with the costs of running a business. "The recent Government agreement with the Irish Medical Organisation to invest €210 million in general practice and reverse some of these cuts will resuscitate general practice. It won't, however, significantly ease the recruitment and retention crisis, particularly because GPs will be managing chronic illness like COPD and diabetes, and seeing more children as free care is rolled out.

“There will still only be a few spare slots for urgent appointments and it could be nigh on impossible for people to get a sick cert. A lot of people are getting retrospective sick notes, where the doctor can only really say, ‘this patient advises me that they were unwell’.”

O’Driscoll says sick leave entitlements require a fine balance. “People can be very close to the edge with bills, and unpaid sick leave might be the final straw. I have also had employer clients who are similarly close to the edge in terms of keeping everything going, and they say that they simply cannot afford generous sick pay entitlements. I can see both sides.”

Online doctors to the rescue

With GP appointments becoming as rare as hen’s teeth, employees are turning to online doctors, which are cheaper and more accessible. There are concerns, though, that telemedicine doctors may not know the patient and their past medical history, and that they cannot provide a physical examination to check on vitals such as blood pressure and temperature.

Services including VideoDoc and Laya Healthcare’s GP Live are among those that will offer sick certs, although not all online GPs will provide the note. “Our services are getting busier,” says Dr Brian McManus, medical director of VideoDoc. “Some patients have reported to us that they can’t register with a GP. Others are not able to get an appointment with their GP that day. Patients don’t need to take a half-day off work and our average waiting time is 15 minutes.”

VideoDoc can see patients for a range of illnesses including colds and flus, skin conditions, mental-health problems and requests for contraceptive pills. If patients present with chest or abdominal pain, breathlessness or symptoms suggesting a stroke, they refer appropriately. A detailed history and observations from the screen are usually sufficient, says McManus.

“We can provide sick notes for a maximum of seven days. If a sick note for longer than this is required, a face-to-face appointment with a patient’s regular GP is more appropriate. We have a limit of three sick certs in a 12-month period, but most are for two-three days. Respiratory tract infections and gastroenteritis are the most common reasons for sick certs.”