“The sick note” – An exploratory study examining General Practitioner perspectives on sickness certification in the Republic of Ireland

Research output: Types of ThesisDoctoral Thesis


he increase in certified sickness absence recorded in most European countries during the last decade is of increasing concern to public health agencies (1, 2). While sickness absence can promote rest and recovery from illness, it may also have negative consequences, including increased risks of inactivity and isolation, poorer quality of life and increased uptake of health services (3-5). In the Republic of Ireland (ROI)sickness certification is part of General Practitioners’ (GPs’) contractual service to the Department of Social Protection (DSP). Sickness certificates are also issued to patients as evidence of illness for employment purposes. There is limited research exploring GPs certifying practices in the Republic of Ireland. The aim of the thesis was to explore perspectives on sickness certification in general practice in Ireland. The data collection consisted of three stages. Study 1 consisted of in depth individual interviews with 14 GPs across 11 primary care practices in Ireland. Study 2 was based on an on-line questionnaire survey using a number of vignettes with 62 GPs working in primary healthcare. Finally, study 3 consisted of a focus group conducted with eight GPs in a large urban practice in Ireland. Qualitative analysis was conducted in NVivo eight using content and simple thematic analysis techniques. Quantitative data was analysed by descriptive and inferential statistics using PASW version 18 statistical software. Combined results indicate that GPs can find their role as certifiers’ problematic and a source of conflict during the consultation process with patients. GPs concerns are with breaching patient confidentiality and in particular disclosing illness to employers. They reported feeling inadequate in dealing with some cases requesting sickness leave, including certification for adverse social circumstances and they felt a need for better communication between themselves, employers and relevant government departments. Willingness to issue a sickness cert may be influenced by the nature of the patient’s presenting problem. A psychological problem generated greater belief that patients were unfit for work, and GPs were more sympathetic and showed greater satisfaction with the decision they had made to certify these patient in comparison to patients with a physical problem. Average sickness certification periods were longer incases of psychological nature (1-2 weeks) in comparison to the physical complaint (4-7days). Overall GPs displayed a negative feeling towards prescribing sickness leave and there was a perception that sickness certificates were being used by employers as a management tool in controlling absenteeism. GPs also mentioned cultural factors in work place absenteeism and lack of rehabilitative pathway as impacting on sickness certification practices in Ireland. Issuing a sickness certificate appears influenced by medical and non-medical factors. Potential exists for improving the system, but requires significant engagement with other stakeholders such as employers and social benefit agencies. Focus should be placed on referral and rehabilitative pathways for patients to ensure appropriate certification and early return to work.
Original languageUndefined/Unknown
QualificationDoctor of Philosophy
Awarding Institution
  • University of Manchester
  • Esmail, Aneez, Supervisor, External person
  • Thorley, Kevan, Supervisor, External person
Award date16 Jun 2022
Publication statusPublished - 2015


  • sickness absence
  • sickness certification

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