Family doctors feel disillusioned with the sickness certification system and many would like to see their "gatekeeper" role removed, according to new research.

This study will be available on bmj.com on Monday 22 December 2003.

Researchers conducted 11 focus groups with 67 GPs in Scotland to explore how they operate the sickness certification system, their views on the system, and suggestions for change.

A self-certification scheme exists under which any employee can sign his or her own sickness certificate for up to seven consecutive days. After that period they can visit their doctor for a signed sickness certificate.

GPs believed that the system failed to address complex, chronic, or doubtful cases. They described various ways of operating the system, but in practice, most operated a "sick certificate on demand" system.

Almost all GPs felt that they were endangering the doctor-patient relationship when challenging or confronting patients about sickness absence. One said: "How can we act as policeman, friend, social worker and all the rest of it? We can't."

There was some misuse of the system by general practitioners for reasons such as patient confidentiality, stress, demands on time, and disillusionment with the system. Many experienced contradictory demands from other stakeholders and often felt caught between their advocate role as a doctor and their role as a judge.

Suggestions for change included a self assessment system akin to current taxation self assessment, other healthcare workers providing sick certificates to patients, the streamlining of forms, better occupational health and rehabilitation, sick line clinics, and copying other countries' systems.

These findings have several implications for policymakers planning both future research and strategies, say the authors. If the gatekeeper system is continued, problems must be resolved. For example, pressurising of the gatekeeper by other agencies, and the ability of the consumer to "shop around," weakening the gatekeeper role.

Click here to view the full paper:http://press.psprings.co.uk/bmj/december/sickcert.pdf