In-house doctors can help reduce sickness absence

Direct links with GPs, whether on-site or offsite, can help employers cut sickness absence.


  • An in-house doctor service may reduce short-term sickness absence by offering staff earlier GP intervention.
  • An in-house doctor service is particularly useful for employees who have long commutes to work.
  • Good communication between employers and local doctors can positively impact sickness absence levels.

Job cuts and recruitment freezes are putting increasing pressure on employees to perform, so employers need to help them stay healthy. But despite their best efforts, sickness is inevitable, which is why an in-house general practitioner (GP) service could help.

The most visible way to provide support is through a regular on-site GP surgery. But this is only really an option for large employers with workers concentrated in one location.

Jenny Hawker, principal at Mercer, says on-site GPs are expensive and typically provided by City of London law firms and financial services companies with highly paid staff, many of whom travel long distances to work. “The cost benefits are really about the employees’ time away from work,” she says.

Peter Mace, assistant medical director at Bupa Health and Wellbeing, says: “Rather than having to take a half-day off work, an on-site GP visit takes only 20 to 30 minutes out of a busy day.”

Christine Yeomans, human resources manager at Farrer and Co, says this is one reason the law firm has offered a GP service for eight years. “It is an essential service to support the wellbeing of the firm, as well as the business benefits of less time away from the office to attend medical appointments,” she says.

Theoretical concerns about breaches of employee confidentiality where a GP is employer-funded are generally minimal. Consultant occupational health physician Yousef Habbab of AXA PPP Healthcare, points out that medical doctors, whether in-house or not, are obliged by the General Medical Council code of practice to protect patients’ confidentiality.

Confidential information

“This duty is also enshrined in data protection legislation and in civil law,” he says. “Confidential information may be disclosed to a patient’s employer only with the employee’s consent.”

There is no data to show how many organisations provide an on-site GP, as opposed to an occupational health specialist, which makes it impossible to quantify the cost benefits of having an on-site doctor. However, common sense dictates that short-term absences can be reduced if employees see a GP as soon as they feel unwell.

Bupa’s Mace says: “Commonly, employees will see on-site GPs about coughs and colds, abdominal pain, repeat requests for contraception, blood pressure and medication checks, and sore throats.”

According to the Chartered Institute of Personnel and Development/Simplyhealth’s Absence management survey, published in October 2012, colds, flu, upset stomachs, headaches and migraines are the main cause of short-term absences for non-manual workers, followed by stress and musculoskeletal injuries. So it makes sense to get such conditions treated early.

Paul Shires, Westfield Health’s executive director, says: “How and when patients access GP consultations has been a topic of debate recently, and as the NHS continues to review its services in a bid to save money, employers are concerned about employees’ ability to get GP appointments when they need to.”

How employers use on-site GPs varies widely. Farrar and Co offers a morning surgery once a fortnight, whereas Freshfields Bruckhaus Deringer runs two afternoon GP clinics and two afternoon prescribing nurse clinics each week. Mercer’s Hawker says the frequency of the service will clearly impact its effectiveness.

Mace says Bupa’s on-site GP and nurse service, available on a full-time or periodic basis, is tailored to the needs of individual employers. “Typically, a Bupa GP will work on a sessional basis, doing multiples of four-hour (half-day) surgeries, during which up to 14 patients may be seen,” he says.

Average cost of a GP

Because services vary widely, it is impossible to give an average cost of an on-site GP, but the daily cost of a doctor might range from £200 for a local GP to £900 for a specialist occupational health practitioner, says Sayeed Khan, chief medical adviser at EEF.

An option for smaller employers and those with a dispersed workforce is to use a remote GP service, such as Westfield Health’s 24-hour GP phone line, DoctorLine. This has been upgraded to include a webcam consultation facility, allowing employees to speak with a qualified, practising NHS doctor between 8.30am and 6.30pm, Monday to Friday.

Shires says: “This facility is an ideal way for employers to ensure staff can access GP appointments when they need to, so health problems are picked up and treated at an early stage, minimising sickness absence.”

But Mercer’s Hawker says GP phone lines and online services are relatively new and not widely used, although he suggests they might be particularly useful for employers with a large number of business travellers who find it difficult to access their family GP.

Employers that do not provide any kind of GP access could take a proactive approach by liaising with local GPs as part of their absence management strategy. Mercer’s Hawker says many employers are active in this way, but adds: “I don’t think it’s always managed effectively, mainly because GPs are concerned about revealing confidential information.”

EEF’s Khan agrees that employers’ interaction with GPs is not great, but he says sickness absence management is not generally prominent on GPs’ radar, so it is down to employers to take the initiative. He says employers should be writing to local GPs, not on an individual employee basis, but along the lines of “we at Browns Ltd are committed to helping our employees get back to work quicker and we can provide part-time work or modify their work and, where necessary, provide for private treatment”.

The EEF’s Sickness absence and rehabilitation survey 2012, published in May 2012, shows such intervention increases the chances of getting a fit note with ‘may be fi t to work’ from a GP (see chart below), which is probably worth noting.



Swift GP access reduces time off

Freshfields Bruckhaus Deringer has offered an on-site GP service for more than 15 years, hence its longstanding relationship with Finsbury Medical Centre, part of the General Medical Clinics group.

The service, which offers two afternoon doctor clinics and two afternoon prescribing nurse clinics each week, was introduced to meet employees’ emergency/acute needs, which were not being met by their own doctors, often because of delays in getting an appointment.

The law firm has seen an increasing number of international employees using the service, in line with the growth in its international secondment activity.

Jackie Palmer senior manager, compensation and benefits at Freshfields, says: “It would be quite difficult measuring the absolute correlation between offering this service and reductions in sickness absence because we have offered a service for many years.

“The service certainly contributes significantly to employees being able to swiftly access treatment and I am sure that this does have a direct impact on the amount of time taken off for sickness.”

Source: EEF’s Sickness absence survey 2012