The Code HR team recognise that being appropriately staffed is key to be able to deliver the best possible service to patients. When a team member doesn’t attend work and does not contact you to notify their absence this can be very disruptive. Not only may it be costly to source cover, either through overtime or agency staff, it can also be time consuming for the management team to establish the team members’ welfare and intentions moving forward.
- Sickness can affect anyone, but difficulties arise when a team member takes repeated or extended periods of leave
- It is important to have a sickness management system in place that enables you to record and monitor employee sickness and take appropriate actions before the situation gets out of control. Take care not to discriminate against people with disabilities or pregnant staff members
- A sickness management system can be based on the sickness and absence policy (M 233-SAA) that explains how sickness is handled, who it is reported to, how it is monitored and what actions can be taken if it is abused
- The policy must be clearly explained to all employees and applied consistently throughout their employment
- All cases of absence should be clearly recorded, monitored and investigated to help you identify any factors contributing to levels of absence. Employees must be informed about any targets for sickness absence levels
- You may want to introduce an online application to help monitor sickness and absence
- Return to work interviews (M 232B) should be held after every period of absence
- All sickness records and supporting monitoring documents should be kept confidential
- If you identify a pattern of absences e.g. Monday mornings, meet with the employee to discuss the reasons for absences and agree targets for improvements. Recurrent sickness may be due to problems at home or associated with their work or working environment
- If you suspect that there is an underlying medical condition for the absences:
- Ask for the employee’s permission to contact their GP for a medical report using form (M 232C), in certain cases it might be prudent to ask them to see an occupational health specialist regarding their health status (provided you are prepared to cover the costs)
- Provide additional support if necessary
- Consider adjustments to their responsibilities or
- Initiate the disciplinary procedure if necessary (if you suspect absences are not genuine)
- Take care not to give the impression that staff members are not allowed to be ill or that they must attend work even if unfit to do so, and provide support with smoking, alcohol or stress-related problems
- Sickness absence is generally low in a pleasant working environment under good team management
- If you are planning to dismiss due to sickness, first take legal advice from your Employers’ Liability Insurance
Tips to manage sickness and absence
Check attendance records when an offer of employment is made
Ask your new employees to complete the Confidential Medical Questionnaire (M 222A-MQA), which includes questions about sickness absence and basic medical history. You may request information about sickness and absence when obtaining references, however, the previous employer may not be willing to provide this information, nor are they obliged to do so. It is important to consider absences may be related to a medical condition and therefore you must be careful not to discriminate on that basis.
Implement a clear policy
- How to report absence and who to
- How sickness is monitored and what records are kept (i.e. on an online application)
- Sick pay
- Keeping in contact whilst off work
- Unauthorised sick leave (if it is not reported by the staff member)
- Targets for absence levels and what will happen if they are reached e.g. a sickness record investigation
Allocate absence handling to the practice manager and provide training
The practice manager is the best person to deal with sickness and absence provided they have received appropriate training. They should know how to ask searching questions when a team member reports sickness, how to keep in contact during sickness leave and how to maintain and monitor sickness records. In cases of long-term sick leave the practice manager will need to plan staff cover and when the staff member returns to work they may need to make some adjustments to the person’s responsibilities or work place.
Pay sick leave
Some practices do not offer any enhanced sick pay other than SSP (Statutory Sick Pay). Others offer contractual sick pay, which is included in the staff member’s terms and conditions of employment. Many employers reserve discretion as to whether or not to pay full contractual pay during sick leave.
Sick pay legal requirements
You must provide SSP to all employees whose average weekly earnings are at or above lower earnings limit before tax and NIC. The first three days of absence are considered “waiting days” and SSP is paid from the fourth day of sickness absence. The rate is reviewed annually in April. For the current rate refer to gov.uk.
- You must send an employee on sick leave form SSP1 within 7 days of them going off sick if they do not qualify for SSP or on or before the beginning of the 23rd week if it is expected to end before their sickness does. For more information refer to Statutory Sick Pay: employer guide
- If an employee returns from sick leave of 4 days (or more) and is then off sick again within an eight week period, then SSP is applied from the first day of the latest absence; i.e. there is no period of waiting because the absences are linked. Should the employee return after two days sick leave but there is a further absence period within 8 weeks, the first two days of the first sickness count towards the second period’s waiting days; SSP is therefore payable from the second day of absence on the second period of sickness
- An employee’s maximum entitlement to SSP is 28 weeks per year. If the period of their sickness continues after that, they may be entitled to claim employment support allowance. Employers are required to advise a member of staff approaching the end of their entitlement sending them SSP1, which will enable them to claim Incapacity Benefit or Employment and Support Allowance
- Employees with at least one month’s continuous employment, who are suspended from work on medical grounds are entitled to remuneration for up to a maximum of 26 weeks
- As an employer you are liable for payment of SSP subject to PAYE, NI and any other usual deductions, you can’t reclaim it
There is no longer a regulatory requirement to keep SSP records for 3 years, however, HMRC suggest a list of voluntary SSP records that might be helpful in case of an employee dispute about SSP payments or their withholding. In Northern Ireland you may be required to produce records to show that SSP has been paid to your employees. You can use SSP2 form for record keeping purpose in the whole of UK.
Provide holiday leave accrued during sick leave
Statutory holiday entitlement is accrued while the employee is off sick. Any statutory entitlement that has not been used because of illness can be carried over into the next leave year. If an employee is ill just before or during their holiday they can take it as a sick leave instead.
As an employer you can’t force an employee to take annual leave when they are eligible. However, an employee can ask to take their paid holiday if they are off sick and do not qualify for sick pay.
Ask for self-certification or doctor’s note
If the staff member is absent for less than 7 days they can self certify using either (iComply members) Self-certification form (M 232A) or complete an HMRC employee’s statement of sickness form SC2 online. In cases of absence over 7 days the form must be accompanied by a doctor’s fit note. You can take a copy of the fit note and the employee should keep the original. The fit note may say that the employee is either not fit for work or may be fit for work. In case of the latter, you should discuss any changes that might help the employee return to work (e.g. different hours or tasks). If the parties have not reached the agreement on these changes, the employee must be treated as not fit for work.
Note that you must make reasonable adjustments under the disability provisions of the Equality Act 2010 in Great Britain and the Disability Discrimination Act 1995 in Northern Ireland see (M 285) and (M 285-NI in Northern Ireland).
The employee signs a declaration on the self-certificate, which can render them liable to disciplinary action including dismissal, where information is deliberately falsified.
Conduct back to work interview
Use form (M 232B) for back to work interviews. This helps to uncover any underlying causes for absence and what can be done to prevent them. These interviews also reinforce to the employee that their absence is monitored carefully.
Ask for employee’s permission to contact their GP
If an employee is absent for more than 1 month or 20 working days you can make a request to contact their GP for a medical report using form (M 232C). Make it clear to the employee that medical evidence will help you to determine your duty of care, i.e. if you need to make any reasonable adjustments if there is disability or create a plan of gradual return back to work.
If the employee refuses permission to contact a doctor, and the levels of absence are unacceptable, disciplinary action may be appropriate. You should take legal advice in this situation before instigating disciplinary procedures. Note that people with a specific condition, such as epilepsy may have a protected characteristic under the 2010 Equality Act.
Contact the GP
Use the Letter to GP Regarding an Employee’s Sickness (M 232D) to contact the employee’s GP. List the employee’s responsibilities and ask for the doctor’s comments on what effect the illness will have on the employee’s ability to cope with the job. Include a copy of the employee’s job description and permission (M 232C). It is important to include as much information as possible to enable the GP to assess and comment on the suitability of the job and suggest any reasonable adjustments.
In case of complex health problems, consider asking the employee to attend an independent medical examination, (i.e. Occupational health) provided you are prepared to cover the cost.
Take appropriate actions
When dealing with short-term sickness, use collected information to identify trends, e.g. if a member of staff takes excessive time off because they are overburdened with responsibilities or if they have problems working with a particular colleague because they feel harassed or bullied. Take appropriate actions to resolve the issues.
Having obtained medical advice for long-term sickness cases consider suggested actions that can include: phasing their return (which may be a requirement of the GP for that employee to return to work), changing hours of work, re-allocating some of their work temporarily, modifying targets. You may need to make adjustments, including the provision of special equipment. If adjustments are not sufficient offer alternative work if it is available.
If an employee is addicted to drugs or alcohol, this is considered a serious illness and handled as such. However, if the addicted staff member refuses to accept that they have a problem or seek help, it may become an issue of unacceptable conduct, in which case a disciplinary procedure may be appropriate.
Where alcohol/drug use is a purely conduct issue and it leads to regular absences/lateness, you should consider invoking a disciplinary procedure.
If your staff experience stress, anxiety, depression or other mental health conditions, refer to a guide to supporting staff with a mental condition from mindfulemployer.net.
If an employee is frequently absent or late due to unexplained or unconvincing reasons, follow the disciplinary procedure based on (M 227B). In most cases, apart from gross misconduct, employees should be given an opportunity to improve. Verbal (NI) and written warnings are sufficient in most cases but if the situation does not improve dismissal may be considered. Dismissal is a last resort after a fair disciplinary procedure has been followed.
Manage absence fairly and consistently
Make prompt contact with employees if they do not turn up for work and avoid making assumptions of their situation. Require employees to keep in contact with the practice whilst on sick leave and inform them to advise the practice of any changes to their expected return date. Avoid putting pressure on the employee to return e.g. by saying that their colleagues are having to work harder. Consider that recovery times for the same condition can vary for different people and warmly welcome employees back after their absence.
Give your employees an opportunity to discuss concerns of their health or any other issues that affect their performance, in private.
As always, iComply users will be able to utilise our Staff Terms and Conditions of Employment (M 245A) and Sickness Absence Policy (M 233-SAA).
Our Code Total HR members will receive additional support with bespoke communication to employees.
You can read the ACAS guide on managing staff absence here.
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