The Fit Note

Health professionals have always been a “gateway” to sick pay and benefits.But since late 2010 that has been standardised with the introduction of the Fit Note. The Fit Note allows the GP, in collaboration with the patient, to suggest a return to work based on one of four possible options:

• a phased return to work;

• altered hours;

• amended duties; or

• workplace adaptations.

There is no “fit for work” option on a Fit Note. This is because, as was previously the case, where a worker is fully fit for work, the GP will simply not issue a new certificate. A GP should only recommend a return to work for a person who is not fully recovered after discussing it with the patient and making sure they are fully aware of what is being suggested. But it is the “default position” that if the GP assesses that the patient’s fitness for work is not impaired by their health condition, then they are fit for work and do not need a Fit Note.

A fifth (22%) of manufacturing employers say Fit Notes have resulted in earlier returns to work (EEF, Sickness Absence Survey 2015) but two-fifths (43%) disagree, and they are ambivalent about whether it has led to an improvement in the advice given by GPs.

An employer is not obliged to accept the advice on a Fit Note (they may in fact need expert advice to do so). But the government says: “Unless the employer implements the advice on the medical certificate, the worker is not fit to return and should continue to be paid his or her sick pay entitlement.”

In practice, problems are likely to arise if the employer either fails to take the steps promised, or fails to carry them through adequately. An employee in this position should seek help from their union rep, and would normally use a grievance procedure.

The employer should carry out a revised risk assessment of any changes or adaptations needed to implement the recommendations on the Fit Note to avoid introducing new risks. The Fit Note procedure does not change the employer’s overriding statutory duty to make reasonable adjustments for a disabled employee (see page 29) regardless of what the GP recommends.

Revised guidance issued in March 2013 emphasised that GPs should look at what a person can do, rather than what they cannot, and options for a return to work could include exploring a period of homeworking or different ways of working. The Fit Note is about someone’s general fitness for work and is not tied to their most recent job, allowing flexibility to discuss what changes could help them do some work.

www.gov.uk/government/organisations/department-for-work-pensions/series/fit-note