Fit notes

The “Statement of Fitness for Work” or “Fit Note” was introduced in April 2010. The Fit Note is stored electronically by the GP, but as with the old certification system, a hard copy is handed to the employer by the worker and is used to prove entitlement to sick pay. 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; and

• workplace adaptations.

There is no “Fit for Work” option. 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 s/he is fully aware of what is being suggested.

In many cases, employers need expert advice in order to implement suggestions made by the GP, and union reps have a role in making sure that the employer always seeks professional support before introducing any adaptations. An employer is not obliged to accept the advice on a Fit Note, but if the employer decides not to follow the advice, the Fit Note must be treated as if the GP has advised that the employee is “not fit for work”. Government advice states clearly that “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 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 his or her union rep, and would normally use the 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, regardless of what the GP recommends.

In March 2013, the Department for Work and Pensions (DWP) issued new advice on GP fit notes. This advises doctors on how they can give the most useful advice about what patients can do at work and how they can return to the workplace as soon as possible. This could include exploring a period of home working or different ways of working. The guidance clarifies that 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 someone do some work. It also includes:

• improved question and answer sections based on common queries;

• explanation about how a fit note indicates whether a patient is expected to be fit for work when it expires;

• ideas for patients and employers about possible changes to accommodate the advice in the fit note;

• clarification about the legal status of the fit note in relation to sick pay, situations where an employer cannot make any changes, and non-medical problems at work;

• details about the computer-generated fit note; and

• more information on further resources, with links to DWP programmes as well as charity and occupational health support.