Fit notes



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


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 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 he or she is fully aware of what is being suggested.



In many cases, employers need expert advice to implement suggestions made by the GP, and union reps have a role in making sure that the employer seeks appropriate 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.
The Improving lives strategy document (see pages 193-194) reports that the government has conducted an internal review of the Fit Note and aims to reform the system over the next two to three years. It wants the Fit Note to “become an enabler for conversations about health and work, focussing on what people can do, not what they cannot do. It should facilitate returns to work and help people stay in work where appropriate, by providing information to the employer about what support might enable that to happen.”


While employers and GPs support the idea of helping people to return to work when they can, recently published Fit Note statistics show that only 6.6% of Fit Notes used the “may be fit for work” option. In response, the government is:


• starting development work to legislate for the extension of Fit Note certification powers to other healthcare professionals, along with the design and development of a set of competencies for those completing Fit Notes; 


• conducting a feasibility test to investigate whether, for the purposes of Statutory Sick Pay, employers could use the Advisory Fitness for Work report (which can be completed by some Allied Health Professionals) as an alternative to the Fit Note; 


• integrating Fit Note training into GP undergraduate and postgraduate education; 


• commissioning the feasibility of clinical guidelines for workplace adjustments for the top five clinical reasons people are off work sick or are on health-related benefits; and 


• exploring whether changes to the way GPs complete Fit Notes could support better return to work conversations.