The purpose of the Fit Note 



The Fit Note allows the GP, following discussions with the patient, to suggest a return to work based on one of four possible options:


• a phased return;



• altered hours;



• amended duties; and



• workplace adaptations. 



There is space on the Fit Note for the GP to provide more information on the condition and its effect on the member’s work. There is no “Fit for Work” option on the Fit Note. This is because once a worker is fully fit for work, the GP will simply not issue a new certificate. 



Sometimes, an employee’s GP agrees that they are fit to return but the employer insists on extra medical checks. The employee should be paid their normal wages while these extra checks are being carried out, unless a clear written term in the employment contract allows the employer to pay something less than normal wages. This is because there is an implied term in every employment contract that an employee who is ready, willing and able to work must be paid their normal wages (Beveridge v KLM UK [2000] IRLR 765). Withholding wages without a clear written term would be an unlawful deduction of wages (see Chapter 4), and a fundamental breach of the employment contract (see Chapter 3).



The guidance lists examples of possible changes to discuss with the employee. The employer is not obliged to accept the advice on a Fit Note, but if an employer decides not to follow GP advice or follows it inadequately, the Fit Note should be treated as if the GP has advised that the employee is not fit for work. The DWP guidance is clear: “if you can’t agree to any changes, you should treat the Fit Note as if it says that your employee is not fit for work”. 



The employer should carry out a revised health and safety risk assessment of any changes or adaptations needed to implement the recommendations on the Fit Note, to ensure new risks are not introduced. 



The Fit Note procedure does not affect an employer’s statutory duty under the Equality Act 2010 to make reasonable adjustments for a disabled employee (see Chapter 7).



Fit for Work assessments carried out by the government Fit for Work Service (see below) should not affect a worker’s sick pay entitlement. If anyone does not get a Fit for Work assessment, remains unfit for work at the end of any period set by a Return to Work Plan, refuses to participate in the Fit for Work process, or withdraws consent to the sharing of health information with the employer (see below) the GP should continue to provide Fit Note(s) as usual, using their professional judgement to decide whether a Fit Note is required.