The Fit for Work Service 



The government’s Fit for Work Service went “live” in December 2014 and is available for advice and referrals in England, Scotland and Wales. There is a website: http://fitforwork.org for online and telephone advice. There are separate helplines for employers and workers. They can be used at any stage, for example by employers wanting advice about intermittent absence.


Anyone can be referred to the Fit for Work Service if they live in England, Wales or Scotland, are in paid employment, off sick and likely to return to work. The service is not available to the self-employed. A worker can only be referred once during a 12-month period, and the Service will cease to be involved if a return to work has not been possible within three months of the referral. 



Most people can be referred though their GP after they have been signed off work for four weeks. This would generally happen as part of a normal GP visit. Sometimes a person will not be referred, for example, if they are already fit to return, or if an ongoing serious condition means it is obvious that they will be off work for a considerable time. GPs can refer before four weeks if they expect the worker to be off work for more than four weeks. After four weeks, an employer can make a referral if the GP has not done so. Individuals cannot self-refer, and neither can hospital consultants. 



In most cases, the referral will lead to an assessment with an occupational health professional such as a nurse, doctor or physiotherapist. The vast majority of workers will simply be given a telephone assessment, although in some cases, for example where there are communications issues, a face-to-face meeting may be suggested. The telephone assessment should normally happen within a couple of days of the referral (or five days for a face-to-face meeting).


Every person who is referred should be allocated a case manager with occupational health expertise as their point of contact. If a face-to-face assessment is needed, the individual concerned is not supposed to need to travel more than 1.5 hours for an appointment, and can reclaim these travel costs.


All referrals are voluntary and must be based on the worker’s informed consent. No worker should be forced to have an assessment. DWP guidance says: “Your consent must be explicit, informed, specific and freely given and must be given at different parts of the process”. 


Anyone who is referred for an assessment can withdraw that consent at any time, and this should be made clear to the worker. No report or plan should be sent to the GP or employer without first being discussed with the worker, who can ask for changes, or refuse to agree to it being shared. Any worker with concerns or doubts should be encouraged to contact their union.



Following the assessment, workers should be given a “Return to Work Plan” with recommendations aimed at helping them get back to work more quickly, and information on accessing appropriate “interventions”.


Fit for Work is meant to complement rather than replace existing health provision. Examples of recommendations might be a referral for some form of therapy or treatment, or adjustments to the workplace.


The confidential Return to Work Plan is produced by the case manager with a detachable section that works like a Fit Note. The Plan should set out whether the worker is not fit for work, may be fit for work (subject to the employer meeting the recommendations) or is fit for work. With the employee’s consent, the Plan will be sent to the worker’s line manager or HR department.


With the employee’s consent, the case worker may contact the employer for their input before finalising the Plan, and if the employer disagrees with anything in it they can contact the case worker direct to discuss it.


It is up to the GP, employer or worker to take forward any recommendations. There is no compulsion on the employer to take action, and the cost of anything that the employer provides falls on the employer, not the Fit for Work Service.


If the employer pays for any treatment recommended by Fit for Work, or by any employer-arranged occupational health service, there is no tax liability for the first £500.


Fit for Work should contact the worker again, to check whether the Plan is being implemented at work. If it is being implemented but the worker is not on track to return to work as anticipated, then another assessment may be made.


If the employer fails to implement the recommendations, for example because they are unwilling, or unsure what to do, the worker is supposed to notify their case manager, who may be willing to speak to the employer. They should also be encouraged to contact their union rep.


Consistent with DWP advice on Fit Notes (see page 290), if an employer fails to implement recommendations set out in a Fit for Work Plan, the worker should be treated as unfit for work.


The TUC has welcomed any measure that could help employees return to work after illness or injury, but cautions that care must be taken not to force people back to work before they are well enough. There is also a danger that some employers may ignore the voluntary nature of the service and try to force staff to agree to a referral, or threaten to withhold sick pay if they do not participate.


The TUC has produced guidance for reps, including guidance on negotiating over any proposed changes to sickness absence or sick pay rules — Fit for Work Assessments, guidance for union reps (https://www.tuc.org.uk/sites/default/files/Fit%20for%20Work%20Guide%202015%20pdf_0.pdf). The guidance emphasises that there must be no penalty, such as loss of sick pay, for workers who withhold consent to a referral.


In England, the new system is delivered by private sector firm Health Management Limited, a division of US “health and human services” giant Maximus Inc. In Scotland, the programme is delivered by the Scottish government, where it is called Fit for Work Scotland.