GP fit note role set for overhaul under government review

Non-medical staff could be allowed to sign off fit notes under reforms proposed by the government on Monday.

Ministers announced plans to review the current system to decide 'whether fit note certification should be extended from doctors in primary care and other settings to other healthcare professionals'.

Implemented properly, the government argues, fit notes have the potential to 'shorten periods of sickness absence and ultimately reduce the need for repeat fit notes, reducing pressures on GPs and potentially reducing costs over the longer term' by identifying patients' needs and helping them to manage their condition.

But under the current system, the fit note is 'not fully achieving what it set out to do' according to a government green paper, Improving Lives: Work, Health and Disability.

GPs signing fit notes 'rarely' make use of the option that allows them to specify that a patient 'may be fit for work subject to the following advice', the green paper says.

GP fit notes

Evidence suggests that GPs sometimes find it difficult to refuse to issue fit notes, the paper adds, warning that as a result the mechanism can be seen simply as an administrative burden.

Launching the green paper and a consultation, work and pensions secretary Damian Green told MPs: 'The purpose of the changes in the fit note are to make it useful so that it can be given by a properly qualified medical practitioner and that it will act not just as a note writing someone off work, but guide them into a system that will help them get back to work.'

His Labour counterpart Debbie Abrahams warned that weakening the role of medical professionals in the fitness to work process must not become an 'underhand tactic' to push people back to work too early.

She told the House of Commons: 'On plans to broaden number of professionals who can provide a fit note, which can currently only be provided by a general practitioner, will these be appropriately trained clinicians?

GP workload

'We know from the government's use of the so-called healthcare professionals under the work capability assessment that this is an underhand tactic to force people into work before they are ready by weakening the role of the medical professional in the assessment processes.'

Chartered Society of Physiotherapy chief executive Professor Karen Middleton said patients and GPs would benefit from a wider range of health professionals signing off fit notes.

‘Allowing physiotherapists to issue fit notes would give patients the opportunity to be assessed, given advice and therefore begin their rehabilitation on the day they were signed off,' she said. ‘This greatly improves their chances of a full and swift recovery or, for people with a long-term condition, getting their symptoms back under control to the point where they can return to work.

‘We also believe there would be considerable benefits to the economy as a whole, through reduced sickness absence and social security, fewer people seeking GP appointments and lower demand for other health and care services.'

Click here to take part in the consultation on work, health and disability

Photo: JH Lancy

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