Doctors should assess patients' ability to work generally when issuing fit note

Doctors should consider a patient's ability to work generally when issuing a fit note not just focus on their capacity to carry out a specific job, a government-commissioned review has recommended.

A review into long-term sickness absence found many employers are ‘frustrated’ with the fit note as they believe patients are often signed off as ‘unfit for work’ when they could be supported to remain in or return to work.

The review highlighted a recent Department for Work and Pensions survey which found only 10% to 15% of fit notes issued include the ‘may be fit’ assessment.

It suggested one reason why doctors issue relatively few ‘may be fit’ certificates is that they think about a patient’s specific job when they make a judgment on their ability to return to work.

It therefore recommends that doctors should consider a patient’s capacity to work generally, rather than carry out a specific job.  

It said: ‘We therefore recommend that the government revise fit note guidance to ensure that judgements about fitness to work move away from only job-specific assessments.

‘Such an approach would help employers to make sound judgements about whether an early return to work can be facilitated, but the certifying doctor would not be required to have extensive occupational heath knowledge about specific jobs.’

The review also recommended that GPs no longer take responsibility for signing-off patients on long-term sick.

It said the government should fund a new Independent Assessment Service (IAS) that GPs can refer long-term sickness absence cases to for advice. GPs would refer a patient to the IAS after they have been off work for around four weeks, the review said.

It said: ‘The IAS would provide an in-depth assessment of an individual’s physical and/or mental function. It would also provide advice about how an individual on sickness absence could be supported to return to work.

‘The assessment could be used by employers to help support a return to work, and by doctors to inform their advice to patients.’

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