Fit notes were introduced in 2010 to allow GPs to give more information to patients about the functional effects of their health conditions.
They have been broadly welcomed by GPs and employers and allow more flexibility for people who are fit for some work, but not necessarily their normal job.1
Fit notes can only be completed by doctors and, when issued, must be provided free of charge.2
Is a fit note needed?
GPs do not need to issue a fit note for the first seven calendar days of sickness absence. Patients self certify for this period.2
If a patient or employer requests certificates for periods of less than seven days, the GP is entitled to charge a fee.3
Seeing the patient
A useful rule change in 2010 was that these assessments can be conducted face to face, by telephone or issued after considering a written report from another doctor or healthcare professional.2
Who fills in the fit note?
The duty to provide a fit note rests with the doctor who at the time has clinical responsibility for the patient.2,4 GPs currently issue about 20 certificates per week.1
There is specific guidance for hospital doctors to avoid unnecessary referrals to GPs solely for the purpose of sickness certification.4
How long do fit notes last?
The rules here are clear. In the first six months of a condition, the fit note can cover a maximum of three months. After that, it can be any clinically appropriate period.5
Dates are inclusive, so a fit note from 1 to 2 January no longer applies from 3 January onwards. Backdating is possible in certain situations and this was clarified in the March 2013 guidance.5
If it is based on an earlier assessment, you enter that date in the 'date of assessment' field. If a condition has affected function for some time without a previous fit note, an estimated date of onset is entered in the 'this will be the case from' field. You cannot issue future start dates.5
Fit for work or not?
The assessment whether the patient is fit for work is not intended to be job-specific. The guidance asks GPs to consider whether a patient could do work of some kind before advising they are not fit for work.5
The guidance also reassures GPs that they are not expected to have specialist knowledge of workplaces or occupational health. There is no need to suggest possible changes to your patient's workplace or job. Focus your advice on the functional effects of their condition on their fitness for work in general.
Work itself has obvious financial benefits, but there is also evidence of a beneficial effect on physical and mental wellbeing (depending on the nature of the job). GPs may be able to help prevent a patient's absence from work developing into joblessness.1
If you state that they may be fit for work taking into account the following advice, you can tick as many boxes as apply (phased return, amended duties, altered hours and workplace adaptation). Further information can be added in the comments box.
If you indicated the patient may be fit for work taking into account certain conditions and the employer is unable to accommodate your advice, the fit note is treated as if it stated the patient was not fit for work.5
Who uses the fit note?
Fit note advice is not binding on employers and it is up to the employer whether they accept the advice; they can if they wish seek their own comparable advice.5
If your patient is out of work, they can use a fit note to support a claim for health-related benefits or to show they have been unable to fulfil certain benefit criteria.5
The cover of the blank fit note pad identifies them as a 'Statement of Fitness for Work - For social security or Statutory Sick Pay.'
Med 3 fit notes do not cover other matters, such as fitness for leisure activities. Fitness for court attendance (of defendants, witnesses or jurors) is not the same as fitness for work. For guidance on this, see the Crown Prosecution Service website.6
- Dr Lackey is a GP in Newcastle upon Tyne
Reflect on this article and add notes to your CPD organiser on MIMS Learning
References
1. Fit for work? Changing fit note practice among GPs. Br J Gen Pract 2012; 62(595): 102-4.
2. Statement of Fitness for Work: General Rules (notes on inside cover of Med 3 pad).
3. Patient.co.uk. Sickness certification in primary care. www.patient.co.uk/doctor/sickness-certification-in-primary-care
4. Department for Work and Pensions. Statement of fitness for work: a guide for hospital doctors. March 2010. www.gov.uk/government/publications/fit-note-guidance-for-hospital-doctors
5. Department for Work and Pensions. Getting the most out of the fit note: GP guidance. March 2013. www.gov.uk/government/publications/fit-note-guidance-for-gps
6. Crown Prosecution Service. Issuing of medical certificates. www.cps.gov.uk/legal/l_to_o/medical_certificates/
