Yesterday BBC News published some new research around the use of fit notes by General Practitioners (GPs) and other medical professionals.
From sick notes to fit notes
Fit notes were first introduced in 2010 to replace the existing sick notes system. Fit notes were designed to offer more than a binary choice between being either sick or fit for work and include the “may be fit for work” option allowing the family doctor to offer thoughts or advice about what work may be suitable and what reasonable adjustments could be considered to allow at least some work to be undertaken.
In 2022 the fit note system was improved further to create digital certification and to allow other healthcare professionals to complete fit notes. Despite the above changes the family doctor still completes the vast majority of fit notes. Fit notes are typically first issued after one week of illness absence and have become the primary evidence used by employers to record short-term sickness absence.
BBC research
The BBC looked at NHS data and found that almost three in four fit notes (72%) did not include any reason for absence. This suggests that the majority of fit notes are no more useful today than the sick note system they replaced some 16 years ago.
Yet some do include additional details. Of the remainder, the most common reasons given were “mental health” and “behavioural disorders”.
The BBC contacted more than 5,000 GPs asking how they responded to a patient request for a fit note citing one of the above conditions. Of the 752 family doctors who responded, 540 indicated that they had never refused such a request. Of the remainder, 162 had turned down at least one request, and 50 other doctors preferred not to say.
The disconnect
The above findings suggest that the fit note system is still not providing the detail, evidence and potential solutions to help employers and employees manage and shorten periods of sickness absence.
So why is this?
One of the main problems is that the family doctor must, by definition, put the health and wellbeing of their patient front and centre of their thinking. It follows that most GPs will be reluctant to turn down a request for a fit note on mental health grounds. As one doctor put it;
“It is hard to be patient’s advocate and a judge.”
Another challenge is that mental health is far more difficult to diagnose and treat than many physical problems. Another practitioner said in their response to the survey;
“Who am I to say I don’t believe that someone is struggling with their mental health? It’s not like a chest infection where there is definite proof of illness.”
There are other challenges, most notably the time available in the typical GP daily surgery to undertake more detailed investigations and analysis. And even if the GP is able to provide a more nuanced response, the family doctor is unlikely to have the necessary information about job role and working conditions to make informed recommendations.
One solution to this last issue may be the wider and more frequent use of specialist occupational health assessments. Such medical reviews can provide a more in-depth review of the health challenges faced by the employee. It follows that any suggested reasonable adjustments will be more practical and meaningful.
The value of early returns
It is clear from this research that fit notes are not yet consistently providing the data needed to facilitate an early return to the workplace. Yet an early return is central to the wellbeing of the worker and also the productivity of the employer.
The Keep Britain Working review published in November last year found that there is a 96% chance of a return to work after absences of 4 to 6 weeks. Yet an absence of 12 months drops this rate to less than 50%. So early intervention is strongly recommended for the good of all parties. For more information on this topic please see this post from September last year.
About Occupational Health Assessment Ltd
Occupational Health Assessment Ltd is an SEQOHS Accredited and Certified B-Corp nationwide occupational health provider.
We provide rapid access to expert occupational health support for businesses right across the United Kingdom. Appointments are available nationwide within two days.
With a unique occupational health assessment service, night worker health assessments, fitness certifications and access to clinics in Belfast, Birmingham, Bradford, Brighton, Bristol, Cardiff, Coventry, Derby, Edinburgh, Glasgow, Hull, Leeds, Leicester, Liverpool, London, Manchester, Newcastle, Northampton, Nottingham, Plymouth, Portsmouth, Reading, Sheffield, Southampton, Stoke, Surrey and more, the business provides high quality, expert medical advice.
Please contact us for further information or assistance.