The success of the fit note is being compromised, in part, by GPs' reluctance and lack of confidence in suggesting workplace changes to help patients return to work, new research from the Department for Work and Pensions (DWP has found.

The qualitative study, which was issued just prior to the publication of an independent report looking into how the sickness-absence regime in Britain could be improved, explored the extent to which the fit note has helped people with health conditions stay in work, or return to work more quickly. It found that many GPs do not see giving specific occupational-health advice to employers as part of their role, and identified a number of barriers experienced by GPs in using the fit note effectively.

The DWP conducted 45 in-depth, semi-structured interviews with GPs in England, Scotland and Wales. The findings revealed that GPs without occupational-health training believe that some aspects of the fit note, such as recommending amended duties and workplace adaptations, fall outside their area of expertise.

GPs said they would feel more confident raising return-to-work issues with their patients if they had more training in communication and negotiation skills in patient management, as well as further guidance on what to write on the fit note to make it useful to both patients and employers.

They also believe there is a role for other agencies in helping remove non-medical barriers to a return to work, such as lack of skills, or problems with their employers.

Barriers that GPs encounter in using the fit note to facilitate a speedy return to work for the patient include:

• a sense of lack of power in using the fit note, owing, in part, to a lack of feedback from employers about the value and feasibility of the advice they provide;
• the patient’s age;
• the local economic and labour-market conditions;
• their reluctance to damage their relationship with patients; and
• the patient’s own agenda – for example, their motivation to return to work, and their illness perceptions.

GPs felt that the fit note is most effective for patients with conditions such as chronic fatigue syndrome, mild-to-moderate health conditions, and musculoskeletal disorders.

The GP research is available at http://research.dwp.gov.uk/asd/asd5/rrs-index.asp