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February 19, 2010

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Employers and GPs advised on functioning of new fit note

The Government has published guidance for employers and doctors, outlining how the new fit-note system will work.

From 6 April, GPs will be required to issue patients with statements advising that they are either ‘not fit for work’ or ‘may be fit for some work’. Doctors will also have the option to suggest that the patient would be able to work if, subject to the employer’s agreement, temporary changes to their work conditions could be made.

The guidance has been created by the DWP together with the Confederation of British Industry (CBI), conciliation service ACAS, the Federation of Small Businesses (FSB), the Chartered Institute of Personnel and Development (CIPD), EEF — the manufacturers’ organisation, the Association of British Insurers, and the British Retail Consortium.

The advice for employers explains what the options mean and goes through the new form line by line. It includes a flow chart describing what to do with a ‘may be fit for work’ statement, and contains case studies, an FAQ section, and a comprehensive list of contact details of organisations to go to for more information and support.

It clarifies what has not changed from the previous sick-note system, such as: the form can still be used a evidence for why an employee cannot work due to an illness or injury; the information on the form is still advice to employee — it is not binding on employer; and Statutory Sick Pay is still payable under current rules.

What has changed is that GPs can now include comments on how the employee’s condition will affect what they do, and they can suggest common ways to facilitate a return to work. These include a phased return to work, altered hours, amended duties, and/or workplace adaptations, all of which are explained in the guidance.

The guidance for GPs states that they do not need specialist expertise in occupational health, or a detailed understanding of the patient’s job to complete the form. They are also encouraged to discuss the health benefits of work with the patient, as well as the adverse effects of worklessness on health, and how to overcome obstacles to returning to work. Based on their discussion with the patient, they can recommend on the form that an OH assessment be considered.

The DWP says the new ‘may be fit for work’ option means fewer employees will be signed off work when they could possibly do some, or all of their job, with some support. It also provides employers with more information on how the employee’s condition will affect what they do.

However, concerns have been expressed that many employers lack the necessary expertise and specialist support to act on GPs’ recommendations. Brendan Barber, general secretary of the TUC — which launched its own guidance for union representatives to coincide with the Government’s advice — said: “If employers use the additional information on the revised medical certificate to work with individuals who want to get back to work, and give them the support they need, this could help reduce sickness absence.

“But if employers see the changes as a green light to force workers back to work before they are well enough to return, in the long run, it will only lead to increased sickness absence and unnecessary conflict.”

The DWP guidance is clear that if it is not possible for the employer to provide the support suggested, s/he and the employee should use the statement as if the doctor had advised ‘not fit for work’. Similarly, if the doctor advises that the employee may be fit for work but he or she remains off because the employer cannot provide the necessary support, or make the recommended adaptations, the advice should be considered the same as ‘not fit for work’.

In terms of how long any support or adaptations should last, the doctor will indicate on the statement a time period during which their advice is applicable. When agreeing a return-to-work plan, says the guidance, the employer should be clear on the length of time for which support will be provided. If the employee cannot then return to their normal duties further discussion with them, or alternative temporary measures will be necessary, or the long-term effects of their health condition on their job will need to be evaluated.

Employers who feel that someone is fit for work even though a GP says they only ‘may be’, or those who simply want to be sure that their employee is fully ready to return to the workplace, can enter into a private arrangement with a GP or occupational-health specialist for a ‘second opinion’. The same advice applies if the employer offers support, or adaptations that the employee does not feel are adequate.

Commenting on the guidance, the CIPD’s senior public policy advisor, Ben Wilmott, said: “The new fit note will encourage more employers to help people with health conditions make an early phased return to work as part of their rehabilitation and recovery. It will prompt all GPs to start a conversation with their patients about the possibility of a phased return to work, and also provides them with a framework to suggest possible workplace adjustments for employers to consider.”

Mary Boughton, health and safety chair of the FSB, added: “Encouraging employees to do what they can within their jobs while they are not 100-per-cent fit is good for business and the wider community. The FSB has been calling for its introduction for years. Small firms now need to check the ‘fit note’ guidance to make themselves aware of what it means for them.”


Dame Carol Black, who came up with the idea of the fit note as part of her review of the health of Britain’s working-age population, said: “Work plays a significant role in determining a person’s health. The fit note is a hugely important development, which means that GPs will be encouraged to think about their patient’s ability to work and provide more helpful information to patients to discuss with their employer. This is why the fit note is a win-win for both employees and employers.”

The DWP is also reminding small and medium-sized businesses that the occupational health advice line will be providing help on the new system, and it has announced that this service, which is currently being piloted in nine locations throughout Britain, will be rolled out nationwide from 1 April.

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