The scene

A practice manager called the MDU's advice line after being contacted by the HR administrator of a large local employer, who asked whether a fit note issued by the practice was genuine.

The practice manager asked the HR department for a copy of the fit note and could see that it was issued for a patient of the practice; it had the surgery stamp and appeared to be genuine. However, when he reviewed it with the issuing GP, it was clear from the records made at the time that the note had been altered.

The GP recorded a condition of 'depression' and that the patient was not fit to work for four weeks. However, the fit note stated a period of 14 weeks and the condition had been changed to 'stress at work'.

The member asked whether he or the GP were allowed to tell the employer anything at all.

MDU advice

The employer was alerted to question the fit note's veracity by its duration; the maximum period a fit note can cover in the first six months of absence is three months.

The MDU adviser explained to the member that they could confirm whether the note was as written to anyone properly entitled to hold it, but that providing further information - such as the actual diagnosis - may amount to a breach of confidentiality. Of course, once the practice confirmed the note to be not as it had been written, it would become clear to the employer that it was altered. It would then be for the employer to decide how to manage this with their employee.

The member asked whether there was anything else they should do about the patient having altered the note.

The adviser explained that although they were under no obligation to tell the patient, they may still choose to do so. It would be an opportunity to explore why the patient had altered it and also for the practice to make clear that they had told the employer that it was not what they had written. Unless the patient gave consent, the practice would be unable to discuss the diagnosis with the employer unless a failure to do so would lead to so serious a risk that it outweighed the duty of confidentiality owed to the patient.

The outcome

After a later discussion with the patient it became clear that he'd felt he might be treated adversely if his employer learned of his mental health problems, and the GP wanted to know if she was obliged to put a detailed diagnosis on a fit note.

The adviser subsequently explained that the government guidance asked for 'as accurate a diagnosis as possible, unless the doctor thinks a precise diagnosis will damage the patient's wellbeing or position with their employer'.

The adviser also drew the doctor's attention to the GMC guidance in 'Good medical practice' (2024), which states that a doctor must be honest and trustworthy when completing and signing forms and must make sure any such documents are not false or misleading. While the doctor may decide that a more broad description of the condition was appropriate, she should remain able to justify her diagnosis.

An altered fit note

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