The current system for fit notes was introduced in 2010, with a change in emphasis from certifying sickness to helping patients stay in or return to work where possible.
The fit notes system is under further review.
Statement of Fitness to Work
GPs are contractually required to complete the Statement of Fitness to Work free of charge, when the patient has been off sick for more than seven calendar days.
Telephone consultations are an accepted form of assessment, as well as face-to-face consultations or reports from another doctor or healthcare professional.
When filling out the form, doctors should do the following.
- State whether the patient is 'not fit for work' for a stated period of time; or that the patient 'may be fit for work taking account of the following advice...' with the doctor's recommendations.
- Can comment on the effects of the patient's condition in the space provided, or use the tick boxes to indicate that the patient may benefit from additional support (such as changes to their working conditions) to help them return to work. If it is not possible for an employer to provide this support, the form can be taken as a statement that the patient is 'not fit for work'; it is not necessary to fill out a new form.
The statement can be issued for no longer than three months in the first six months of sickness.
Government advice for GPs on issuing fit notes states that 'you are not expected to have specialist knowledge of workplaces or occupational health, and you do not need to suggest possible changes to the patient's workplace or job'.
Advice given should be on the functional effects of the patient's condition within the limits of your knowledge and expertise – for example, a person with lower back pain might be advised that they 'cannot sit for long periods of time'.
When completing forms, doctors should be aware of their ethical obligations – being honest and trustworthy, taking reasonable steps to make sure information is correct and not deliberately leaving out relevant information.
Some doctors will be more confident than others in giving advice on fitness to work, but it's always important to recognise and work within the limits of your competence.
In some cases, you may prefer to recommend that the patient sees an occupational health doctor.
For any further advice about completing Statements of Fitness to Work, contact the MDU.
This guidance was correct at publication 30/08/2018. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.