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Nigel's surgery 40: GP Fit Note

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  • Organisations we regulate

"Fit note" is the informal name for a Statement of Fitness for Work. This is also referred to as a fit note, sick note, med cert, med 3 or doctor’s note.

The Department for Work and Pensions (DWP) has produced guidance for patients. It explains that they are able to self-certify for up to the first seven days of the illness. From the eighth day, patients need to submit medical evidence to pursue a claim. Patients should tell Universal Credit of the health condition preventing them from working. NHS have provided information about when patients need a fit note.

The BMA and DWP have produced guidance for GPs. For benefit purposes DWP will accept a properly signed and scanned fit note sent by email to the patient.

The fit note was introduced in 2010. It changed the emphasis from what patients couldn’t do to identifying what they could do. GPs are able to consider the ‘maybe fit’ option. This brings together clinical aspects of illness and how it affects function and ability to work.

The DWP have produced a set of questions and answers about certification and medical reports for healthcare practitioners. This includes information on who can issue fit notes, answers about issuing duplicate medical statements, expectations from Jobcentre plus and where GPs can access further information.

NHS England state that patients do not always need to see a GP in person to get a fit note. It depends on:

  • why they are off work sick
  • whether a GP needs to assess the patient face to face
  • if the patient has been in hospital

The role of GPs

All GPs can provide simple fitness for work advice. This can help patients return to work and aid their recovery. It is then up to a patient and their employer to discuss this advice and consider possible changes.

There is a general consensus that GPs and other healthcare professionals:

  • play a role in advising patients about (return to) work
  • agree that (return to) work is an important health outcome for clinical management
  • help patients develop a return to work plan
  • help return to work through shared decision making
  • enable patients to effectively communicate with their employers.

Evidence to support regular work

Evidence that the right work is good for people’s health is now well established. Being out of work can increase long-term health risks. Most people with long term health conditions do in fact work. If patients are likely to be absent from work, the advice their GP gives in the fit note can have a major influence on their future wellbeing. Particularly if patients are absent from work an extended period of time.

GPs should carefully consider whether to tell a patient that they are not fit for any type of work at all. This increases their longer-term health risks.

Guidance for GPs

DWP has produced guidance for GPs on how the fit note can help GPs, patients and their employers.

The guidance sets out how GPs should:

  • assess a patient’s general fitness for work rather than making it job specific
  • consider if a patient could do some form of work - if they cannot only then advise that they are not fit for work.

Facts about fit notes

  • The GP guidance suggests when the ‘may be fit for work’ box on a fit note might be appropriate. It suggests what extra advice they could give. GPs are able to use the free text boxes to give advice on what the patient can or can’t do. GPs need to consider this in line with occupational health advice from the patient’s employer. Patients should be encouraged to discuss with and agree a return to work programme with their line manager. The text in the fit note should reflect this.
  • GPs are not expected to have specialist knowledge of workplaces or occupational health. Their advice on a ‘may be fit for work’ fit note is about the functional effect of a patient’s condition on work in general. Many people seeking a medical certificate are declared completely unfit. This is wholly warranted when the patient’s condition precludes any form of work, during expected recovery time or indefinitely.
  • All GP practices with GPSoC systems can access the computer-generated fit note template. This saves time and can be sent electronically. The system pre-populates many of the details and stores them on the patient record. DWP will accept fit notes that are printed, signed, scanned and emailed to patients.

When signing and sending fit notes electronically, attention must be given to:

  • confidentiality
  • information governance

When filling in a fit note, doctors are asked to consider an individual’s functional capacity. They should consider the patient’s capacity to return not only to their own job but to work in general. This approach opens up ways to return to work that a patient may not have otherwise considered.

Further information

Last updated:
22 October 2020