The Government has now launched, what is termed ‘a call for evidence’, obtaining views on reforming the fit note process and tackling what is described as the ‘sick note culture’, as part of its Back to Work Plan; that is to help over 1 million people with long-term health conditions, disabilities, or long-term unemployment, to look for, and stay in work.
What is a Fit Note?
Fit notes are the medical statement used by eligible healthcare professionals to provide advice about the impact of a patient’s health on their ability to work.
What were the 2010 Fit Note Reforms?
The fit note was introduced in 2010 to replace the ‘sick note’ and to ensure patients received advice about the benefits of returning to work, and employers had the information they needed to make changes to facilitate an earlier return to work.
The 2010 reforms included a new option to allow a GP to indicate that a patient ‘may be fit for work subject to the following advice’ and for the GP to then provide general details of the functional effect of the individual’s condition and recommend common types of workplace adjustments, such as a phased return to work, altered hours, amended duties and workplace adjustments.
However, between October 2022 and September 2023 across England in GP/primary care, only 6.2% of fit notes were issued as ‘may be fit for work taking account of the following advice’. As a result 93.8% of fit notes were issued as ‘not fit for work’, meaning that over 10 million fit notes each year are issued where the patient is simply signed off, and no further advice is given about what the employee could do or providing further advice/recommendations in relation to reasonable adjustments.
To support and empower better conversations about work and health between employers and their employees, in 2022 the Government enabled nurses, occupational therapists, pharmacists, and physiotherapists to legally certify fit notes. Yet there has been low take-up of this reform. Between April and September 2023, only 8.4% of fit notes were issued by these groups with the vast majority still issued by GPs.
What is the ‘Call for Evidence’ and the potential reforms hoping to achieve for Employers?
It is acknowledged advice provided through the fit note can help employers to have quality conversations with their employees to enable them to return to work and remain in work. However, with just 6.2% of fit notes being “may be fit for work”, employers do not always get the information they need to give them confidence or understanding to have those productive and supportive conversations and in making appropriate adjustments for their employee.
The ambition of the proposals is to co-develop a new process that brings healthcare and employment systems together to support people who are at risk of falling out of work, or who have already fallen out of work, due to ill health. The core components of this new process which are currently being tested are:
• a triage service that supports people seeking a fit note into a pathway that best suits their individual health and employment needs;
• an assessment of someone’s ability to do their job, and a work and health conversation with a healthcare professional or with a work and health adviser. Healthcare professionals and work and health advisers will have work and health training and dedicated time, making them better placed to take into consideration a wider set of factors that affect someone’s ability to work;
• the ability to refer people to more intensive work and health support and assist employers in accessing expert work and health support through Occupational Health services, where appropriate.
The Government believes these core components will produce a fit note service that facilitates faster and simpler, work and health support.
The Government wants the fit note reforms to be underpinned by as much evidence as possible and informed by a wide array of perspectives.
Can I contribute to the ‘Call for Evidence’?
Yes, definitely, the call for evidence is focused on the impact of the current fit note process in supporting work and health conversations and the enhancements stakeholders would need to better support people to start, stay and succeed in work. The Government is therefore particularly seeking views from employers (amongst others) on their experiences of using fit notes; whether employers needs are met by the current process; what works well; what can be improved and what additional information and support would be required to better support employers in understanding and assisting employees in returning to work, this includes also in relation to the role of Occupational Health.
What do I need to do to contribute?
The contribution is by way of set questions, these are contained on the Government website, there are 41 questions in total, some with open answers, some by way of an option answer, but you can select which questions you wish to answer, you are not required to answer them all.
If you wish to take part in this consultation, we have provided the link to the website below
Fit Note Reform: call for evidence - GOV.UK (www.gov.uk)
Further updates
The Call for Evidence will be open until 8th July 2024, and we will continue to keep you updated of any further changes which may result from this and any proposed reforms.