On 6 April 2010 the statement of fitness for work ("fit note") was introduced. This replaced the previous "sick note" and allows doctors to indicate not only if an employee is "not fit to for work" but also if they "may be fit for work". The fit note gives doctors the opportunity (by way of tick boxes) to suggest ways in which the employee may be able to return to work such as altered hours or reduced duties.

Where an employee is off sick, particularly for long periods of time, a fit note will be used in a variety of situations. For example it can be used in some circumstances as evidence of incapacity to work for the purpose of receiving Statutory Sick Pay and Contractual Sick Pay where the doctor has indicated the employee is not fit for work, and it can help an employer manage long term absences through aiding discussions with the employee of ways in which they can begin work again.

My impression from speaking with employers is that GPs are fairly reluctant to tick the "may be fit to work box"and it is not particularly common for pro-active suggestions to be made by the GP of adjustments that could be made to allow the employee return to work.

It may well be then that, with this in mind, the Department for Work and Pensions has recently issued new guidance for employers, employees and doctors on how to best utilise fit notes. This guidance encourages the use of fit notes to show what an employee can do and not what they can't do. It advises doctors on how they can give the most useful advice about what a patient can do at work and on how they can return to the workplace as soon as possible. The guidance makes clear that a doctor's task is to assess whether an employee is fit for work in general and not whether they are fit for a particular job, thus providing flexibility to discuss what changes could be made to allow employees to work. Moreover it encourages doctors to give advice on the functional effect of the employee's condition on their fitness for work in general.

The guidance encourages employers to use the fit note as an aid in trying to find ways which will allow the employee to come back to work and indicates that employers should discuss the contents of the fit note with the employee. In relation to employees the guidance emphasizes that an employee does not need to be fully recovered to go back to work. Moreover it encourages the employee to ask their doctor to give them practical advice in the note on what they can do at work as opposed to just stating what their health condition is.

In general the guidance also includes an improved question and answer section based on common queries and ideas for patients and employers about possible changes to accommodate the advice in the fit note. It also clarifies the legal status of the fit note in relation to sick pay and in particular that an employer can still refuse to pay this despite the employee having obtained a fit note.

The Department for Work and Pensions' guidance can be found here:-

Fit note Guidance

It will be interesting to see whether this new guidance results in GPs taking a different approach to fit notes moving forward.