Organisations across the UK depend on the fit note as a crucial piece of medical input regarding an employee’s health and ability to work. Employees must provide a fit note after seven calendar days of sickness absence. In a minority of cases, other forms of medical evidence of health affecting work are provided as an alternative. The seven day threshold prompts the employee to consult a healthcare professional about their health condition and how it affects their work capabilities. The healthcare professional then provides a note (now most often in digital form), with information about the employee's health and what they can and cannot do at work for a specified period.
Understanding the purpose of the fit note
The fit note is called the fit note because it is intended to focus on what an individual is fit to do at work, rather than what they are not. It replaced the sick note over a decade ago and includes a 'may be fit for work' section, along with tick-box options like 'amended duties' and 'a phased return to work.' This allows for suggestions on how the individual may be fit to work while still recovering.
For example:
● An administrator with mobility issues may be able to do some work remotely.
● A teaching assistant recovering from anxiety may benefit from a phased return to gradually build up to their full workload.
Is the fit note underused?
Data from the NHS demonstrates that the 'may be fit for work' section is rarely used. More than 90% of the time, clinicians sign patients off as 'not fit' for work altogether. This means that, much more often than not, the fit note is being used as a sick note. The longer someone is off sick, the less likely they are to return to work.
There are various reasons for this, such as time-pressured consultations in general practice. Some policy experts have questioned whether the fit note is actually fit for purpose overall.
Supporting employees to return to work sooner
What matters to both the employee and the organisation is: How can the employee be supported with their health, and how can they return to work sooner?
At Insight Workplace Health, our team supports organisations and employees aiming for a return to work during sickness absence. It's not uncommon for us to work together with the employee and the organisation on a plan that allows a return to work sooner than documented in the worker’s fit note. This can be confusing for both the worker and employer and may even appear conflicting. To address this, we've developed a short guide on where the fit note fits into the wider occupational health landscape.
Maximising occupational health services alongside the fit note
Here’s what we have found helpful in supporting the organisations we work with:
1. Take ownership of your sickness absence policy
Fit notes are not legally binding but can be useful tools. If your organisation wants to leverage them, make it clear in your policy when they will be requested and how they will be used.
2. Get one step ahead of the fit note
The most forward-thinking organisations we work with use the Insight Workplace Health Day One Sickness Absence product to engage with employees from the very first day they go off sick. An occupational health clinician touches base with the employee within 24 hours to see what can be done to support them. Why wait seven days to understand what's going on?
3. Acknowledge differing advice
If an occupational health professional's recommendations differ from what is documented on an employee’s fit note, it's important to explore these differences rather than ignore them. For example, if a GP has signed an employee off for the next two months, but occupational health recommends a return to work with adjustments next week, this discrepancy should be addressed. From both the employee and employer perspective, it's crucial to ask the occupational health clinician about this if they haven’t already explained it. Clearing up any confusion is essential for a return to work plan to be successful.
4. Understand why there is different advice
This will vary from case to case, but reasons include:
a. Expert knowledge of the workplace
Occupational health clinicians bring specialist knowledge to discussions around return to work. They have more time to explore the specifics of the employee’s role and workplace. This can open up more options for return to work and possible adaptations that could facilitate an earlier return compared to the outcome of a fit note consultation.
b. Health and function are dynamic
Health conditions and functional abilities can change. By the time of an occupational health appointment, things may have improved enough to consider a return to work, especially if treatment has had time to take effect.
c. Missing information
While occupational health clinicians specialise in work-related health matters, an employee’s GP team will have a more comprehensive, longitudinal view of their health and circumstances. The fit note advice may reflect this broader perspective, but specifics might not be communicated on the note itself or by the employee during their occupational health consultation.
Confidentiality is always key, and the clinician completing the fit note would not share information with the employer without the employee's consent. Therefore, when there's a significant discrepancy between the fit note advice and the occupational health clinician's advice, the occupational health clinician may ask the employee to share the occupational health recommendations with their GP team before proceeding.
If the GP team is concerned that returning to work is not appropriate, there's an opportunity for them to feed this back to the occupational health clinician. It’s important that an employee’s treating team endorse the occupational health plan. A joined up approach is always more effective.
Conclusion
From all angles, when it comes to sickness absence the goal is to support the employee with their health and enable them to return to work as safely and sustainably as possible.
By taking proactive steps, acknowledging and understanding differing advice, and leveraging occupational health services effectively, organisations can better support their employees' return to work.
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