When an employee falls ill they are faced with a decision to work or not. After 7 calendar days of sickness absence the GP can issue a Fit Note. Prior to this the employee can self-certify In addition to GP Fit Notes there are also AHP Fitness for Work Report. This blog focus is the GP Fit Note, as those are the ones an employer is most likely to encounter.
The base principle behind the Fit Note is that appropriate work is good for mental and physical health and 100% fitness (I am not sure this exists ever!) is not necessary for the person to work. The longer an individual is off sick from work the lower the chances are of return to work. 4 weeks is the usual time period after which specialist occupational health advice is to be considered.
If the employer requires evidence for the first 7 days of sickness absence they can make private arrangements for this.
The Fit Note usually enables sick pay (statutory or company) to be processed.
Fit Notes must always be signed by a Doctor. This could by the General Practitioner (GP) or hospital doctor. A telephone or face to face assessment can trigger the issuing of a Fit Note or after considering a written report from another healthcare professional (examples nurse, physio).
The information in the Fit Note is guidance or advisory. If the GP feels that revealing a particular diagnosis or limitation would harm the patient’s wellbeing or compromise their position with the employer, the GP can enter a less precise diagnosis on the fit note.
The initial choices on the Fit Note are:
Not fit for work - only medical reasons should be given to explain why the employee is not fit for work. The Government guidance states bereavement is not an accpetable reason but distress due to bereavement is.
or
May be fit for work taking the following advice into account - this may change to not fit for work if the employer cannot implement adjustments and the Fit Note should be treated as though Not Fit for Work was indicated.
As you can see in the above sample of a Fit Note, the Doctor has a choice of 4 boxes to tick plus additional script to explains what limitations the individual experiences as a result of the named conditions. This is to allow the employer and employee to think further about the work and if with alterations being at work is possible.
On receipt of a Fit Note stating not Fit For Work or May be Fit it is advisable to have a discussion with the employee, for instance to explore work adjustments that may enable the employee to do some work.
Examples of adjustments are:
Removing activities that aggravate symptoms
Allow for shorter working hours
Allow to work from home
At this point you may want to consider a specialist occupational health assessment for a deeper exploration and discussion about employee abilities, limitations, estimated time periods for limitations and adjustments specific to the role. GPs and hospital doctors have no specialist training in occupational health, their role is to diagnose, treat and the limited time they have with your emloyee their patient is not spent exploring the workplace demands and expectations.
The employee can return to work before the Fit Note expires and they do not need a Fit Note to state Fit for Work.
Here is a link to the employer and line manager Fit Note Guidance from the Government.
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