Exploring perceptions and attitudes towards the extension of fit note certification

The Employers, Health and Inclusive Employment directorate (EHIE) includes the cross-government Work and Health Unit (WHU), jointly sponsored by the Department for Work and Pensions (DWP) and the Department of Health and Social Care (DHSC). EHIE leads the government’s strategy to support the employment of working-age disabled people, or people with long-term health conditions. In the 2017 ‘Improving lives: Future of work, health and disability’ paper, the government announced its commitment to extend fit note certification powers beyond General Practitioners (GPs) and hospital doctors to a wider range of HCPs. This research explores how different healthcare professionals (HCPs), employers and patients experience and view the current fit note process, their perceptions and attitudes towards the suitability and acceptability of extending fit note certification powers to a wider range of HCPs as well as offering insight into the ways in which future legislative reform can be most effectively and efficiently implemented in practice.

What is a fit note?

Currently, fit notes are issued by either a GP or hospital doctor when an individual’s health condition has impacted on their fitness for work. A GP or hospital doctor will assess an individual’s fitness for work to determine whether they are ‘not fit for work’ or if they ‘may be fit for work’ if certain workplace adjustments are put in place (such as phased returns to work or amended duties). Individuals can self-certify for seven consecutive calendar days before they need to provide medical evidence for a sickness absence.

Key Findings

• Participants acknowledged that good quality work could have a positive impact on individuals’ health and wellbeing, particularly mental health. Work was described as providing individuals with structure, routine and purpose, as well as the opportunity to socialise with work colleagues and gain financial security.
• Individuals in poor health were able to provide other forms of medical evidence to their employers. This included the AHP Health and Work Report, the Patient Care Reference (in Scotland), reports from Allied Health Professionals to GPs, and attendance slips (indicating an individual had visited a walk-in clinic, for example).
• All of the participant groups were receptive towards the idea of extending fit note certification to a wider range of HCPs. Participants identified the following benefits:
  • Greater continuity of care
  • ­More detailed fit notes (completed by a specialist)
  • ­Reduce current workload and time pressure on GPs
• Whilst participants identified risks to extension (including employers and patients feeling that a fit note certified by another HCP was not valid, and poor access to and sharing of clinical records), they felt that the potential benefits far outweighed these risks. They also felt these risks could be mitigates through an effective communications campaign raising awareness of the changes, and enhanced IT infrastructure to facilitate wider access to patient clinical records.
• Participants were positive towards the ‘may be fit for work’ option, as a means of ensuring individuals remained in work, or could return to employment. However, a key finding of the research was the current discord between the level of detail that many employers expect from fit notes, and the type of detail that HCPs are able to offer.

Technical note

Ipsos undertook 68 in-depth interviews between April and June 2019, with the following groups:

• GPs (10)
• Advanced Nurse Practitioners (10)
• Other HCPs (10)
• Employers who had experienced fit notes (17)
• Employers who had not experienced fit notes (6)
• Patients/employees (15)

Employers were mainly recruited from those who had agreed to be recontacted during the Sickness absence and health in the workplace: Understanding employer behaviour and practice survey, conducted by Ipsos during the summer of 2018. Employer sample was supplemented via free-find recruitment. Patients were recruited via free-find methods, and HCPs were recruited through a mix of commercially available sample (Wilmington Healthcare) and free-find recruitment.