The ‘Fit Note’ Debate – Where are we now?

In April 2010, the old system of GP’s signing off an employee as unfit for work was replaced by a 'fit note' in a bid to reduce sickness absence across the UK. The fit note is a medical statement that GP’s are issuing to people who are, or have been unable to attend work due to sickness for over seven days. The reasoning behind the change was the government felt that the old provision was too restrictive, employees were either totally fit to work, or totally unfit to work, with nothing in between. 

The Government's new fit note system was supposed to help reduce the £13bn sickness-related benefits bill by getting people back to work more quickly. The introduction of the new ‘fit note’ regime was aimed to cure sick-note Britain; but where are we now?  Has it been the success it was hailed to be or has it failed to have the required impact on absence levels?  Nearly two years on and it is fair to say that the jury is still out; it depends which reports you read as to the finding you get.

In June of last year, a national newspaper reported that employers at a sickness absence conference had a mixed reaction to the 'fit note', some people saying that doctors didn’t have enough knowledge about the work environment, which was standing in the way of a doctor making a valuable assessment, and some employers saying there were concerns about the fit note and that GP’s don’t have the training in occupational health to be able to make an assessment.

However, on the other side, a large manufacturer and a national bank stated the new fit note had already enabled 'tens' of staff to come back to work earlier than would have been possible under the old sick note system.  It was quoted that “The fit note has so far made a small contribution but it works well”.

Absence Management Firm FirstCare Study
Workers who asked their GP for a fit note during sick leave were absent from work for 48 days on average, the analysis of 22,086 employee records by absence management firm FirstCare revealed. 

The findings show the majority of doctors are locked into old habits of signing off workers for lengthy blocks of time, rather than considering how they could return to work earlier by adapting their job roles or working reduced hours, First Care said. 

The news is a blow to the Government's new fit note system, which replaced the contentious "sickie", or sick note, and was supposed to help reduce the £13bn sickness-related benefits bill each year by getting people back to work more quickly. 

Employers have long warned that too many workers are signed off for lengthy periods at a time without any thought given to what work they could do, either by adapting their day-to-day activities or making reasonable adjustments. 

The fit note was designed to help GP’s advise on helping people back to work but appears to have made little impact, the survey showed. 

The Department for Work and Pensions (DWP) Report
The study from the DWP has shown general practitioners agree it has made a positive impact on the speed their patients are returning to work, with 61% of GP’s somewhat or completely agreeing the fit note had improved the quality of their discussions with patients about a return to work.

Just under half (48%) agreed that it had increased the frequency with which they recommend return to work as an aid to patient recovery and 70% agreed the fit note had helped their patients make a phased return to work.

Almost all GP’s agree that work is beneficial for people's health (99%) and that helping patients stay in or return to work is an important part of their role (88% of GP’s were in agreement).

The implementation of the fit note was aimed at helping individuals become more aware of their own health and wellbeing. They are also encouraged to be able to see the scope of their capabilities at work and, supported by the expertise of the GP, can make an informed decision about the fit note recommendations and play an active role in getting back to work.

Studies show that work is good for health and prolonged sickness absence can produce its own set of problems, such as:

• isolation
• loss of confidence 
• mental health issues 
• de-skilling 
• social exclusion.

So working with the employee, their GP and even Occupational Health can only be a good thing all round if it gets someone back into work.

The ‘Fit Note’ may take five years to become fully integrated
The fit note is failing to reduce employee sickness absence and may take five years to become fully integrated, the Chartered Institute of Personnel and Development (CIPD) has revealed. 

Although companies do not believe it is being used effectively by GP’s the fit note's introduction has encouraged discussions between line managers and staff around absence issues. The findings mirror some of those found by the Department for Work and Pensions last month which said GP’s were embracing the new method but were still uncertain of some features.  It also reinforces the Confederation of British Industry's (CBI) view that the fit note was not reducing workplace sickness absence after levels rose in 2010.

Employers remain unconvinced that the fit note has yet had much impact in helping to reduce levels of sickness absence. Just one in ten respondents (11%) said it had reduced absence in their organisation while the same number believed GP’s were using it effectively. This suggested there is a clear disconnect between employers' needs and current outcomes.

However, more than half of employers (52%) agree that the fit note has enabled line managers to prompt conversations about absence and health issues with their staff. Just under a third of the organisations (31%) questioned in the CIPD and Simplyhealth survey agreed that the fit note helps line managers to manage absence more effectively.

Conclusion
Dr Jill Miller, CIPD Adviser, said the research revealed fit notes can promote good quality conversations between managers and their employees, which has a positive impact on the management of absence. See some quotes from Dr Jill Miller below:

 “We are seeing some positive reviews of the fit note from GP’s, but employers do not share such a warm view at present”.

"GP’s and employers need to work from the same page, promoting what is best for the individual employee's health and well-being, but also what makes sense for the business”.

"Policy makers, however, should not be discouraged as it may well take five years or so before the fit note is consistently used effectively and viewed more favourably by GP’s, employers and employees, to support early and lasting returns to work”.

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