The fit note at five years old is not achieving its aims

25 January 2016

Independent research published by the University of Nottingham shows that the fit note is widely misunderstood by employers and GPs and needs more investment in time, resources, training, commitment and legislation to fully realise its potential.

Getting the best from the fit note is a report commissioned by IOSH, the Chartered body for health and safety professionals. The report discusses the gaps in the evidence-base on the GP 'fit note' and describes the investigation into the key features of successful fit note use in order to optimise its effectiveness from the perspective of all three stakeholders: GP, employer and employee.

In the UK, the old sickness certificate was replaced in 2010 by the ‘fit note’, to encourage General Practitioners (GPs) to help patients to stay at work, or return to work as soon as they are able. GPs can use the fit note to advise that a patient is ‘not fit’ for work. They can also advise that the employee ‘may be fit’ if the employer can make necessary modifications – including a phased return to work, altered hours, amended duties and/or workplace adaptations.

However, although the fit note has been broadly welcomed by GPs and employers, difficulties and uncertainties have resulted in wide variations in their use. For example, GPs report that employers seldom act on the advice given; employers complain that GPs fail to use the fit note to provide sufficient advice.


In the study, consensus was reached on good practice in the use of the fit note in over 60 areas to aid return to work and work retention. These are just a few of the recommendations:

  • GPs should have the option of selecting both fitness to-work options (‘not fit’ and ‘may be fit’) if they qualify these choices with clear dates, duration and advice.
  • Other healthcare professionals with relevant training and competency should be able to complete fit notes.
  • If a patient has another job with different demands, the GP should complete the fit note to cover each job.
  • If medical terminology is used on a fit note, then a lay person’s version should also be provided e.g. CVA (stroke).
  • GPs must ensure there is no ambiguity as to the return-to-work date on the fit note.
  • The option should be available, with patient consent, for fit notes to be emailed to the employer.
  • Employers should ensure that sickness absence monitoring schemes do not discourage employees from returning to work before the expiry of their fit note, if they feel able.
  • The DWP should provide more detailed guidance to employers on best practice in the management of the fit note through their organisation.
  • Employees should contact their employer to discuss a ‘may be fit’ note within two working days of being issued with one.
  • Where necessary, and with patient consent, GPs should communicate with their patient’s employer to seek more information on the employee’s job and possible modifications.
  • GP fit note training should be mandatory.
  • Employers must inform their workforce about how their organisation manages the fit note.
  • Employers must inform individuals as to any impact that work modifications advised on a fit note might have on their pay.

The report concludes, as in the title of this news item, that the fit note is not achieving its aims and is unlikely to do so without increased investment of time, money, commitment, and further legislation.