Fit notes introduced to tackle long-term sickness absence

Long-term sickness absence is one of the most complex and expensive issues facing HR professionals in the UK. Daniel Thomas asks if the new fit-note system will help cure the UK’s sickness absence problem.

A new fit-note system came into effect on 6 April in response to the enormous costs to employers associated with long-term sickness absence.

The cost to the UK economy of absence and unemployment due to ill health is estimated to be £100bn each year, according to a 2008 report by Dame Carol Black, the government’s national director for health and work.


Black had been commissioned to produce a review of the matter the previous year in response to the high levels of sickness absence in the UK.

Published in March 2008, the report, Working for a Healthier Tomorrow, recommended the introduction of a Statement of Fitness for Work – or ‘fit note’ – to replace the sicknote system.

Fit notes at a glance

The main changes are:

  • The removal of the ‘fit for work’ option
  • A new option for a doctor to advise if an employee may be fit for work with some support
  • More space for a doctor to provide information on how your employee’s condition will affect what they do
  • Tick boxes for doctors to use to suggest common ways to help a return to work.

Staying the same:

  • The form can still be used as evidence for why an employee cannot work due to an illness or injury
  • The statement is still not required until after the seventh calendar day of sickness
  • The information on the form is still advice to the employee. It is not binding
  • The requirements for the payment of Statutory Sick Pay have not changed
  • Employers’ obligations under the Disability Discrimination Act have not changed.
The government agreed to introduce the fit note, after concluding that the sicknote system fostered the mistaken belief that employees have to be completely fit to return to work after sickness absence. It hopes the fit note will cut the cost of sick leave for employers and benefit the UK economy by an estimated £240m over the next 10 years.

The fit note will ask doctors to tick one of two options regarding a person’s health – either that they are ‘unfit for work’, or ‘may be fit for work taking account of the following advice’.

Doctors are then told to list whether the employee would benefit from a phased return to work, altered hours, amended duties or workplace adaptations. The note does not, however, require them to go into detail regarding which activities an employee can carry out at work.


This ambiguity about the detail that GPs will be required to provide will be a major stumbling block to the success of the fit note, according to HR chiefs and legal experts.

Linda Maughan, director of HR at Middlesbrough Council, warns that it could well lead to disputes between employers and staff.

“If GPs were going to indicate that an employee was fit for some work and give an idea of activities that could be undertaken, or those which should be avoided, then this could be very helpful,” she says.

“However, if the employer is left to determine suitable work with only a ‘fit for some work’ note and a diagnosis, then those without occupational health advice may struggle and there will inevitably be disputes about what constitutes suitable work.”

Jane Hobson, employment partner at Weightmans, says the new system could cause more problems than it solves. “Certainly, anything that leads to disputes between employers and employees, which fit notes are sure to do, will ultimately mean more grievances for employers to deal with and the potential for an increased number of employment tribunal applications,” she warns.

There is also the risk the GP will recommend a course that is costly or not feasible for the employer, warns Rachel Dineley, head of the diversity and discrimination unit at Beachcroft.

“Undoubtedly there will be teething troubles at the start, and GPs will require training,” she says. “Those already working under pressure will not necessarily welcome the additional time that will need to be taken to make this regime work. From an employer’s perspective, it will be all important for GPs to understand the workplace environment and what, in practice, can be accommodated, to facilitate a return to work.”


The government acknowledges that GPs will require training – they will be given access to the national occupational health helpline, as well as an e-learning programme, modules on the Royal College of General Practitioners website and detailed guidance accompanying the fit note. But Hobson points out that GPs and employers will always have different priorities. “GPs are primarily the advocate of the patient they are treating and will have their health, and not necessarily their job as their priority,” she says.

“Quite rightly, GPs are unlikely to want to compromise their relationship with their patient, nor will they want to add to their workload and police sickness absence for employers. The burden will remain upon employers to seek detailed information about an employee’s condition and then consider how they can be rehabilitated and what adjustments can be accommodated.”

While the system is designed to get people who can work back into the workplace, employers need to be cautious and remember that the GPs recommendations are not legally binding, says Claire Hollins, employment law solicitor at Mace & Jones.

“GPs will have limited knowledge of the employee’s workplace and what their job entails,” she says. “The doctor’s recommendations are therefore really intended to encourage discussions between employer and employee to work out exactly what changes can be made to enable the person to work.”

Mary Canavan, HR director at the British Library, agrees that it would be unrealistic to expect too much too soon. “The anticipated reduction in GP time spent in appointments with employees asking for ‘fit to return to work’ statements may be outweighed by the time they will now spend in identifying what the employee will and won’t be able to do functionally if they return to work,” she says.

Amanda Harris, head of HR at The Institute of Ismaili Studies, admits that she finds it difficult to be optimistic that, in practice, the fit note will bring about the improvements promised.

“Employers are likely to find that there are additional costs involved if workplace adjustments are required to enable the employee to return to work,” she warns.

“The absence of a distinction between long-term and short-term sickness absence could mean that employers are expected to incur the expense of these adjustments for someone with a short-term illness.”


For Stephen Moir, corporate director of people, policy and law at Cambridgeshire County Council, a more wide-ranging approach is needed to effectively address absence.

“This should include support for occupational health services to be made more accessible to more employers, fundamental benefits reform and, potentially, creating opportunities to ‘reward’ or otherwise incentivise employers with a strong track record in managing workplace absence,” he says.

But while Black herself admits it will take time for GPs to adjust to the new system, she insists that the fit note will be a success in the long-term.

“I don’t think on day one we will be in nirvana, but I do believe it is a fundamental cultural and mental change that you are no longer labelled sick, and for me that’s the most important thing,” she says.

Find out more

To help employers understand the information that will be provided on the fit notes and how this will affect their return-to-work policies, the government issued guidance in February. It states that if an employer does not understand the advice on the fit note, they should discuss it with the employee in question, and if the matter is not resolved, they could then contact the GP in person – but this could come at a cost to the employer.

XpertHR has a range of FAQs on managing sickness absence and fit notes.

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