Are fit notes working?

Introduced to considerable fanfare last year, fit notes were intended to reduce the number of people on long-term sickness absence and to help employers identify areas where convalescing employees may still be able to contribute at work.

They replaced the traditional sick note by giving doctors the option not just to sign people off as “unfit for work” but also, where appropriate, to advise that a patient “may be fit for work” if offered a phased return to work, altered hours, amended duties or workplace adjustments.

quotemarksFit notes are working where doctors are putting in the time and effort to understand the work culture and issues. Sometimes it’s much easier to sign someone off than to put the effort in.”

Cary Cooper,
professor of organisational psychology and health,
Lancaster University

Almost a year after the April 2010 launch of the fit note, has the reality lived up to the hype? Is this fresh approach to sick workers delivering tangible benefits for employers or is it mired in the complexity of dealing with the age-old headache of sickness absence?

At the Department of Work and Pensions, which oversaw the introduction of the fit note, there are no plans to produce any quantitative data to answer these questions until next year. However, a spokesman for the department said that informal feedback from employers suggests that in many cases the fit note has aided the employer to support an employee to make an earlier return to work.

And while some employers, speaking to Personnel Today, say that they have heard anecdotal evidence that fit notes have worked in some cases, all report that in their personal experience they have delivered no benefits so far.

“I’ve seen no change whatsoever,” says Stephen Moir, director of people and policy at Cambridgeshire County Council.

“In reality, all that has happened is they have changed the forms, but the approach and mentality of doctors has remained the same.”

quotemarksThe new fit note is just a prompt for a conversation to take place between the employee and employer about what is doable and what adjustments can be made.”

Ben Willmott,
senior public policy adviser,

Likewise, small-business owner Mary Boughton, who runs a 12-man herbal medicine firm and also chairs the Federation of Small Businesses’ health and safety policy unit, reports that the two doctors she has dealt with “just aren’t using” the fit note. She says that, in one instance, she had to wait three weeks for a reply after writing to a doctor to inquire whether or not an employee could return to work in a reduced capacity. Eventually, she received a fit note with the unfit-for-work box ticked and no other comments included.

“It was all very wishy-washy. By [the doctor] putting nothing, you as an employer are left wondering what to do next,” she says.

However, according to John Canning, a spokesman for the British Medical Association and a GP from Middlesbrough, in many cases it is inflexible employers, unable to accommodate workers in some kind of reduced capacity, who are encumbering the spirit of the new fit note.

“The good news about the fit note is that many more patients and doctors are having a conversation about returning to work in one shape or form,” he says.

“But the impression I’m getting from patients is they feel their employers won’t go for it. For many line managers, the issue of taking people back in this way goes on the ‘too-difficult’ pile. The situation is particularly prevalent in smaller firms and the NHS.”

quotemarksThe fit notes provide a lowest common denominator of best practice for employers. If fit notes are solely responsible for an employer improving their sickness absence, I can’t help thinking: ‘What was it like before?'”

Graham White,
HR director,
Westminster City Council

Evidence of this impasse was highlighted in a recent survey of 114 employers, two-thirds of which admitted that they did not fully implement the recommendations made in every fit note they received.

The report, published in January by XpertHR, found that common employer complaints were that doctors made suggestions that were impossible for the company to accommodate and that they did not understand the nature of individual jobs.

Not understanding the nature of a particular job or workplace culture can be especially problematic when it comes to dealing with the 40% of people who are off work because of stress or bullying, according to Cary Cooper, professor of organisational psychology and health at Lancaster University.

In a lot of cases, says Hope Daley, head of health and safety at Unison, patients end up describing in detail what they think might be the issue at work, which is often “too much information for busy doctors to take in”.

There is general agreement that the best way around this situation is to involve occupational health professionals in the process. Graham White, HR director at Westminster City Council, puts his organisation’s impressive 2.2% absenteeism levels down to progressive OH policies. When it comes to liaising with doctors over fit notes, he says, good occupational health professionals can “help the doctor with their understanding of a particular job”.

“They can analyse the elements of work that make up a job and advise on the degree of flexibility to make reasonable adjustments,” he continues. 

quotemarksDoctors deal in fact and do not want to get drawn into offering opinion. I can tell you Mr Smith has a bad back but we are not qualified to start saying he can do this job and not this one. This is a potential area of conflict.”

John Canning,
Middlesbrough GP

But while this is the ideal, Canning says that he has been very surprised by “how little occupational health there is out there compared with other countries in Scandinavia and northern Europe”.

It is perhaps too early to fully pass judgement on the success of the fit note but it appears to be an initiative that the coalition Government wants to explore further. Last month, it announced the launch of an independent review of workplace sickness absence to be led by Dame Carol Black, national director for health and work, and David Frost, director-general of the British Chambers of Commerce. The issues of fit notes and occupational health are expected to feature prominently.

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