Fit-note tsar Carol Black warns note won’t work without more detail


The health expert who invented the fit note has warned it is in danger of becoming just “another version of writing a sicknote”.

Dame Carol Black’s comments come after the government released its final version of the fit note last month, which asks 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, but the note does not require them to go into detail regarding which activities an employee can carry out at work.

The note – due to come into effect in April – attracted immediate criticism from HR chiefs, who said it would “inevitably” lead to disputes between employers and staff about what constitutes suitable work following a period of sickness absence.

Black, the government’s director for health and work, told Personnel Today the fit note would amount to little more than a sicknote if GPs did not volunteer information about activities workers can carry out.

She said: “If the employer and the employee can’t get to a reasonable decision with what is written on the [fit] note, then the [fit] note will sadly be a sicknote, deeming them not fit for work.

“I think any sensible employer would say if I don’t know what adjustments I have to make then the sicknote will have to stand as a sicknote.”

Black stressed, however, the new fit note – which she suggested in her report Working for a healthier tomorrow – would not create “nirvana” from the outset and would take time for GPs to adjust to.

She said: “To start with you’ll get some GPs that feel they can fill it out in its entirety, and I think you will get some that do have some questions. I think it will evolve.

“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.”

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Shadow welfare reform minister David Freud talks to Personnel Today about the new fit-note system. He urges doctors to talk to HR about what activities a worker can carry out after a period of sickness absence.

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To help GPs to be as detailed as possible with their fit note advice, they will be given access to the national occupational health helpline, Black said, as well as an e-learning programme, modules on the Royal College of General Practitioners website and detailed guidance accompanying the fit note.

The fit note is being introduced in a bid to cure the UK’s high sickness absence rates. In 2007, 172 million working days were lost to ill heath, according to Black’s report.

David Freud, shadow welfare reform minister, urged doctors to communicate directly with HR departments about the capabilities of workers returning with a fit note.

He told Personnel Today: “I would hope that GPs would be able to let the HR departments know what the reasonable parameters [of work activities] are, so writing it onto the fit note or verbally explaining it, and that’s what the whole process is designed to do. The whole approach has got to be much more individualised.”

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