Fit notes and sickness absence management

Handling long-term sickness absence is a major issue for many employers. They will, no doubt, be disheartened by the news that, in a recent study published in the journal Occupational Medicine, researchers found there was very low awareness and application of the Department for Work and Pensions’ sickness certification guidelines.

According to that research, only one in 20 GPs follow government advice on sick leave, with employees often being signed off for far longer than the time recommended, and an enormous disparity between GPs in the amount of time signed off for the same conditions. Perhaps unsurprisingly, the same research also found that nearly two-thirds of the GPs surveyed had not received any training in sickness certification. Lastly, and equally concerning, is the fact that the study found most GPs felt that patients and GPs have equal influence on the length of the period covered by the sickness certificate. This is clearly unsatisfactory and extremely frustrating for employers.

Counting costs

The cost to the economy of absence and unemployment due to ill health is estimated to be £100bn each year. In March 2008, Dame Carol Black published her report Working for a Healthier Tomorrow following a comprehensive review of the approach taken to health at work. Her recommendations included an overhaul of the sickness certification process and the introduction of a new computerised certificate system to replace the paper sickness certificates currently filled in by GPs. The new electronic ‘fit note’ is due to be introduced in April this year. Where does this leave employers in light of the recent research, and will the new ‘fit notes’ make any difference in tackling long-term absence?

Fit notes

Fit notes (which are the subject of a government consultation which closed in August) are intended to change the focus, with an emphasis on fitness rather than sickness, by giving GPs another category on the form indicating that the individual “may be fit for some work now”. If the GP completes this category, they will be asked to describe the functional effects of the employee’s condition, with the option of setting out suggested arrangements which could help them back to work, such as a phased return, altered hours, amended duties or workplace adaptations.

However, the fit notes have already been subject to criticism on the grounds that GPs have not been sufficiently trained in occupational health to make an informed assessment of the employee’s work-related capabilities. In addition, employers are not required to follow the GP’s recommendations (subject to any obligations under the Disability Discrimination Act) and, therefore, this may not prove to be such a simple solution to helping people back to work.

 Sickness policies

In view of the lack of consistency from GPs revealed by the research, and the potential problems with the new fit notes, it continues, above all, to be essential for employers to have in place detailed sickness policies which clearly set out trigger dates for action, and for employers to follow those procedures rigorously.

Key points

• Employers should take the initiative when it comes to managing sickness absence.

• A detailed sickness policy, which is followed through to maintain regular contact with the employee during their absence, and which is backed up by line manager training, is essential.

• Consider referral to an independent specialist, unless new fit notes provide enough information to enable you to make decisions about an employee’s fitness to return to work, particularly if dismissal is a possibility.

A policy that promotes dialogue between the employer and employee, making it clear that the employer wants to try to get the employee back to work and giving support including, where appropriate, adjustments such as a phased return, will all help the employee to get back to work. Employers should also consider referral for an independent assessment from a specialist doctor or occupational health expert, and this is an important part of this process, depending on the illness concerned.

Although the new fit notes may mean that the process of returning to work no longer requires 100% fitness and may result in a cultural shift, this will take some time, and training for GPs will be essential. Therefore in the meantime a clear and detailed policy including training for line managers in implementing that policy continues to be the most important tool for employers in tackling sickness absence.

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