Fit notes could pave way to better understanding

Stuart Craig’s observation that ‘fit notes’ on their own are unlikely to significantly change the way GPs manage people on sick is well made (‘Fit notes in need of a good workout’, Personnel Today, 9 December 2008).

Rolling out the fit note nationally could create an exciting opportunity to take our understanding of sickness absence to a new level. When constructing the fit note, the government should get GPs to ask employees some additional simple questions about job satisfaction, access to flexible working, and whether their employer gives them healthy living advice or other such support.

Fit-note data could, in turn, be fed into the soon-to-be established National Centre for Working-Age Health and Wellbeing, which should be well placed to identify links between employee behaviour and attitudes towards work and sickness absence.

Analysis of fit-note findings should help employers and healthcare providers to better understand which factors and medical interventions, when combined, will positively affect attendance, as well as provide an evidence base for future policy development.

GPs may be unhappy to undertake extra questioning, but the invaluable data that would quickly accumulate more than justifies the extra 30 seconds it would take to obtain the answers.

Well-crafted fit notes, set within a proactive system, would also help to alert GPs and employers to potentially long-term absences for early assessment and intervention – especially those with psychological problems and musculoskeletal disorders.

Dudley Lusted, head of corporate healthcare development, AXA PPP

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