Fit notes in need of a good workout

Fit notes will certainly be a healthy improvement on sick ones, but more detail is needed.

Plans for a national system of electronic fit notes was the most eye-catching measure included in last month’s response to Dame Carol Black’s study of the heath of Britain’s working population.

Fit notes are part of official plans to make a dent in the 170 million or so days lost to sickness each year at an estimated cost to the taxpayer of £100bn. Both the Department of Health and the Department for Work and Pensions (DWP) were behind the report, which detailed a range of proposals to carry forward Black’s recommendations.

Ill-advised system?

The sicknote system, which has not changed for 60 years, has been regarded as partly to blame for the fact that there are more than 2.5 million people in the UK receiving incapacity benefits. From the employers’ perspective, traditional sicknotes are short on detail and do little to help assess the employee’s ability to return to work.

Although fit notes are now being piloted, there is little information publicly available about the level of detail they will contain. The DWP has given the example of back pain, where the fit note could indicate the level of activity that is reasonable for sufferers – for example, whether lifting or bending is appropriate.

GPs have not been slow to point out that they do not have access to enough information about the content and demands of a patient’s job to be able to make a detailed assessment of their work-related capabilities. In any case, that is the job of occupational health professionals. GPs have also expressed concerns about being pressurised into policing incapacity benefits for the DWP.

It is likely that the final proposals, due to come into effect in 2009, will be a compromise between the information employers and the government would ideally like to see, and what GPs can realistically be expected to provide.

That will mean that although employers are still likely to want more information, fit notes will provide a better starting point than the current system. They are likely to be most effective if combined with other measures the government has announced. These include the “fit for work service” pilots, which will involve co-ordinating all the relevant professional disciplines to help people back to work.

Are fit notes the cure?

Fit notes in isolation are unlikely to have a major impact on the way employers manage sickness absence, unless the legislation promised for next year is much more ambitious than the proposals outlined in the report suggest.

Until we see a major culture shift in the way GPs view their role in dealing with patients on sick leave, immediate benefits are likely to be administrative.

The most obvious plus-point will be that legibility of the notes will be guaranteed. It will also be beneficial if one regularly updated document replaces multiple sicknotes each covering a relatively short period.

The increased flexibility of electronic certificates is likely to come at a price in terms of data security. Both employers and GPs will need to assess whether their systems are sufficiently robust to ensure fit notes are processed in accordance with the Data Protection Act and their wider duties with regard to employee/patient confidentiality.

Although it is unclear exactly how fit notes will be generated electronically, one obvious point of concern is the increased ease with which highly confidential information about employees could be transmitted and accessed.

Potentially, these proposals could offer benefits to employers, although as always, the devil will be in the detail.

Key points

  • Electronic ‘fit notes’ are due to replace the 60-year-old sicknote system in 2009
  • More information is needed to assess how HR-friendly they will be
  • Data protection and e-security issues will need to be addressed before the new system goes live
  • They may make the GP/patient relationship more fraught
  • The plans should be seen in the context of other measures announced in last month’s report on the health of the UK’s working population.

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