Fit notes: occupational health practitioners respond to government proposals for reform

The Government has announced a major review of statutory sick pay, fit notes and the role employers can play in helping people with long-term health conditions to stay in or return to work.

In a Green Paper consultation document – Improving lives: work, health and disability – the Department for Work and Pensions (DWP) and the Department of Health (DH) called for:

  • A review of statutory sick pay and fit notes “to support workers back into their jobs faster, and for longer”.
  • Jobcentre Plus work coaches to signpost claimants to therapy, as well as a “health and work conversation” between new people on employment support allowance and their work coach, “focusing on what they can do rather than what they cannot”.
  • A consultation on the Government’s controversial work capability assessment processes.
  • Encouraging “employers to work with their employees with long-term health conditions to stop them from falling out of work”.
  • A “wide-ranging debate about recognising the value of work as a health outcome”.

The review of fit notes will also include “consideration” being given to allowing other health professionals, not just doctors, to issue them.

For example, Karen Middleton, chief executive of the Chartered Society of Physiotherapy, argued that allowing physiotherapists to issue fit notes “would give patients the opportunity to be assessed, given advice and therefore begin their rehabilitation on the day they were signed off”.

Other proposals outlined in the document include:

  • The creation of a “Disability Confident Business Leaders Group” to work alongside ministers and officials to increase employer engagement around disabled employment, starting with FTSE 250 companies.
  • Developing large-scale trials on how health-led services and support can help get disabled people and those with long-term conditions back into work, with a particular focus on mental health issues and musculoskeletal conditions.
  • A closer working relationship with Health Education England, Public Health England and others “to make the benefits of work an ingrained part of the training and health workforce approach”.

Work and pensions secretary Damian Green said: “When things need to be improved, such as the work capability assessment and fit notes, we must not shy away from big decisions.”

The response to the Green Paper within the profession was largely positive, with the Faculty of Occupational Medicine (FOM) and Society of Occupational Medicine (SOM) both welcoming the consultation.

SOM president Dr Sally Coomber said: “We are keen to work with the DWP and the DH over the next few months, as they consult on the Green Paper, so we can develop better occupational health support right across the health and work journey.

“At the heart of this must be an accredited and quality-assured, multidisciplinary occupational health workforce.”

And Dr Richard Heron, FOM president, said: “We support the ambition to develop a system where healthcare professionals recognise the value of a referral for occupational health advice.

“While ‘Fit for Work’ is a step in the right direction, there is still a way to go before we can say that all employees have timely access to safe, effective and quality-assured occupational health support that puts the individual and their health circumstances at the heart of a support-tailored programme,” he added. “There also needs to be workforce capacity to deliver this support.”

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