Fit notes need to become more ‘dynamic’ to allow people off work because of ill health to be referred to more specialised support, including occupational health professionals, a think-tank has recommended.
Prime minister Rishi Sunak last week unveiled plans to move responsibility for assessing fitness to work away from GPs to non-medically qualified “specialist work and health professionals” in England.
Separately, the right-wing think-tank Policy Exchange has outlined its own perspectives on how the fit note system needs to change.
Key to the report Not fit for purpose is the recommendation that the fit note should become more flexible and nuanced.
Rather than people just being signed off work, they should be categorised as either requiring ‘Further Assessment’ or ‘Ongoing Assessment’, Policy Exchange has argued.
Fit notes
Ending of pandemic restrictions led to sharp rise in fit notes
Those deemed needing ‘further assessment’ should be able to be referred to a more specialised assessment of their needs. In particular, there should be a recommendation for “further assessment from an occupational health professional”.
Occupational health professionals should also be given the power to issue fit notes, should be able to request updates to the GP record, or to seamlessly inform and update GP staff.
The ‘ongoing assessment’ category would then be introduced for those with long-term or chronic conditions where more routine appraisal of fitness to work would be required.
In any instance where a person is signed off with a mental or behavioural disorder diagnosis for more than 14 days, they should automatically be referred for ‘ongoing’ assessment, Policy Exchange has argued.
Except for a limited number of conditions – such as seasonal respiratory illnesses which are defined by the government – individuals should no longer be able to request a repeat fit note without ‘further’ or ‘ongoing’ assessment, it added. This assessment “should be delivered by a relevant, qualified professional to provide continuity”.
NHS England should collect data on the number of repeat fit notes that have been issued, it also recommended.
The report argued: “Ultimately, the ‘fit note’ in its current form is uniform and analogue, but needs to become a more dynamic, digital tool to capture a complex range of needs: those with multiple or long-term conditions that will need recurrent support with periods in and out of full-time work; the young who are at risk of falling out of employment and education but where more proactive intervention and shorter periods of absence ought to be recommended.”
The latest recommendations follow a report published in February that argued more specifically for reform of occupational health.
The None of our business? report recommended an extension of workplace health tax reliefs through the creation of an ‘annual allowance’, set at £2,500 for every employee.
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It called for the NHS Health Check, which is currently offered via GPs to screen over-40s for a number of health conditions, to be made routinely available via workplaces and for eligibility to be extended to those over 25, with a focus on areas of the country where economic inactivity rates are highest.
It recommended that more doctors and nurses should be trained in occupational health. The leisure sector should also play a greater role in offering pain management and physiotherapy sessions to support people with musculoskeletal problems, it argued.
