How to get to grips with the fit note

Written by
Changeboard Team

28 Apr 2010

28 Apr 2010 • by Changeboard Team

What is the fit note?

This April saw the introduction of a new fit note (medical statement) to replace the traditional sick note that has been used by GPs for the past 60 years. Introduced in 1948 to protect the vulnerable, the sick note system gave GPs the authoritity to sign people off work for the first six months of incapacity, before they moved into the state incapacity Benefits system.

While this approach was fit for purpose at the time, it has done little to control long-term sickness absence rates. The number of people claiming incapacity benefit in the UK has trebled to 2.7m since the 1970s and 300,000 people move out of work on to incapacity Benefits each year. 

The introduction of the fit note aims to move away from the sick-note culture to one that encourages GPs and employers to work together to help people with a medical condition to return to work faster. Under the new fit note initiative, line managers and HR professionals will have an increased responsibility in the decisions taken to support an employees rehabilitation back into the workplace. While they arent obligated to take the GPs recommendations, they can use them to help bring the employee back into the business faster which Benefits both parties.

Flaws in the system

Among the 500 employers questioned, just 5% said they thought fit notes would reduce absence rates. One in ten thought they would be hard to administer and 68% had little or no knowledge of the change and how it would work for them. On the employee side, the majority of the 1,000 respondents (57%) did not think their doctor was in a position to say if they are fit enough to work *(2.) This is a view shared by GPs with nearly two thirds (64%) feeling ill-equipped to provide fit notes for the UK workforce. A further 15% were non-committal. *(3.)

The research also indicates that employees who dont have a full understanding of the process may feel fit notes could be used to get them back to work too early or even as grounds for dismissal. If left unchecked, this could foster a culture of suspicion or lead to an increase in workplace presenteeism.

Occupational health support

Any move on behalf of the government to get people back into the workplace is commendable. However, the move from sick notes represents a big change for businesses and will take time to embed. Our research suggests that theres an apparent lack of awareness of fit notes among employers and their workforce which needs to be bridged for fitnotes to work properly in practice. Whats more, employers will only reap the long term Benefits of this move if the right support and training is in place. While fit notes will encourage employers to act more responsibly towards employee rehabilitation the initiative doesnt give them the tools or knowledge to do so.

Moreover, some problems can actually be made worse if not handled in the right way. Stress caused by a situation at work is a prime example, where encouraging an early return to the workplace without the right support could actually hinder an individuals recovery. Put simply, being able to do a vocational task, doesnt necessarily mean that a person is ready to cope with the work environment. Employers therefore need to have access to appropriate, evidence-based expert occupational health support, to ensure that they do not inadvertantly exacerbate the problem, or trigger a relapse.

Prevention is better than cure

While fit notes are a step in the right direction, they do little to prevent employers going off ill in the firstplace. Rather than just focusing on rehabilitating employees back into the workforce, employers have an opportunity to to go one step further and address an area not covered by the fit note proposal employee wellness.

In todays economic climate, making the smart employee benefit choices is even more important than ever. Pro-active workplace wellness initiatives have been found to reduce absenteeism by up to 20% in some cases, and can increase employee job satisfaction and reduce staff turn-over by between 10 and 25% *(4.). Moreover, evidence suggests that wellness programme costs quickly translate to financial Benefits through cost savings or additional revenue generation. *(5.)

Wellbeing programmes

With such appealing statistics driving an increased interest in workplace wellness, it comes as no surprise that Buck Consultants third annual global wellness survey, Working Well: A Global Survey of Health Promotion and Workplace Wellness Strategies, predicts that the fastest-growing components of wellness initiatives around the world are expected to increase 100% or more over the next three years. These include technology-driven tools, such as web portals, online healthy lifestyle programmes, and personal health records.

The good news is that there are now workplace wellbeing programmes available that include a range of online and offline communications designed to help you fully engage your staff. Whether its support for cutting back on alcohol and cigarettes or guidance on stress management, doing exercise or healthy eating, theres a whole host of information available to support your employees.

These resources can be complemented with insurance services that aid rehabilitation such as group income protection and private health insurance and other occupational health services to help identify any health risks early and enable employees to take steps to rectify them. And, whats more, if your employees health profile improves, in addition to the potential improvements in sickness absence, morale and productivity you could even receive a direct financial benefit for your efforts.

Bridging the communications gap

Our research shows that there is a major communications issue to address before fit notes can begin to have a positive impact on absence rates. Success of the scheme hinges on GPs being prepared to comment on the functional impairment that their patient has, as well as employers having the capabilities and support to being flexible to adapt the role or the workplace in the short-term.

While the DWP has introduced an Occupational Health Adviceline for SMEs, when it comes to making fit notes work in practice they are missing an important trick by ignoring the invaluable role private health insurance, group income protection and occupational health services could play in the success of fit notes. Currently occupational health and rehabilitation experts are the missing piece of the jigsaw. Yet, they could perform a potentially crucial support role in bridging the knowledge gap between employers, HR, managers, GPs and workers. Without this engagement, the introduction of fit notes may cause more problems than it solves.


*1. CIPD Absence Survey 2009.

*2. All figures, unless otherwise stated, are from Avivas Early intervention prevention research. Total sample size was 500 employers and 1,000 employees. Fieldwork was undertaken in January 2010. The survey was carried out online. The figures have been weighted.

*3. Aviva Health of the Workplace 3 Research, April 2009

*4. NICE public health guidance 13 Workplace Business Case

*5.  PricewaterhouseCoopers LLP Building the case for wellness, February 2008