Changes to the “Fit Notes” rules

Changes have been made to who can legally certify "fit notes".

Doctors are now no longer the only medical professionals who can certify them.

With effect from 1 July 2022 nurses, occupational therapists, pharmacists, and physiotherapists can also do so.

The change is being delivered in GP surgeries, hospitals, and other NHS settings where healthcare professionals (HCPs) delivering NHS services will have access to the new fit note form. HCPs are regularly at the forefront of patient care, with professions keen to identify work and health requirements, get the right treatment, and support and assist patients to manage their condition and remain in work or return to work in a timely manner.

Having more professionals offering this service should therefore speed up the process and support people to return or to remain in work.

The New Changes

Fit notes, formerly sick notes, are official statements from a registered healthcare professional, giving their medical opinion on a person's fitness for work. They can now be provided in writing or electronically and might also include recommendations for how the employer could support the employee. Whether a fit note is needed or not depends on the length of sickness absence.

The Guidance has issued key resources covering broad principles applicable for those involved in certifying fit notes which includes: -

• Non-statutory guidance for healthcare professionals and their employers
• Getting the most out of the 'fit note' - which covers the practical task of undertaking a health and work conversation and completing the fit note form
• e-Learning for healthcare fit note training module - which supports healthcare practitioners in preparing to certify fit notes as part of their practice

How do fit notes work?

HCPs can issue a fit note once an employee has been absent from work for more than seven calendar days (the employee self-certifies for the first seven days).   The fit note can state that an employee 'may be fit for work or 'not fit for work.'   The HCP will only issue a fit note if an employee's health affects their fitness for work. Their decision will be based on the individual's general ability to work, not their ability to do their own job, as employers may be able to make adjustments so that the employee can carry out some work during their recovery period. The fit note also informs the employer when the HCPs assessment ends and whether the employee needs to see them again on expiry of the fit note.

NB. HCPs cannot issue fit notes for non-medical problems (such as home or relationship issues). 

In order to provide the employer with advice on getting the employee back to work, the HCP may tick one or more of the following, to indicate that the employee might benefit from:

• A phased return to work
• Altered hours
• Amended duties
• Workplace adaptations

Employers should ensure that that any adjustments suggested by the HCP are suitable and do not pose a risk to the employee.

What must an Employer do?

If the fit note states that the employee is 'not fit for work' the employer should note when the fit note expires and whether or not the HCP requires to see them before their return to work. The employer should be aware that the employee can return to work before the fit note expires and does not need to visit the HCP again to "sign them off". That said, if the employer is not sure if their early return is appropriate, (sometimes the case if an employee is not being paid) they could suggest that the employee return to the HCP for confirmation.

If an employee is deemed "not fit for work" and this is for an extended period, the company may consider obtaining a medical report from a third party, for example, an occupational health professional.

If the note states that the employee "may be fit for work" the employer should discuss the HCPs recommendations with the employee, which could include a complete change of role for the recovery period, adjusted/part time hours, working from home or increased breaks, for example. If the employee's conditions means that they are disabled under the Equality Act 2010, the employer is under a legal duty to make reasonable adjustments to the working environment to support the return to work.

The HCPs advice on the fit note is not legally binding - it is there to provide further information on what the employee can/cannot do.  

If the fit note states that the employee's job may be affecting their health, this should be discussed with the employee to determine what aspects of the job are having a negative impact on their health and wellbeing.

The employer should remember that they are at liberty to obtain further information from a GP or occupational health specialist.

Possible Concerns for the Employer

These recent changes have caused some employers to raise concerns about employees potentially manipulating the process by seeking out HCPs who are more likely to offer a fit note or being able to visit any pharmacy and easily obtaining a fit note "over the counter". 

These concerns have been addressed in the Government guidance which states that healthcare professionals "should consider their scope and practice and ensure they have the relevant skills, knowledge and experience before undertaking health and work conversations and making decisions around certifying fit notes." 

In addition, HCPs are required to assess an individual's fitness for work before issuing a fit note, which prevents employees obtaining a fit note without a professional assessment being completed.

N.B. Following on from these changes, employers must ensure that their contractual sick pay is not conditional on an employee seeing a GP as this approach may well cause problems.

What are the positives for employers?

The pandemic had a massive effect on consultations with the doctor and the subsequent issue of fit notes.  Also, employers have had to become more flexible with regards to the evidence required for any type of sick leave.  

The change in the way fit notes are issued, should mean that employers receive more accurate up to date information from an HCP who is treating the employee and therefore more likely to be aware of what work their patient is fit to do.  

Employees do not always need to be fully recovered to go back to work, and it is proven that work can often help in the recovery process. The HCP will discuss how an employee's health affects what they can do at work - thinking about fitness for work in general, and not just in the job they are in. 

 The HCP can also give practical advice on the fit note rather than simply recording the health condition. This should assist employers when making decisions regarding what adjustments can be made to facilitate a return to work.

Useful Resources:

Further information and guidance can be found in the following:

On the Government website:

•  The fit note: guidance for patients and employees
• Getting the most out of the fit note: guidance for employers and line managers

Also see the ACAS website regarding fit notes and proof of sickness