Statement of Fitness for Work (the fit note) Department for Work and Pensions

1. Statement of Fitness for Work (the fit note) Department for Work and Pensions

2. Background • Medical Statements (aka Med3s, sick notes or fit notes) are used by patients for sick pay and benefit purposes. • In April 2010 the format of the Medical Statement- the ‘sick note’ was changed with the introduction of the Statement of Fitness for Work (the fit note). • The new version: • aims to provide more useful fitness for work advice to patients and their employers • recognises that often patients can, with some support from their employer, return to work as part of their recovery • builds on the evidence that work in general is good for individuals health and wellbeing

3. Just another form to complete? • Evidence shows that work is therapeutic and helps promote recovery and rehabilitation(1); and • Unemployment is generally harmful to health and can lead to increased morbidity and poorer physical and mental health as well as poverty and social exclusion. • Most sickness absence is caused by mild or moderate mental ill health, musculoskelatal or cardio-respiratory conditions; • the effects of these conditions can often be accommodated at work with appropriate adjustments, adaptations or support • as a doctor you should be able to provide simple fitness for work advice based on an assessment of how the patients health condition affects what they can do. (1): Waddell, G. and Burton, A.K. (2006), Is work good for your health and well-being? TSO

4. The ‘sick note’ No longer in use No longer in use No longer in use No longer in use MED3 MED5

5. The fit note 1 2 3 6 4 5 7

6. Key terms (1) • Assessment- this can be a face to face consultation, a consultation by telephone or the consideration of a report by another doctor or registered healthcare professional. • Not fit for work- where your assessment of your patient is that they should refrain from work for a stated period of time. • May be fit for work- where your assessment of your patient’s health condition does not necessarily mean they cannot work; however they may not be able to complete all their normal duties or hours, or they may need support to undertake their normal duties.

7. Key terms (2) • 4. Phased return to work; gradually increasing working hours or the intensity of work duties. • A patient returning to work after an operation on reduced hours, gradually increasing over time. • A patient with a manual job and a shoulder injury, returning to work with the lifting aspect reduced and gradually increasing this over time. • 5. Altered hours; a change in hours in order to aid a return to work- does not necessarily mean less hours. • A patient whose health condition means they cannot easily travel in rush hour public transport being given the option to start (and/or leave) later. • Allowing more flexible hours for a patient who is still attending treatment.

8. Key terms (3) • Amended duties; a change in work duties in order to take into account the functional affects of the condition. • Temporarily removing lifting from the job from a patient with a back injury; • Reducing or removing the more pressured part of a job role whilst a patient recovers from. • 7. Workplace adaptations; changes to the workplace to aid a return to work- note. in most cases these should be temporary. • A ground floor workstation for a patient who has problems with stairs. • A parking space near the entrance of the workplace for a patient with reduced mobility (eg. post surgery).

9. Case Study- back pain (intro) • Alison- 35 year old contact centre worker. • Job involves taking customer calls. • She has been off work for 6 weeks with mechanical back pain and this has been her third episode in the past 12 months. • She goes to her GP for a new Medical Statement (fit note) and they discuss her condition and how she might return to work…

10. Case Study- back pain (the fit note) • Her GP completes the fit note as follows: • Advises ‘may be fit for work’. • Completes the comments box: • Referred to physiotherapy- may need time off to attend; • Need to avoid static positions by taking more frequent breaks; • Review workstation; and • Consider referral for occupational health advice. • Ticked ‘a phased return to work’, ‘amended duties’ and ‘workplace adaptations’. • This will be the case for 8 weeks. • I will need to asses your fitness for work at the end of the period.

11. Case Study- back pain (outcome) • Alison takes the latest Statement to her manager and they discuss the advice. • They agree a phased return to work with more frequent breaks. • Alison returns to work immediately and within 4 weeks is back to her normal hours • Her manager organises for an OH assessment to identify any action that may prevent future episodes

12. Frequently Asked Questions • How does the fit note affect my role as a patient advocate? • By considering work outcomes, you are continuing to act in the best interest of your patient and their family. There is strong evidence that long periods out of work are associated with poor mental and physical health, increased use of health services and poverty.

13. Frequently asked questions • Is the advice I give legally binding on the employer? • No, what you complete is advice to your patient and is not binding on their employer. The purpose of the advice you provide is to help your patient and their employer explore ways of facilitating a return to work. In some cases this will not be possible and your patient will remain off work until they have further recovered. They will not need to see you again for a new fit note to say this.

14. Frequently asked questions • What type of advice should I give? • When advising patients that they ‘may be fit for work’, the advice in the comments box should describe the limitations that the person may have and should not be too prescriptive about the solutions. • For example with a patient with lower back pain: • “Cannot sit for long periods of time”  • “Needs a new chair”  • Or, for a patient with problems travel related anxiety: • “avoid travel in peak hours”  • “should work between 10am and 4pm” 

15. Frequently Asked Questions • What do you do with a patient with two jobs? • You can only issue one fit note per ‘assessment’. Patients with two jobs will need to show the fit note to each employer (the employer may take a copy for their records). • Where the patient’s condition affects each job differently, you may want to reflect this in your advice.

16. Frequently Asked Questions • How does this affect patient confidentiality? • There are no patient confidentiality issues as you are providing the form direct to the patient, not to their employer or DWP. • However, you can give a less precise diagnosis where you feel that stating a precise diagnosis on the form would be harmful to the patient’s wellbeing or compromise the patient’s position with their employer.

17. Where to find more information • DWP guidance: www.dwp.gov.uk/fitnote • Further guidance and information on health and work and • the fit note, including e-learning for primary and secondary care and a fit note module: www.healthyworkinguk.co.uk • The evidence base: • Waddell, G. and Burton, A.K. (2006), Is work good for your health and well-being? TSO • Waddell, G., Burton, A.K. and Kendall, N.A.S. (2008), Vocational Rehabilitation, what works, for whom and when? TSO