Fit Note Policy

 

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Introduction

A fit note must be issued by a healthcare professional, who could be a doctor, nurse, pharmacist, physiotherapist, or occupational therapist.

When doctors are asked to issue fit/sick notes or sign any paperwork, they have to use their professional judgement to determine whether the requested statement is true and an appropriate one for them to make.

Doctors also have a responsibility to the public bodies that oversee medical practitioners in the UK and can only provide statements that they can justify on clinical grounds.

This is the foundational basis on which the Practice deals with any requests for fit/sick notes.

Fit notes are issued as part of a “package” of care plan to facilitate the return-to-work agenda of the government.

Patients who are issued fit notes by Penrhyn Surgery GPs must have a clear, agreed-upon management and treatment plan with a clinician.

Example of management plans including taking prescribed medication, ensuring engagement with care plan as demonstrated by regular attendance with appointments (specialist, counsellors, and GP), clear evidence of engagement with their employer’s occupational health plan and social prescriber’s advice, etc.

The fit note focuses on what patients can do at their work. This brings together clinical aspects of illness and how it affects their functioning and ability to work.

 

What is a fit note?

'Fit note' is the informal name for a Statement of Fitness for Work. This is also referred to as a sick note, med cert, med 3, or doctor's note.

It provides evidence of the advice patients have been given about their fitness to work.

A fit note explains details of your condition. This will also assist you and your employer to think about steps to help you return to work.

 

How can I request a fit note?

You can request a fit note by any of the following methods listed below:

  • You can submit your request for a Fit note via Klink, our online portal
  • You can request one via the Surgery reception
 

Who can issue a fit note?

The healthcare practitioner (HCP) providing the patient's clinical care is responsible for assessing the patient's fitness to work and deciding if a sick note is required based on their knowledge of the illness, the expected recovery time, prognosis, any complication of treatment, and any other patient’s circumstances they consider to be relevant.

Previously fit notes were issued by GPs and Hospital doctors only.

From 1 July 2022, in addition to GPs and hospital doctors, it was widened to include other health care professionals including nurses, occupational therapists, pharmacists and physiotherapists.

All GPs, nurses, occupational therapists, pharmacists, and physiotherapists can provide simple fitness for work advice. This can help patients return to work and aid their recovery. It is then up to a patient and their employer to discuss this advice and consider possible changes.

 

Sick notes after hospital care

For sick/fit notes following hospital admission, outpatients, or operations, please ask your hospital doctor to provide you with one before you leave the hospital.

Despite what the hospital might say about seeing your GP for a sick note, it is the legal and contractual duty of the hospital doctor treating you to provide a fit note should you require it.

If you have already left the hospital without your sick note, please contact the secretary of the consultant under whom you were treated. It remains the hospital's responsibility to issue the first sick note after any hospital attendance. When asking for your sick note, please ensure that it is for the correct/required duration - there is no legal requirement for the first note to be only two weeks if your consultant has already advised that your absence from work is going to be a lot longer.

Hospitals have access to paper sick note pads and the postal service to get your sick note to you.

This is an extract from the guidance from the Department of Work and Pensions about fit notes (also known as the doctors’ statement or Med 3s in this text). A copy of this has been attached, and you can present this at the hospital.

The role of hospital doctors in issuing the Statement of Fitness for Work

The duty to provide a Med 3 rests with the doctor who at the time has clinical responsibility for the patient.

Hospital in-patients Form Med 10 should continue to be issued to cover any period that a patient is in hospital. On discharge from hospital, the doctor who has clinical responsibility for the patient should provide them, if appropriate, with a Med3 to cover a forward period. This is to avoid unnecessary referrals to GPs solely for sickness certification.

Hospital out-patients For an out-patient this will generally be the hospital doctor. In cases where the patient’s GP has not taken over responsibility for the incapacitating condition the treating clinician should issue any subsequent Statements for an appropriate forward period.

UPDATE: From November 30, 2023, as part of hospital contract changes, all hospitals must have in place facilities to be able to send a fit note to any patient electronically. There is therefore no excuse for the hospital not to be able to issue a fit note for you should you require it.

 

Occupational Health Services and Fit Notes

If your illness is impacting your ability to work for a long time, you can also be assessed by an occupational health clinician who is trained to assess your fitness and ability to work or not work.

Please discuss with your line manager at work or the Human Resources department who can signpost you on how to access the services of an occupational health specialist.

Please ask your manager or HR to refer you appropriately for the assessment.

 

What are the outcomes of the Fit Note assessment?

  • The Patient is not fit for work – The total length of time expected off work should be given (do not issue 2 weeks when 6 weeks is expected for recovery), and HCP should note that any further sick notes requests will be redirected back to them from the GP.
  • If it is your opinion that the patient is unlikely to ever work again, please be clear about this and document this in the sick note.
  • The Patient may be fit for work – To direct them to their employers or the DWP (benefits department).
  • The Patient is Fit for Work – No sick Note is required.
  • The patient should be Fit for work (after x period). This may be written as part of a “not fit for work” sick note. This will guide GPs when the patient returns for any issues after the x time has elapsed, and GPs can then review the case and determine the appropriate steps in patient management.

It is also possible for a fit note to be based on consideration of a written report by another healthcare professional involved with the diagnosis or care planning of the patient. This does not need to be one of the five professions listed in the regulations.

 

What is the purpose of a fit note?

The fit note focuses on what patients can do at their work.

There is a consensus that it is good practice for GPs and other healthcare professionals to:

  • play a role in advising patients about (return to) work
  • Agree that (return to) work is an important health outcome for clinical management
  • Help patients develop a return-to-work plan (for example, patients may be required to take medications, attend specialists’ appointments etc. in support of their return to work plan)
  • Help return to work through shared decision-making
  • Enable patients to effectively communicate with their employers (for example patients may be advised to speak with their employers, line managers and occupational health departments)
 

What is the relationship between work and the fit note?

The fit note focuses on what patients are able to do in relation to their work.

The assessment about whether a patient is fit for work is about their fitness for work in general and is not job specific.

If we assess that the patient’s fitness for work is not impaired by a health condition, they are fit for work and do not need a fit note.

We always consider if our patient could do work of some kind before advising that they are not fit for any work.

We want our patients to remember the long-term health risks of worklessness when we are advising them that they are not fit for work.

The fit note focuses on what patients can do in relation to their work. This brings together clinical aspects of illness and how it affects function and ability to work,

Further informaton on health, work and wellbeing evidence and research

 

When do I need a fit note?

7 days off sick or less

If you're off work sick for 7 days or less, your employer should not ask for medical evidence that you've been ill. Instead, they can ask you to confirm that you've been ill. You can SELF-CERTIFY by filling in a form yourself when you return to work. 

How to self-certify

More than 7 days off sick

If you're off work sick for more than 7 days, your employer will usually ask for a fit note from a healthcare professional.

 

What happens after I submit my fit note request?

The issuance of a fit note is an administrative task and may take up to 10 working days (2 weeks).

Given this, do not request emergency or urgent appointments to request fit notes, as they will be declined.

Should you have a health concern, you view to be urgent please book an appointment for this independently of your fit note request.

Please note, when deemed appropriate by the healthcare professional, a fit note can be backdated.

All fit note requests are reviewed every week at the Fit Note Clinic. The Fit note clinic is led by a GP and comprises a team including Doctors, nurses, the Practice manager and sometimes wider health professionals such as the mental health nurses and social prescribers.

 

How do I get assessed after submitting my fit note request?

Patients do not always need to see a GP in person to be assessed for a fit note.

The assessment for sick notes can be based on your records and the doctor does not need to speak with you if they think there is enough evidence from your records to either issue or refuse to issue you with a fit note.

An assessment of your fitness to work can be done by a variety of methods including:

  • A review of your clinical records
  • A face to face appointment
  • A telephone consultation

If you are off work due to a hospital admission, a fit note can be issued by the hospital to cover the period you were in the hospital. Once discharged, your GP can issue a fit note, based on your hospital discharge letter without necessarily needing to see you.

 

Can I specify the duration I would like my fit note to last for?

The length of time requested is a clinical decision made by the health professional, based on a thorough assessment of your health condition and how long they think is appropriate for you to be off work.

If the health professional deems you not fit to work, they will ascertain how much time is required (backed by clinical evidence-based guidelines) for you to be fit for work. 

Recovering from Surgery

 

Can my fit note request be declined?

The issuance of a fit note is discretionary and based on a full assessment of the patient’s fitness to work by the health professional.

If you are deemed fit to work, following a full assessment of your fitness to work, your fit note request can be declined.

The healthcare professional may choose the "may be fit for work" option if they think that you can do some work. This may not be your usual job. They may also advise that you get some extra support from your employer.

You should discuss this advice with your employer to see if you can return to work. For example, your healthcare professional may suggest possible changes, like:

  • returning to work gradually, for example, by starting part-time
  • temporarily working different hours
  • performing different duties or tasks
  • having other support to do your job - for example, if you have back pain, avoid heavy lifting
 

Can I request a backdated fit note?

We may issue back-dated fit notes, if:

  • There is documented evidence of consultation with a health professional for the condition for which the patient is requesting a fit note. E.g. recent attendance at A and E / consultation with an Out of Hours doctor.
  • Following an assessment of the patient, the health professional has determined that it is appropriate to issue a fit note.

We will not issue fit notes for any condition for which there is no documented evidence on our notes of the illness in question. e.g. A&E letter or GP consultation.

If you are off work, due to a Hospital admission, a fit note should be issued by the Hospital to cover the period of time you were in the Hospital.

Once discharged, your GP can issue a Sick Note, based on your hospital discharge letter. If you think this is your situation, our Reception Team will assist you.

 

Can I request a fit note in advance (for a date in the future)?

Sometimes patients have requested a fit note to commence at a future date e.g. in anticipation of an operation/intervention or procedure.

Unfortunately we are unable to issue fit notes for dates in the future and can only issue fit notes for already established illnesses/health concerns.

 

Don’t I need to be fully recovered before I return to work?

You do not need to be fully recovered to go back to work.

For example:

  • Your employer may agree to make some changes to help you return
  • If your health condition no longer affects your ability to do your normal duties, you may be able to return, even though you have only partly recovered
 

Do I need a note saying I’m fit for work?

No, you do not need to see a healthcare professional again to go back to work.

Some employers have their policy that requires employees to obtain medical evidence that they are fit for work. If this is the case, your employer should help you arrange this privately with a healthcare professional or occupational health specialist.

A healthcare professional cannot issue a fit note for this purpose.

 

Do I need a note saying I’m fit for work?

No, you do not need to see a healthcare professional again to go back to work.

Some employers have their policy that requires employees to obtain medical evidence that they are fit for work. If this is the case, your employer should help you arrange this privately with a healthcare professional or occupational health specialist.

A healthcare professional cannot issue a fit note for this purpose.

 

Can I request a fit note for my child for school?

It should be noted that GP practices do not provide sick notes for school children. Parents/guardians are responsible for excusing their children from school.

GPs cannot provide retrospective sickness certification.

 

My child has missed an examination, can I request a fit note?

Children who have missed exams due to illness are frequently told by schools that a note from a doctor is required;

But this cannot be provided by the GP.

When a child suffers from a long-term condition, any certification will be provided by the responsible specialist.

The General Practitioners Committee (GPC) has sought and received confirmation from the Office of the Qualifications and Examinations Regulator that Awarding Organisations make no requirement for pupils to obtain a medical certificate in support of their application for special consideration.

Students are asked for information in support of their application, but this may take the form of a statement by the school.

The Joint Council for Qualifications has confirmed that, as far as they are concerned, if a student was absent from an examination as a result of illness and has the support of the school or centre to be absent, special consideration will be granted on that basis.

Awarding organisations do not insist that medical proof is provided.

Missed or Deferred Exams, Schooling or University Letters: We do not provide sick notes or letters for educational institutions. Examples include letters for toilet breaks, menstrual periods, term work, exams, or specific dietary requirements. It is a responsibility of the parent or student to provide this information. For school exams, please see the Joint Council for Qualifications website http://www.jcq.org.uk and look for “access arrangements and special consideration”.

 

Do I need to pay for a fit note?

There is usually no charge for providing a fit note if you are off sick for more than seven days.

Some employers may request a fit note (e.g., from employees who repeatedly take time off sick) even if they are off work for seven days or less. This is a private, non-NHS medical certificate.

For sickness of seven days or less, a charge of £20 is payable for us to provide a certificate.

If you are off work due to a hospital admission, a fit note can be issued by the hospital to cover the period you were in the Hospital. Once discharged, your GP can issue a further fit note, based on the assessment of your hospital discharge letter.

 

What about Private Consultations and a fit note?

The private healthcare practitioner whom you have seen is responsible for issuing you a sick note.

Issuing a fit note is discretionary, and we are under no obligation to convert your private fit note to an NHS fit note.

 

What happens if I can’t get a fit note?

An employer can accept alternative evidence of sickness (for example, evidence of admission to hospital) and can decide to pay SSP if the employee has a good reason for not supplying a fit note.

Please contact the secretary of the consultant under whom you are so that you can put your request directly to the responsible doctor.

When appropriate, our secretary can help certain patients write letters of support regarding their sick note requests to their hospital or community specialist. Please ask for further information at the reception.

If you still have difficulty obtaining your sick note from the hospital, please contact the PALS (Patient Advice and Liaison Service) of the hospital concerned, and they can assist you.

 

Further Information

Can I get a fit note without seeing a healthcare professional?

Health, work and wellbeing - evidence and research

Kindly click on the links below for further information about Fit notes: