Fit for purpose?
Hazards issue 110, April-June 2010

Ahead of the introduction of the new medical statement or ‘fit note’, which replaced GP-issued sick notes on 6 April 2010, the TUC warned employers against using the new system to force workers back to work before they are ready.

Fit notes will allow doctors to recommend that a person go back to work before they are fully recovered, if certain changes are made to their work or the workplace. That’s all well and good if the employer is willing and able to make the changes needed to accommodate a below par worker – revised working hours, a tweaked job description, or modified workstation, for example.

But there are potential flies in the ointment. Not all employers will be interested in doing the preparatory work to welcome an ailing worker back into the fold. And scarcely any GPs have the first clue about the nature of a patient’s job, how it is done and how it could be modified to make it a practical proposition. Unless that patient happens to be another GP.

TUC general secretary Brendan Barber commented: “Good employers already assist their workers who are on long-term sick leave to return to work on a phased or a supported basis. The new 'fit note' arrangements will hopefully lead to more workers being given the support they need to return after an illness or injury. But GPs may not have a detailed enough knowledge of where someone works to be able to make realistic recommendations for changes to an individual's workplace or duties to allow the worker to have the confidence to return before they are able. Similarly many employers lack the occupational advice support needed to act on a doctor’s recommendations.”

He said a positive approach involving the affected worker in genuine discussions about the possibilities might work, “but if employers see the changes as a green light to force workers back to work before they are well enough to return, in the long run, it will only lead to increased sickness absence and unnecessary conflict.”

Making it better

A new TUC guide spells out the changes, but stresses the key to ensuring that workers are not forced back to work early, or on reduced pay, is for them to have proper union representation and access to grievance procedures. ‘Preparing for the new fit note’ recommends union safety reps and stewards ensure procedures are in place to deal with potential pitfalls. It advises unions to:

Inform their members about the changes and ensure employers knows about them;

• seek agreement that any disputes over changes to work or working time proposed as a result of a medical certificate can be dealt with by the grievance procedures;

• make sure that, where necessary, the employer’s sickness absence arrangements are updated to take account of the changes; and

• where there is an occupational sick pay scheme, seek to negotiate a ‘no detriment’ agreement.

How fit notes work

Previously a sick note simply stated whether a doctor believed a person should or should not be in work.

The new medical statement, or ‘fit note’, will either indicate that a person is not fit for work, or that they might be fit for work under certain circumstances. The doctor can suggest changes in work practices to assist a return to work – although there is no requirement for the GP to write anything apart from that the person is not fit for work and for how long the person is “signed off”.

TUC says in most cases the patient and employer will see no change in the information given on the medical statement. Unlike the old sick note, the fit note will be completed and stored electronically by the GP rather than handwritten, although it will still be given directly to the worker to send to the employer. But there will be no change to the basic purpose of the medical statement and it will still be used by employees as confirmation of illness if claiming sick pay. It will not normally be required until the seventh calendar day of sickness.

The present arrangements for Statutory Sick Pay (SSP) and any occupational sick pay scheme will not change. The fit note is advisory and is given to the worker to provide to the employer as evidence of illness. It is not binding.

The GP can choose one of two fit note options; the patient is “not fit for work” or thepatient “may be fit for work taking account of the following advice.” There is space for the doctor to provide more information on the condition and how it may affect a worker’s ability to do their job.

“In most cases there will be nothing to recommend and, as at present, the worker will go back to work once the GP feels they are ready to,” the TUC guide says. There is not an option for the GP to say a person is “fit for work”. In that instance, “the doctor will simply not issue a new medical certificate,” TUC says. It adds that where a worker is not fully recovered, the doctor should only recommend a return to work after discussing it with the patient and making sure they are fully aware of what is being suggested.

It’s work, but tweaked

In the case of “may be fit for work” patients, the GP can tick one or more of four types of work alterations on the fit note.

Phased return  According to the TUC guide, the doctor is likely to propose a phased return to work where someone is suffering from an illness that has left them fatigued, or has been away for a long period of time and is not confident about returning full-time. It may also be used if a person has an injury where the doctor believes that their strength has to be built up gradually. Often a phased return to work may be proposed along with other changes, such as amended duties.

Altered hours  This may be recommended, for example, if the GP feels that the person may not be able to travel in rush hour public transport, or if shift working should be avoided.

Amended duties  The GP could recommend amended duties where they believe an employee cannot fully do their former work, but may be able to do their job if some duties or processes are avoided or changed. This could include not doing any kind of lifting if recovering from a back injury, or avoiding any work with the public if a person is recovering from workplace stress.

Workplace adaptations  Simple measures –new computer software or hardware, alterations to a workstation, modification to a machine - may be recommended if the GP believes these are needed to help the person return to work. Frequently adaptations could involve no or low cost and little disruption – moving someone’s desk to the ground floor of a building if they have trouble with stairs, for example.

“In each of these cases the GP should base the recommendations on what the patient has told them about their workplace and should discuss the proposals and the implications fully with the patient,” the TUC guide says.

Back at work

The ‘fit note’ medical statement is given to the patient, who should then send it to the employer.

The TUC says “it is good practice for the employer to then discuss the proposals with the employee and agree what changes will be made. If they disagree then the employer should not force the employee to come back until they feel comfortable with the changes proposed.” It adds: “If in doubt, the worker should ask their trade union for advice and support. In many cases, employers will have to get professional advice to help them decide on what action to take in relation to adaptations...  Unions should always make sure that the employer seeks professional advice before proceeding with any adaptations.”

The employer does not have to accept the advice on the medical statement, TUC adds, but says if they do not do so then the statement should be treated as though the doctor has advised the worker is “not fit for work”.  TUC warns “union representatives will have to make sure that employers do not ignore the GP’s advice and still expect the employee to come back to work.”

Where a worker is returning on a “may be fit for work” basis, the employer must do a revised risk assessment if they make any adaptations or changes to an employee’s duties. The purpose is to ensure that these do not introduce new risks that could create new health problems or exacerbate the existing condition.

If the employee is disabled and covered by the Disability Discrimination Act then the new “fit note” procedures do not alter the duty on the employer to make adequate adjustments, regardless of what a GP recommends. Neither can GPs override existing rules covering fitness for work in certain safety critical jobs with pre-existing medical rules – diving, driving, or working with lead or radiation, for example.

Resources

‘Preparing for the new fit note: guidance for union representatives’ is available on the TUC sickness absence webpages [pdf].

Hazards
Work and health webpage
Sickness webpage

Health and Safety Executive
Sickness absence webpages
Disability webpages

Government guidance

Fit for purpose?

Contents

• Introduction
• Making it better
• How fit notes work
• It’s work, but tweaked
• Back at work
• Resources

Hazards webpages
Work and health

Hazards 110 contents