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Fit Notes To Get A Radical Makeover

26th February 2018

The government is bringing forward legislation to extend fit note certification powers to other healthcare professionals, such as physiotherapists, psychiatrists and senior nurses. Could this be the game-changer that fit notes have been crying out for?

Employee health and wellbeing – fit notes to get a radical makeover

The government has signalled it intends to launch a major reform of fit notes, including legislation to extend fit note certification powers to other healthcare professionals, such as physiotherapists, psychiatrists and senior nurses, “along with the design and development of a set of competencies for those completing fit notes”.

The move was announced within its Improving Lives: the Future of Work, Health and Disability document published in November, a response to its 2016 Work, health and disability green paper consultation.

The government will also conduct a feasibility test to investigate whether employers could use the Advisory Fitness for Work report, which can be completed by some allied health professionals, as an alternative to the fit note.

Fit note training will be integrated into GP undergraduate and postgraduate education. A study will take place to examine the feasibility of developing clinical guidelines for workplace adjustments for the top five clinical reasons people are off work sick or are on health-related benefits.

The government pledged to explore “whether changes to the way GPs complete fit notes could support better return-to-work conversations.” In addition to fit notes, the government outlined a major review of the future role of occupational health.

Expert working group

It will set up an expert working group to build the evidence base, look at new funding models and consider “where responsibility for OH support should fall”, which is expected to report in 2019.

Finally, the government confirmed it is to pull the plug on the Fit for Work service.

The decision to close it was blamed on “low referral rates” with the service coming to an end in England at the end of March and in Scotland at the end of May.

The service was launched at the end of 2014, initially as a free, GP-led service, before being extended to allow employers to refer staff in September 2015.

However, it has consistently struggled with a low public profile and scepticism among GPs and employers.

A survey by GP magazine last summer identified that 65% of GPs had not referred a single patient to the service and that a lack of publicity was the cause. A study by Willis Towers Watson last March found only 21% of HR professionals said they had used it.

So, what should employers make of this?

Fast-track support

Certainly, the announcement on fit notes was warmly welcomed by Professor Karen Middleton, Chief Executive of the Chartered Society of Physiotherapy.

She said: “The proposal to allow physiotherapists to issue fit notes is excellent news for patients, as is the focus on musculoskeletal conditions, which are one of the leading reasons for sickness absence in the UK.

“Physiotherapists are experts in rehabilitation but also in understanding a person’s condition and identifying what adaptations can be made to enable them to return to work.

“This proposal should mean fewer unnecessary appointments for patients and faster access to the answers they need. But it must be backed up by action and we need more roles for physiotherapists in GP surgeries to deliver that expertise and fully realise the potential of this policy,” she added.

One of the complaints from employers around fit notes has been the sense that GPs have not really embraced them; that  more often than not, employees are simply signed off work rather than suggestions made on adjustments or adaptations that might allow to return to, or stay in work.

If this reform allows the fit note to be used in a more flexible, nuanced way, this is going to be welcomed by employers, as Cabella Lowe, Professional Head of Musculoskeletal Health at Optima Health makes clear.

“We all know that musculoskeletal disorders are one of the prime reasons for both short-term and long-term absence. Therefore, for employees to be able to turn to other health professionals, especially physiotherapists, to help them to offer routes back to fitness, to become ‘fit for work’ is potentially positive. We’ll certainly be wanting to look at the detail of this as we go along,” she says.

“Another potential benefit to this is if physiotherapists accessed through employer-funded fast-track services will be able to write fit notes, as that has the potential to be a real advance for many employers.

“However, extending the fit note to other healthcare professionals needs to be complementary to, rather than instead of, access to GPs. GPs are ‘gatekeepers’ of the NHS for good reasons.

Cabella adds that “ a musculoskeletal disorder can sometimes be a mask for something more serious internally, or even simply used as an excuse by an employee who does not want to ‘admit’ to a mental health issue to their employer. Extending the fit note should not become a way of deterring people who need it from seeking help from their GP."