Fit Notes: New guidance for employers, employees & GPs

We take a look at the new guidance on ‘fit notes’ and its impact for employers.  

6 August 2013

The average number of sick days in the UK is rising.  UK workers have significantly higher sickness absence rates than their global counterparts, which PwC estimates costs UK employers £29bn each year. However, research has suggested that work is good for health and that sick and disabled employees, when their health permits, should be encouraged and supported to remain in or (re-)enter work as soon as possible.  

The fit note replaced the sick note in April 2010 and was the first part of the Government’s package of reform in this area.  A fit note allows a GP to advise that an employee is “not fit for work” or “may be fit for work” taking into account the GP’s advice. However, employers have been dissatisfied with how fit notes have been completed by GPs so far, with many employers not receiving any fit notes stating that their employees “may be fit for work”.  

New guidance has been issued by the Government for employers, GPs and employees to ensure that fit notes are being maximised to their “full potential”. The following information is worth highlighting:

Guidance for employees

  • The employee will only be given a fit note if the employee’s health affects his/her fitness for work.
  • Having a health condition does not mean that an employee will automatically be assessed as “not fit for work”. The doctor will consider what the employee can do.
  • An employee does not need to be fully recovered to return to work.
  • A doctor cannot give a fit note for non-medical problems, such as problems at home or relationship trouble at work.
  • The employee should ask his/her doctor to give practical advice about what he/she can do, so that the employee can discuss this with his/her employer and see if the employer can make any changes to help the employee return to work.
  • The employee should keep the original fit note (and the employer may take a copy).

Guidance for GPs

  • A key message of the guidance for GPs is that “most people with common health problems can be helped to return to work by following a few basic principles of healthcare and workplace management.” Fit notes are a tool for capturing the GP’s advice clearly.
  • A GPs assessment about the patient’s fitness for work is general and not job-specific. A GP is not expected to have specialist knowledge of workplaces or occupational health.
  • The “not fit for work” box should only be ticked if the patient cannot do any form of work at all.
  • In assessing the patient, the GP should emphasise the advantages to the patient’s health of being at work.
  • A GP does not need to issue a fit note if the patient’s fitness to work is not impaired by a health condition. In particular:
    • an employee does not generally need to be signed back to work after an absence. If the employer requires evidence of the employee’s fitness, an occupational health/private GP referral will be required;
    • if “work-related stress” or stress arising from personal problems does not amount to a “mental illness”, the GP is to regard the patient as fit for work and so no fit note is required.
    • Advice should focus on what the patient can do and should be as practical as possible.
    • Where a fit note states “may be fit for work” but the employer and employee cannot agree upon measures to facilitate return to work, the note is to be regarded as “not fit for work” and a GP cannot be requested to submit a new fit note.

Guidance for employers

  • Supporting an employee’s return to work can reduce costs and disruption.
  • Fit notes assist the employer in assessing whether the employee can return to work and in what capacity.
  • The advice in the fit note is general and not job-specific, which gives employers maximum flexibility to discuss possible changes with their employees.
  • A fit note is not binding upon the employer. It is classed as advice and so the employer can choose not to accept it. If an employer disputes a fit note, it should gather evidence to support this. For example, it may request that the employee is examined by an occupational health specialist and should be prepared to demonstrate why it favoured the advice from occupational health if it did so.
  • Employees do not need to be signed fit to return to work. If an employer requires evidence of fitness to work, this should be arranged through a private GP/occupational health specialist.
  • If an employee returns to work earlier than recommended by the fit note, the employer’s liability insurance will not be affected, provided that any relevant safety procedures and a risk assessment, if necessary, have been completed.

The full guidance can be found at:

Impact for employers

It is hoped that the revised guidance should see employees more frequently being assessed as “may be fit for work” taking account of the GP’s advice, thereby reducing the number of sick days taken. Employers will need to be flexible in their discussions regarding what changes can be made to enable their employees to work. That said, the GP’s advice is not binding on the employer. Employers should also bear in mind that employees are not required to be signed fit to return to work (which has been common practice in the past).

Further changes are expected in this area. For example, the Government’s Health and Work Assessment and Advisory Service is expected to be introduced in 2014. This service will help people who have been on sick leave for four weeks get back to work by providing a return to work plan and will provide advice for GPs, employers and employees.  We will keep you updated regarding developments.