On April 6, 2010, new regulations come into force in the UK. The “sick note” which is issued by GPs will change to a “fit note”.
The new fit note replaces the existing form Med 3, which was known as a sick note and was issued by a doctor who could only advise the patient whether they should or should not work. There was no facility to indicate that the patient could do some aspects of their work if given support.
The aim of this change is to try to get people back to work sooner, if at all possible, and for them to get the support they need to do this.
Research has confirmed that work is beneficial to health. The longer someone is off work, the more likely they are to lose confidence and skills, which then become obstacles to returning. Used effectively, the new fit note should be helpful to both employers and employees.
The new fit-note system gives the doctor two options. The patient is either unfit for work or may be fit for work.
The “may be fit for work” option can be used if the doctor thinks their patient’s health condition could allow them to work in some capacity. The “unfit for work” option will be used if the doctor thinks their patient is too ill to work.
There is also a section where the doctor is able to advise on modifications to work which might be beneficial, such as:
A phased return to work.
The doctor can expand on this advice if they wish.
It will be the employer, in consultation with their employee, who will make the decision as to whether they can accommodate any changes to facilitate a return to work.
Employers of offshore workers could, in some circumstances, find it confusing or difficult to implement any recommendations for modifications to work. The current system where offshore employees are assessed by an OGUK-approved doctor for a “fitness to return” certificate remains unchanged.
It is rarely possible to modify duties offshore, although the possibility of finding onshore-based temporary work might be considered. Most offshore workers will need to remain off work until they are fully recovered.
It is in these situations that occupational healthcare providers will come into their own.
GPs will generally have to rely on their patient’s description of their job, the offshore working environment and the patient’s views of what modifications might be possible.
An occupational-healthcare provider is much more likely to have a better understanding of the nature of offshore work, the hazards, and any industry-specific guidance which might be relevant. They are better placed to give an objective, informed and unbiased opinion and advice.
The doctor will indicate on the fit note how long the modified duties should last. When discussing return-to-work plans, it is advisable to have a clear idea and agreement on the length of time this is going to take.
If the suggested timescale is considered unrealistic, then the timescale should be discussed between employee and employer. If they are unable to come to an agreement, they might well consider referring to their occupational-healthcare provider for further advice.
There may be situations where differing opinions are expressed by the GP and occupational-healthcare doctor. This happens already. For example, there can be disagreement on whether an employee is fit to attend a disciplinary hearing.
GPs are not occupational-health experts and have been advised by the medical defence societies to be careful when making recommendations on fit notes. It can also be hard for GPs to give purely objective advice because of their doctor-patient relationship.
Because of their training and experience, occupational-health doctors are likely to have a greater understanding of the job, and if you have access to occupational health, involving them in the return-to-work process at an early stage will ensure that any phased return or modifications to the job are relevant and realistic and have a good chance of success.
A recent study by researchers at the University of Aberdeen suggested that the old-style sick note signed by GPs couldn’t always be relied on. The majority of the 67 GPs interviewed said they operated a “sick note on demand” system as they didn’t wish to jeopardise their “doctor-patient relationship” were they to refuse to issue a sick note.
Some employers are worried about the potential extra work the new sick note will create for their already busy HR departments and line managers. Occupational-healthcare providers will be able to offer useful policy advice to help ameliorate this problem. A number of employers feel open-minded about the new fit note as they believe it has the potential to reduce sickness absence.
Dr Elizabeth Wright is director/senior consultant occupational physician at Abermed, a leading provider of occupational healthcare and industrial medical services. For further information on the new fit note, see www.abermed. com and the Department for Work and Pensions guide at www.dwp.gov. uk/fitnote