Government's ‘fit note’ fails to deliver five years on

There has been an Industry call for increased training for GPs in health and work.

  • 43 per cent of employers say ‘fit note’ not aiding employee return to work
  • More companies saying the quality of GP advice on fitness for work has deteriorated
  • Insufficient GP and medical professional training remains in use of ‘fit note’
  • GPs and medical professionals not working closely enough with employers
  • Only low numbers of ‘maybe fit for work’  fit notes still being issued
  • Government urged to set fixed date by which all GPs and medical professional will have been trained in use of the ‘fit note’

The government’s flagship ‘fit note’ scheme for getting people back to work has failed to deliver five years on from implementation, seriously hampering the UK’s attempts to improve its sickness-absence performance and reduce unnecessary sickness absence.

The findings come from a survey of 345 companies by EEF, the manufacturers’ organisation and Jelf Employee Benefits. They show that far from aiding economic growth and improving productivity by getting people back to work earlier, the situation has failed to improve.

According to EEF, only around 5000 GPs have been trained in health and work out of 40,584 (September 2014 census) while only a small sum has been spent on GP training compared to the 170 £million the government is investing in the new ‘Fit for Work’ service over five years.

In response, among a number of recommendations, EEF is now urging government to set a fixed date by which all GPs and medical professionals will be trained in the use of the ‘fit note’.

Commenting EEF Head of Health & Safety, Terry Woolmer, said: “We have supported the ‘fit note’ since day one and wanted it to succeed. However, the evidence is now clear five years on that it’s not delivering on helping people back to work earlier. In fact, the evidence suggests that the quality of advice being given by GPs to help people back to work is deteriorating.

“It can still be made to work but government now needs to put its shoulder to the wheel with greater resources. The first step must be to ensure that all GPs and hospital doctors are trained in health and work issues so they feel confident in giving proper advice. Without this as a basis there is little prospect of the ‘fit note’ ever delivering genuine improvement in return-to-work performance and absence reduction.”

According to the survey 43 per cent of companies say the ‘fit note’ is not helping employees return to work, up from 35 per cent in 2010. This compares with 22 per cent (24 per cent in 2010) saying that it has resulted in earlier returns to work.

With regard to the advice given by GPs about employees’ fitness for work in 2014, more companies disagree (47 per cent) than agree (17 per cent) that this advice has improved.

However, more positively, there has been a small improvement and reduction in the number of companies who did not receive ‘may be fit for work’ fit notes. Just over a quarter (26%) of companies report that they did not receive any ‘may be fit for work’ fit notes in 2014, compared with 35 per cent in 2010.

However, despite this direction of travel, it is discouraging for employers because just over two-fifths of employers (41 per cent) have said they are able to make all the required workplace adjustments for employees with fit notes signed ‘may be fit for work’ (an increase from 38 per cent in 2011). Only eight per cent of employers said they are not able to make any adjustments (a decrease from 18 per cent in 2011).

In addition to greater resources for GP training and a fixed date for GPs and medical professionals to be trained in the ‘fit note’ EEF is calling for a step up in efforts to create greater interaction between GPs, employers and employees.

Without this EEF believes there is little prospect of the ‘fit note’ ever delivering genuine improvement in return-to-work performance and absence reduction.

To aid this process, EEF has developed a template for use by employers so that employees will be able to take this to consult with their GP on what the employer is able to do to aid return to work.

Terry Woolmer added: “It is vital that employers take their responsibility for working with employees and GPs seriously. This template will spell out clearly the adjustments they are willing to do to enable the employee to return to work in some capacity and should enable a speedier and better quality recommendation from GPs.”

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Key recommendations:

  • link evidence of fit-note training to GP and medical professional CPD and appraisal systems;
  • create e-communities to allow more effective interaction and communication between GPs and employers and employer occupational health services in the ‘fit note’ process;
  • provide targeted advice for SMEs who may come across a ‘fit note’ infrequently;
  • target training of line managers about awareness of the ‘fit note’ process;
  • target employee awareness and training of the ‘fit note’ process at induction;
  • analyse and publish GP performance in using the ‘fit note’ and issuing ‘may be fit for work’ fit notes;
    • modify the ‘fit note’ to include a referral to the Fit for Work Service (FWS);
    • produce clear guidance to show the interaction between the Fit for Work service and the ‘fit note’.

A copy of the survey is available to download from Jelf Employee Benefit’s Wellbeing Knowledge Centre.