Are fit notes reducing staff absences?

If you read nothing else, read this…

• The fit note is the first major change to sickness absence certification since 1923.
• It aims to move away from the idea of whether an employee is simply ill or not, to one of capability, detailing what they are fit for.
• Better communication may be needed between employers and healthcare professionals to help facilitate an individual’s return to work.
• An electronic format, expected to be introduced by early 2012, could enhance the use of fit notes for employers, staff and GPs.

Case study: Fasset facilitates 30% fall in absence

At facilities management firm Fasset, having a clear absence policy that facilitates occupational health and the fit note gives a clear view of absence and helps staff return to work quickly.

Fasset launched a new absence policy in February 2010. It involves training all supervisors and managers, and letting staff know about the new strategy and forms they have to complete if they are off sick. Employees are required to complete a self-certification form and obtain a fit note if their absence is longer than seven days. They also have a faceto-face meeting on their return to work.

As a result, the company has seen absence levels drop by 30% year on year. Debbie Jenkins, HR manager at Fasset,says: “We monitor absence all the time, so I know how many days have been lost in the previous month, and what our sickness absence percentage is across the business. We try to keep it as low as possible, and we have intervention with our onsite occupational health team.”

Fasset’s policy also ensures it provides guidance, advice and support to employees and to managers who may be
struggling to handle continued absences.

Employers may need to be more proactive if the new fit note system is to reduce sickness absence levels, says Tynan Barton

April 2010 saw the first major change to sickness absence certification since 1923. The introduction of the fit note to replace the old sick note was a move away from certifying that an employee is not fit for work, towards creating a culture of capability and helping staff return to work quickly. Championed by Dame Carol Black, national director for health and work, the system aims to reduce the cost of ill-health to the economy.

Under the previous sick note system, doctors could only advise an employee whether their health condition meant they should refrain from work. Although the fit note has not delivered big changes overnight, it is considered an innovative strategy, says Dr Mark Simpson, medical director at Axa Icas Occupational Health Services. “It moves people away from a mindset that sickness absence is like a light switch, that you are either fit for work or you are not,” he says. “That mindset probably existed as much in employers as it did among patients and GPs.”

When the fit note launched in 2010, Black suggested it would create gradual change, perhaps most noticeable after five or six years. Research such as the EEF/Westfield Health 2011 Sickness Absence Survey and the Confederation of British Industry (CBI)/ Pfizer Absence and Workplace Health Survey 2011 (see box) presents differing views on its effectiveness so far.

It may also help prevent some people from heading towards incapacity benefits. “It will help in the long term,” says Simpson. “After months of absence, people’s behaviour begins to change in terms of disengagement with the workplace. The fit note should be used much earlier because after months of absence, the difficulties of getting someone back to work can be consummately greater.”

Online training

Dr Sayeed Khan, chief medical adviser at manufacturers’ organisation EEF, says some employers feel GPs did not complete the old sick notes fully. Doctors had little training on the sick note system, an issue that has been addressed under the new regime. “It is worth noting there is now online training for both hospital doctors and GPs on the fit note and rehabilitation, rather than sickness absence,” says Khan.

To make the fit note more effective, employers can work more closely with GPs and other healthcare professionals to facilitate returns to work. Ksenia Zheltoukhova, researcher at The Work Foundation, says GPs do not seem to be using the fit note in the way it was intended, and are not commenting on what a phased return to work would mean for the employee. “GPs do not necessarily know all the tasks a job involves, and they might lack comments there because they do not know exactly what a person is doing at work,” she says.

Anne Payne, executive director at Validium, says: “There needs to be a review of how we match what is expected of a doctor now, to what is needed in the workplace to stop any further increases in absence levels. Doctors can fully embrace the view that their patients will be healthier if they are able to work.”

Employers can take a more proactive approach, for example by telling local GPs they can offer staff temporarily modified work. “That makes a huge difference to GPs because they then know what is available,” says Khan. “Get across the fact that, where appropriate, the employer would be willing to pay for private intervention, and you can get treatment done privately within a week or two. Many employers will pay for that, but a lot of GPs never thought they would be willing to do so.”

Helping an employee return to work should involve all the main players affected by their absence, says Jerrot Sawden, head of operations at FirstAssist. “We have seen employers review their return-to-work policies to ensure all the key stakeholders are actively involved and engaged: the line manager, HR, and other healthcare providers. Everyone works together for that common goal, which is the person returning to work.”

Dr Katie Tryon, head of clinical vitality at Pruhealth, adds: “There has to be solid communication between the employer and the GP or healthcare professional to make sure the individual can complete the tasks the note says they can do.”

An electronic format could also increase the effectiveness of fit notes, says Khan. “It will make a huge difference to some of the basic problems, for example illegible notes.”

The electronic fit note is undergoing a tendering process and is likely to be launched in late 2011 or early 2012. The form will be completed by GPs in their surgery and printed off for employees to take in to work.


• The EEF/Westfield Health 2011 Sickness Absence Survey, published in May, found 20% of employers said the fit note had helped them reduce absence, and 28% said it had aided return-to-work discussions.

• The CBI/Pfizer Absence and Workplace Health Survey 2011, published in May, showed 23% of employers have found the fit note helpful to their rehabilitation policies, but 65% said it had not moved things forward.

• In the Employee Benefits/Friends Life Group Risk Research 2011, published in July, 55% of respondents felt the fit note and fit-for-work services had had no impact on their healthcare benefits.

• However, 27% of respondents to this survey reviewed their return-to-work or rehabilitation policies in response to the fit note and fit-for-work services.

• Also, 41% of respondents to this survey believe government initiatives such as fit notes and the Welfare Reform Bill 2011 will help get long-term sick back to work.

Read more articles on sickness absence levels