The Big Question: Are the new fit notes fit for purpose and fit for the future?

We ask the experts for their answers … have your say online at the Employee Benefits forum.

Sarah Barnes, HR manager at Crawley Borough Council:

Employers have, for some time, been restricted by the determination of an employee as being fit or unfit to work from a doctor’s certificate. At face value, this is a clear-cut assessment, but it relies on the quality and content of the discussion between the doctor and the employee concerned.

Organisations with their own occupational health service could seek clarification of these decisions, but the process was, at times, slow and reliant on managers being proactive.

We are regularly bombarded with reports that show the cost of sickness to organisations, the impact on individuals and dire warnings about the future health and wellbeing of the workforce, so the introduction of fit notes is clearly a step in the right direction.

There will, inevitably, be some teething problems and it is welcoming to hear that the Department for Work and Pensions (DWP) intends to review their impact later this year. In the meantime, employers need to make sure they communicate how the notes will be used and the benefits to all concerned.

At Crawley Borough Council, we have worked for a number of years to reduce our average sickness levels from 11.2 days to 6.8 days per employee per year, instigating, through discussions, access to support services, phased returns to work and temporary changes in working arrangements to facilitate a return to work. These options are being discussed at the outset of absences, making the process quicker.

By being open to adjustments, we can make a real difference to our employees, improve the services we deliver and make cost savings.

Dr Peter Swinyard, national chairman of the Family Doctor Association:

The old system of Med 3s and Med 5s (and Med 4s and 7s for doctors), [which stipulated different time periods patients could be signed off work for] was last overhauled in 1984, when I was still a GP trainee. Before then, a doctor’s note was needed for all absences of more than two days.

However, the system was complex and not suited for modern general practice, in which phone and email consultations are becoming much more commonplace. It was, for instance, ridiculous that I was unable to issue a sick note legally, without seeing my patient, except in very particular circumstances, when I knew they were unfit. There was also no middle ground in the old system between ‘fit for work’ and ‘off sick’. We all know people can often do some of their job, if not all of it.

The new fit note is more complex for doctors to complete and not all have read the 24-page instructions from the DWP. The Family Doctor Association has condensed this into a one-side-of-A4 guidance. The teething problems are due to doctors’ uncertainty on how to complete the certificates and employers’ uncertainty on how to deal with them.

The main point is that they are ‘advice’, not instructions. We may suggest a graduated return to work or altered hours, but this has to be done in agreement with the employer.

Employers should heed the advice, but GPs are not trying to be occupational health physicians and employers. Many GPs will not know the circumstances in each workplace.

Take these certificates as they are and make the best of them. We try to make them helpful, but they are part of an already time-pressed patient consultation.

Professor Sayeed Khan, chief medical adviser for EEF:

The fit note is a groundbreaking change in the way we aim to get people back to work quicker, saying what they can do rather than what they cannot do. In that respect, the principle of the note is to be applauded and must be given every support.

However, it is too early to say what the impact has been to date, for a number of reasons. Firstly, ever since last summer, employers have been calling for proper information and guidance to be issued, yet this was published only in March this year, on the eve of the note’s introduction. This has given employers little or no time to prepare for the new system.

Coupled with this, there has been a lack of sufficient marketing and awareness of the note among the general public, which means most employees are unaware of it.

Secondly, there has yet to be mandatory training among GPs and hospital staff, so those who are supposed to be applying it are either unaware of it or do not use it as a priority. At the moment, it is treated as an optional extra. This would not be the case with the trialling of a new drug or any other procedure. Why are fit notes being treated differently?

Moving forward, the idea is sound, but so far the execution has been poor. As a result, we need a large awareness campaign among employers and the general public, as well as mandatory training for GPs to ensure we are not in the same position this time next year.