What will the proposed fit note reforms mean for employers?

Last November, the government announced it will take steps to reform the fit note process to support more people to resume work after a period of illness. It will do this through trials in some integrated care systems (ICS) in England to increase access to health and employment support, referrals for those who have received a fit note for a prolonged period of time and a form redesign.

The aim is combat those who are economically inactive due to long-term sickness and disability. But what will the proposed fit note reforms mean for employers?

Current fit note process

The UK fit note is official medical evidence that confirms if an employee is fit for work or not, and includes a healthcare professional’s advice regarding their health. It is needed when an employee is absent for more than seven days in order for statutory sick pay to be paid and can enable a worker to access health-related benefits.

Since July 2022, nurses, physiotherapists, pharmacists and occupational therapists have been legally permitted to certify a fit note in addition to GPs, provided they work in a general practice or hospital setting. Meanwhile, the government updated its guidance in October 2023 to include a new fit note checklist to aid employee conversations, a document explaining how the form should be used and case studies.

Employers’ responsibilities

The government will be trialling reforms to the fit note process to ensure easier-to-access specialised support, and improved triage and signposting. As a result, employees may get the professional help and support that they need in a shorter space of time. This will not only likely help them but also their employer if they are able to return to work faster.

Following the changes, employers should continue to act in the same way, says Kate Palmer, employment services director at Peninsula. “They should review any fit notes to check if an employee’s healthcare professional has assessed whether they are fit for work or not. They should also check how long it applies for, and whether the employee is expected to be fit for work when the note expires,” she adds. “If they are, employers should discuss it with them and see if they need changes to come back to work.”

The new guidance recommends that line managers have regular contact with an employee throughout the time they are off sick, to get a sense of if they feel ready to return to work.

Best practice is about staying in touch, tracking progress, adapting and going at the individual’s pace until they are working at their maximum capacity, explains Matt Smith, group income protection rehabilitation manager at Aviva.

“That’s where group income protection comes in, whether through in-house vocational rehabilitation managers, or through rehabilitation partners who specialise in return-to-work support,” he says. “The case managers monitor progress and look to increase work-related output as someone goes through the stages of recovery, using the workplace as part of an individual’s overall rehabilitation.”

Communication is key to successfully aid an employee’s rehabilitation and help them to remain in the workforce while recovering. A lack of this can leave them feeling isolated and undervalued, so employers should take time to understand how they would like to be supported and how to put the most appropriate plan in place.

Effective return-to-work plans

A return-to-work meeting is often held after a period of absence, regardless of how long or the type of illness, to plan for an employee’s return. An employer will ask the employee questions to confirm why they were off, how long they were off, what treatment they sought and received, how they are feeling now and whether they need any support. The reforms will improve access to this. A meeting is not a legal requirement but it can be useful if a phased return to work is needed, and to discuss what the individual would like to keep confidential.

The employer might also look at any doctor recommendations or consider a referral to occupational health, says John Palmer, advisor at the Advisory, Conciliation and Arbitration Service.

“If the employee is disabled, their employer should discuss whether there are any reasonable adjustments [it] can make to support their return to work,” he adds. “An employer should also look out for signs of underlying problems causing an absence, such as work-related stress or a disability. An employee does not have to tell them anything but talking openly can help put the right support in place.”

Effective return-to-work plans identify appropriate adjustments personalised to needs. For physical conditions such as back pain, that might include ergonomic assessments and specialised desks, chairs and footrests; employees who are fatigued after a stroke or long Covid may need frequent breaks, and those with mental health illnesses may need access to employee assistance programmes or other counselling services.

Employers should have a flexible, progressive plan that phases in hours and duties, and is bespoke to the individual, their work and their condition, says Smith.

“The plan shouldn’t be seen as rigid but should have goals to work towards before increasing responsibilities,” he explains. “Employees don’t have to be 100% before returning to work after a long absence, but with the right support they can return earlier. It’s all about making adaptions to help them make the transition and letting them go at their pace. It’s important to keep fine tuning until the end goal is reached.”

The proposed fit note reforms will offer employers more guidance in the area, while also helping them to potentially decrease the length of time an employee is off sick through extra support.