Fit for Purpose

On the 6th April the Sick Note was officially replaced by the Fit Note. The new ‘Statement of Fitness to Work’ affects employees and employers across the United Kingdom. The former Labour Government, who introduced the change, believed that returning to work at the appropriate time could have a positive effect on people’s recovery from illness. Staying off work, however, for an overlong period of time could exacerbate conditions leading to longer-term absence and other consequences such as loss of confidence, loss of skills and, eventually, loss of employment. General Practitioners have complained that under the old system they were unable to make an accurate judgement on an individual’s ability to return to work as a result of their inevitable ignorance of the details of the individual’s work role.

These changes were heralded in 2009 by the national director of health and work, Dame Carol Black, following her calculations that ill-health and, by implication, prolonged leaves of absence cost the UK economy around £100 billion a year.

Fit Notes will be issued by doctors to employees who have been off work sick for longer than seven days. Whilst doctors will continue to state when someone is ‘not fit for work’ due to their condition, they will now also have the option to outline which elements of person’s work they are able to undertake without adverse effects to their health, i.e. that an individual ‘may be fit for work taking account of the following advice.’ Individuals will still be able to use the completed forms to apply for benefits whichever option is selected if appropriate.

With this new option in place it is expected that employers will play a significant role in enabling employees to return to work for restricted or limited duties rather than continuing to be signed off when they are not completely incapacitated. Employees receiving the Fit Note that states that they ‘may be fit for work’ will have to discuss their options with their employer (they seek support from a union representative or from the Citizens Advice Bureau during such discussions if they so wish). Among the options available to the employer, in addition to amending the employee’s duties, are the possibility of altered hours, a phased return to work or modifications to the workplace i.e. allowing an individual to work on the ground floor if their condition restricts their ability to use stairs. If employers are unable to make the changes required to allow the individual to return to work in any way the Fit Note will be treated as if the ‘not fit for work’ option had been selected.

Under the new guidelines a GP may state that an individual suffering from back pain is unable to undertake manual handling activities but that they should not necessarily be restricted from undertaking administrative functions. It has been said, however, that doctors will have to resist being called upon to make more detailed judgements as they are unlikely to be fully appraised of all the details of an individual’s job. The onus will be on employers, and line managers, to provide realistic plans in light of doctors’ statements to ensure that such returns to work are successful.

Whilst the BMA (British Medical Association) has queried whether businesses fully understand their new responsibilities, the CBI (Confederation of British Industry) has welcomed the moved, claiming that, ‘This is a change that employers will welcome. All too often a person is signed off sick when they are able to manage some forms of their work.’ Unions meanwhile have questioned whether giving someone who is still sick tasks to complete can really be expected to speed their recovery.

Researchers in back pain at Nottingham University have also added their voices to claims that the new policy may be unrealistic. Back pain affects up to a third of the population each year, musculoskeletal injury loses the economy up to four million working days and yet recent research undertaken found that over three-quarters of the GPs who responded to a survey said they did not take responsibility for getting their patients back to work after such injuries and only 33% ever filled out the comments box on the Sick Note designed to advise employers on their employee’s condition. Around 66% felt that rehabilitation for back pain sufferers should not be the GP’s responsibility but that of local authorities.

This apparent reluctance of doctors to address the issue of getting back pain sufferers back to work led study leader Carolyn Coole to conclude that, ‘The... Government expectation that GPs are able to successfully manage this role may be unrealistic.’ Recommending an enhanced programme of training for GPs in offering advice on fitness to work, she went on, ‘It is going to be difficult for (GPs) in terms of the amount of knowledge they will need about a person’s job and to give advice that the employer understands.’

The Royal College of General Practitioners (RCGP) has trained a thousand of their members in how to complete the new paperwork. Professor Steve Field of the RCGP stated that: ‘There has been a lot of preparation for GPs, for employers, and employees but inevitably there will be some who are not up to speed. The launch of Fit Notes is going to be revolutionary because it will change the whole culture and we know that keeping people in work helps their physical and mental wellbeing.’ He concluded that, ‘GPs are well placed to provide appropriate advice, which the employer, who understands the demands of their workplace, can use to decide whether or not they can safely facilitate the employee’s return to work.’

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