Fit notes need to be more effective as PM announces review of the system
Prime Minister Rishi Sunak is expected to announce plans to review the fit note system for people who aren't well enough to work. In response to this, the Society of Occupational Medicine (SOM) is calling for a review of fit notes by health professionals trained in occupational health to support their better use.
As the PM states, the fit note is not used to its full potential, with fit notes generally focusing on the ‘not fit’ for work option, rather than the ‘maybe fit for work’ section. Over a third of fit notes are issued for five weeks or longer, by which time around 20% of people will never return to work.
People seeing their GP team expect an all or nothing ‘sick note’. This makes it harder to manage expectations and come to a shared decision about using the ‘may be fit for work’ option. Discussing the merits of the ‘may be fit for work’ section, or a shorter review period before reassessment can be perceived as punitive by patients who expect to get ‘signed off’ and find it difficult to understand why their GP team would challenge this. That is why SOM is calling for tailored occupational health advice to be made available to patients who receive the fit note - with better use of the 'maybe fit' for work section.
SOM is also calling for comprehensive training in fit note use, including essentials in occupational health, in clinical and medical training curricula.
SOM would like to see fit note certification acting as a triaged referral point to an occupational health professional to support return to work, and skills in occupational health (OH), are barriers to using the fit note to its full potential in general practice.
Only 50% of UK employees have access to OH and the Government needs to fund OH to support people with health issues to return to, and stay at, their workplace.
The Prime Minister also followed up comments made by Mel Stride, MP, the Work and Pensions Secretary of State, stating his concern about the impact of mental health issues on work. He suggested the normal anxieties of life are not mental health issues. However, employees still require support from managers and, occupational health, if a health conversation is needed.
People who do have medically diagnosed mental health issues need support and a working environment where they can disclose their condition. For many, work is part of that support. We know good work is good for you. The UK can achieve both workplace productivity gains and good well-being for employees. NHS professionals should be resourced to have time to have work related conversations; and employers should offer evidence-based support to people.
A leading researcher in this area, Gwenllian Wynne-Jones, Professor of Nursing at Keele University said: "There is a clear need for better support for those struggling at work though better access to OH. However, we must ensure that we don't disassociate the health system and healthcare professionals from supporting people to work. Effective management of sickness absence requires all stakeholders to be engaged in supporting people to manage their health work."
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