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Thousands more 'fit notes' issued - but one in five GPs say their advice is ignored

Exclusive GPs are issuing more so-called 'fit notes' than ever for patients, but a Pulse survey reveals that many say the advice written on them is often ignored by employers.

There have been several recent attempts to cut back on the burden of GPs filling in statements about whether patients are fit for work, but the latest available figures show a 9% increase.

NHS Digital data show 1.4 million fit notes were issued over July-September 2017, compared with 1.3 million over the same period in 2016.

The revised Med 3 was introduced in 2010 and was designed so that GPs could give more advice about what modifications may be needed for patients to return to work, but a Pulse survey of more than 800 GPs found 21% thought employers didn't usually follow their advice, compared with 44% who did.

The NHS Digital report said that there had been 'an 8.7% increase in fit notes issued from Q2 2016-17 to Q2 2017-18 where a diagnosis was available'. There was a significant increase in Med 3 forms issued for mental and behavioural disorders (14% rise), while the number of notes that were for five weeks or longer rose slightly, from 34% to 35%. 

GP leaders said that this demonstrated the lack of services to help patients recover from mental health problems. The rise also comes despite major moves by the NHS to shift the Med 3 form-filling away from GPs.

sick note pie chart

sick note pie chart

Hospitals must now issue fit notes to patients being discharged from their care and covering the entire period until recovery or further clinical review is needed under changes to the NHS Standard Contract 2017-19, which came into effect last April. Also, a new 'Fit for Work' service was introduced in England in 2015 for GPs to refer patients who were off work for four weeks or more, although this new service is not widely known.

Department of Work and Pensions consultation in October 2016 went even further, looking at the extension of fit note certification from GPs to other healthcare professionals, but this has yet to be implemented.

BMA GPs Committee chair Dr Richard Vautrey, said: ‘This is yet another indicator showing the workload pressures GPs are facing as they strive to respond to demand from their patients, and in particular the growing number of people living with stress, anxiety and depression.

‘Despite this, mental health funding has lagged behind, exacerbating the problem. The vast majority of adults with mental health problems are looked after in primary care, but our own research has shown unacceptably long waiting times to access to talking therapies, which can often lead to patients taking longer to recover and further impact being felt in general practice. This is why we need more investment in local mental health therapists and IAPT services.’

Dr Alice Hodkinson, a GP locum in Cambridgeshire, says: ‘I find a lot of employers (and employees) don’t understand how fit notes work, and it takes up a lot of our time for no good reason. Some big companies wanted sick notes after two or three days.’

In June 2016, GPs at BMA’s LMCs Conference voted that fit notes were a waste of clinical time that could otherwise be better spent.

At the time, Merseyside GP Thomas Kinloch said: ‘Fit notes are confusing. Employers, patients and doctors find them confusing. But what do you expect when you call a form issued to cover sickness a fit note? There is absolutely no evidence that fit notes helped early returns to work or reduced overall absence rates and patients still make inappropriate appointments just to get their fit notes in their droves.'

What are 'fit notes'?

The Statement of Fitness for Work system, introduced in April 2010, applies across England, Wales and Scotland, and provides evidence for employers and for those claiming relevant benefits from the Department for Work and Pensions.

Fit notes (or Med 3 statements) are issued to a patient following seven days of absence from work due to sickness, if the assessor believes the employee’s ability to work is hindered by their health.

The doctor will then categorise the patient as either ‘unfit for work’ or 'may be fit for work subject to the following advice'. Accompanying notes can also be provided with suggested changes to the role or workplace that will allow them to continue working.

But in June 2016, GP leaders at the LMCs Conference voted that fit notes were a waste of clinical time that could otherwise be better spent.


Readers' comments (11)

  • I find they are poorly understood and have become a source of Dr / patient friction which frankly I don't need. I am not occupationally trained and have given up on issuing them.

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  • Not worth the paper they are written on.Complete waste of time and effort and increased stress.

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  • They are required if a person or employer is to get sick pay. For us they are inappropriate as we are not OH trained. So I keep them simple and repeat sick notes rapidly become maybe fit and then a note to DWP or employer in the space provided saying I am not in a position to give advice please seek an OH doctor.

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  • Changing the name from Windscale to Sellafield (or sick note to fit note) gives the appearance of reform whilst changing nothing. I’m issuing more than ever before.

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  • Would help if trust contract was observed and enforced - I expect ,many GPs are issueing more due to secondary care dumping

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  • Most of the patients requesting sick notes around here (or "fit notes" of course, in doublespeak) seem to be the unemployed seeking ESA.

    The employed patients often have zero hours contracts and don't get paid when they are off sick so they don't want a Med 3.

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  • Default as normal is to "see your GP"

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  • How can we 'give up on issuing them' please?
    Hospitals have always been required to issue - I did while working in hospitals in 1992-98.
    Many employers 'refuse to accept' anything other than long-term completely unfit, and the DWP is the worst offender - they insist on having repeated notes for patients who are eminently fit for work, because it gets them off the unemployed statistics - ie DWP-originated fraud!

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  • 09:40 agreed!
    The punters sent along by JobCentre are the most vexing of all, especially those who say 'my benefits have been reinstated after an appeal and JobCentre say you have to give me a certificate' with never any correspondence to confirm.

    Oh, and kids off school for a day whose school demand a letter from the doctor...

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  • Just give anyone requesting a sick note and get them out of your office ASAP. I’m not going to be the strict parent figure to patients others want me to be. Not my problem,

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