From next month, the old Med 3 and Med 5 will be replaced by a new ‘fit note'. Dr Nerys Williams goes through the implications of the change and gives advice about how to complete the new form
From 6 April, the Med 3 will be revised and a new version will replace both the current Med 3 and Med 5 forms. Under the new ‘fit note' system, GPs will have to provide more information on the functional effects of the patient's condition and suggest options for a return to work.
Why change the Med 3?
For the first time the fit note will enable GPs to help patients return to work before they are 100% recovered, but when they are able to safely carry out some tasks.
In many cases, a return to work can have positive effects on a patient's health and wellbeing. As doctors, we need to think more carefully about whether a return to work could be beneficial to patients' health.
Work can be therapeutic. It can promote recovery and so reduce the chances of chronic disability and long-term incapacity.
What will change?
GPs will no longer have to make a decision either that a patient is fit for work or that they should be signed off completely. The new fit note gives GPs the option of advising that a patient ‘may be fit for work taking account of the following advice'.
There will be space for the GP to briefly outline the sort of activities their patient may find difficulty undertaking and what support may be useful to them. You may advise that a patient with low back pain should be provided with an ergonomically designed office chair or that a person with travel-related anxiety might benefit from avoiding commuting during peak hours.
Doctors will be able to fill in the fit note when acting on advice from another health professional, such as a physiotherapist. This means the fit note can be completed after the patient has been assessed rather than previously when they had to be examined.
The statement can also be issued by telephone consultation and, during the first six months of illness, it can be issued for no longer than three months.
The advice you give is not binding on the employer, but it will help the patient and their employer explore ways of facilitating a return to work.
What will stay the same?
You can still advise your patient that they are not fit for work and your patient can use the statement for sick pay and benefits.
The statement must be completed in ink and issued only once and it must be signed by a licensed medical practitioner (other than the claimant).
Will I be expected to give occupational health advice?
No, doctors are not required to understand specific details about a patient's occupation and decide on fitness for work.
On the basis of more detailed clinical advice you give on the fit note, employers will be able to make informed decisions about the workplace adjustments that could help an individual return to work.
This could include a ground-floor workstation for someone who has problems going up and down stairs – for instance someone with post-lower limb surgery or someone with COPD – or flexible working hours to support someone with a fluctuating condition, such as a patient with cancer undergoing chemotherapy.
What about patients discharged from hospital?
It is the hospital doctor who should judge how a patient's health affects their ability to do their job and fill out the new statement when they are discharged from hospital, rather than telling the patient to ask for one from their GP.
Hospital doctors who have continuing clinical responsibility for patients and who regularly review them (often more frequently than their GP) should also continue to issue statements as it is in both the patient's and GP's best interests to avoid unnecessary visits to primary care.
Where can patients get more help?
Jobcentre Plus disability employment advisers can advise patients about schemes to help them back to work.
Workstep is one scheme that provides support to disabled people facing complex barriers to getting and keeping a job. It also offers practical assistance to employers.
Disabled people needing support either to get back to work or to stay in work can continue to apply for financial assistance from the Access to Work programme. This can be used to cover an employer's costs for special adjustments and equipment needed by their employee.
What should I do now?
Start to prepare. Read the guidance at www.dwp.gov.uk/fitnote and consider it in two ways – first as a GP completing statements for patients and second as an employer receiving statements about staff.
Review your own policies and procedures and decide how you will manage staff who come back with advice from their GP about adaptations such as flexible hours and avoidance of specific tasks such as lifting.
Remember that if an employer is unable to put suitable adaptations in place, it is as if the person is unfit for work.
Don't keep your staff out of work longer than needed.
Where can I find out more?
The RCGP is running half-day regional courses with funding from the Department for Work and Pensions to help GPs understand issues relating to work and health. Go to www.rcgp.org.uk ‘courses and events'.
Dr Nerys Williams is principal occupational physician for the Department for Work and Pensions and a former GP
Useful resources• Department for Work and Pensions www.dwp.gov.uk/fitnote
• NHS Choices guide to fit notes www.nhs.uk/chq/Pages/2584.aspx
• DirectGov guidance on sick pay
www.direct.gov.uk/en/Employment/Employees/Pay/DG_10027238
To view a copy of the new fit note click here.
