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Fit note may have cut long-term sickness absence

The ‘fit note’ GPs now use to certify people off work due to illness has been linked to a reduction in long-term sickness absence in a study of UK practices.

Researchers found the chance of people being off sick for more than 12 weeks fell by more than one third after fit notes replaced the ‘sick note’ in 2010. However the reduction was not seen in all practices and experts warned more research was needed to determine whether fit notes have been helpful.

The fit note – or Medical Statement of Fitness to Work – was introduced in 2010 following the Black report into ill health among working age people, so GPs could give advice how a patient might return to work depending on workplace adjustments and support, rather than simply stating they were too sick to work.

To look at their impact, a team led by Professor Mark Gabbay at the University of Liverpool compared sickness absence data in 2001-2002 and 2011-2013, before and after the introduction of the fit note.

Seven practices had data available for both periods, and overall there was a ‘highly significant’, 35% reduction in the risk of patients being off more than 12 weeks.

However, the decrease in long-term sickness was only seen in three of the practices – the other four saw no change with use of the fit note instead of sick note.

The study also found the proportion of people off work for mild to moderate mental health problems such as depression and anxiety has risen from 26% to 38% between the two periods.

Professor Gabbay and team concluded ‘there is a suggestion that [the fit note] may have helped significantly reduce absence episodes in at least some of our seven comparison practices’.

However, in an editorial accompanying the study, Professor Raymund Agius and Louise Hussey from the University of Manchester said ‘the ‘jury is still out’ on fit notes, and that more research was needed on these as well as the Government’s new national occupational health service – the Fit for Work Service – for people off work for three weeks or more.

They noted 47% of the fit notes issued in 2011-13 in Professor Gabbay’s study were for periods lasting longer than three weeks, ‘suggesting that considerable resources would be required to operate the Fit for Work Service effectively’.

A preliminary study a year after the fit note was introduced suggested GPs were sending more patients back to work under the new system, but were having to spend longer on consultations.

Occup Environ Med 2015; available online 23 February


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