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Introduction of the fit note: case studies

Dr Nerys Williams gives examples of how to use the new Med 3

Case 1: Back pain

A 55 year old manual worker has a 4 weeks history of mechanical low back pain. His pain is still present but is now adequately controlled. He is mobile but finds that sitting or standing in the same position for more than 20 minutes aggravates his back pain

The GP ticks the box for 'you may be fit for work taking account of the following advice' and ticks the box for 'workplace adaptations' and adds in the comments box:

  • 'should avoid bending, lifting and twisting'
  • 'should avoid static postures for more than 20 minutes' and
  • 'would benefit from more frequent breaks'

and signs the note for 2 weeks

Case 2: Work stress

A 27 year old teacher reports that she has work-related stress. She has been off a few times for odd days and on this occasion has self certificated for seven days.

The GP signs her as unfit for a further seven days and asks her to take the time to reflect on the main causes of her stress at work. She returns for review and reports that she finds that frequently providing feedback to the parents of children who are performing poorly is the main problem.

The GP signs her as 'maybe fit for work taking account of the following advice' and ticks the box 'amended duties' and adds in the comments box:

  • 'avoid parental feedback until provided with additional training and peer support' and
  • 'may benefit from a referral for occupational health assessment'

and signs the note for 3 weeks

Case 3 Back-dated note

A 37 year old female office worker has an exacerbation of knee pain related to a long-standing ski injury. Following previous similar episodes, she expects to return to work in about one week and so the patient self certifies for the first seven days. On Day five she sees her GP for a prescription but does not request a statement.

She suffers further pain and knee swelling over the following weekend and does not return to work as a result. She has a telephone consultation with the GP on day nine. GP, having seen and assessed the patient on day five, ticks the 'not fit for work' box and dates the note from the time the patient was seen up to the present thus covering the period of her absence.

Where to go for more guidance

From April 6, GPs in England will be able to call 0800 022 4233 to access professional occupational health support

In Scotland, GPs are already able to get similar advice through the Healthy Working Lives Adviceline: 0800 019 2211;

In Wales, GPs can obtain health and work advice and support through the Healthy Working Wales Portal:

In addition to the adviceline services, a website supported by DWP and developed by the RCGP, the Society of Occupational Medicine and the Faculty of Occupational Medicine is available at:

Doctors seeking general advice on medical Statements (including the fit note), reports and disability benefits are advised to call the ATOS Healthcare line which can be found at:

The DWP has published comprehensive guidance for GPs on the fit note, which has been developed in partnership with the RCGP and the BMA. It is available at:

Depressed patient