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Non-GPs to sign off fit notes, Government announces

The Government is going to look into allowing non-GPs to sign off fit notes, amid a wider review of the Fitness to Work scheme announced today.

The review will also look at how health professionals and employers can make better use of the fit note to keep people in work rather than just signing them off sick.

In a green paper, the Department for Work and Pensions said that it ‘intends to review the current operation of the fit note’ including looking at ‘whether fit note certification should be extended from doctors in primary care and other settings to other healthcare professionals’.

The Government said the review comes as it has noted the fit note scheme ‘is not fully achieving what it set out to do’.

The paper stressed that the fit note was aimed to help people on employment support to remain in work, by stimulating a discussion with employers about how a person could overcome their disabilities.

But the paper said that GPs rarely use the ‘may be fit for work subject to advice option’ on fit notes and that opportunities to keep people in work are being lost from the first GP consultation onwards.

It also claimed GP sometimes find it ‘difficult to refuse’ a fit note meaning it ends up being seen as an administrative burden ‘rather than an opportunity to provide work and health-focused support’.

The DWP said it wants to overhaul the system so GPs have the ‘right skills and knowledge to provide early advice about functional ability to work’ and better understand that ‘work is important for health’ – and only issue fit notes when appropriate.

‘The review will look at the current system and whether it meets the needs of its users – doctors and other healthcare professionals, employers, patients/claimants and the benefits system,’ the paper said.

Work and pensions secretary Damian Green and health secretary Jeremy Hunt said in a ministerial statement about the plans: ‘This Government is determined to build a country that works for everyone.

‘A disability or health condition should not dictate the path a person is able to take in life – or in the workplace. What should count is a person’s talents and their determination and aspiration to succeed.’

But GPC deputy chair Dr Richard Vautrey said: ‘GPs know that most people’s health benefits from the opportunity to work but also know that for all too many of their patients it’s their poor working conditions that can be the cause of their illness. There needs to be a greater focus on the important role employers have in supporting their employees at times of illness and stress.’

‘GPs are not occupational health specialists and GPC has repeatedly called for the role GPs have in issuing fit notes to be reduced with greater access to occupational health specialists.’

He also reiterated the calls from the GPC’s Urgent Prescription for General Practice to extend self-certification of illness from seven to 14 days to reduce pressure on GP workload.

The fitness to work scheme

The fit note – or Medical Statement of Fitness to Work – was introduced in 2010 in response to the Black report on 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.

Manufacturing bosses previously blamed GPs for the failure of fit notes to help people back into work earlier and called for them to have better training in the fit note process.

But a study published last year suggested that long-term sickness absence may have fallen as a result of the fit note being introduced.

The Government also set up a ‘Fit for Work’ national occupational health service last year, which enables GPs to refer people who are heading for long-term sickness for help to go back to work, a process it has claimed should take the pressure off GPs as it means they can hand over responsibility for the fit note to an occupational health clinician.

However, the RCGP has expressed concerns that the Fit for Work scheme relies too much on telephone consultations rather than face to face assessment.