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Q&A: The new ‘fit for work’ service

The Fit for Work service (FFW) is a new occupational health scheme for GPs to refer patients who are sick long-term, which is being rolled out nationally from 5 April 2015. Since last January the scheme has offered patients, their employers and GPs access to free online and telephone advice about work-related health matters.

But over the course of the next few months, the scheme will extend to enable GPs to refer patients for an occupational health assessment after four weeks of absence (or expected absence) from work (see this map for more info on your area).

Q When can GPs use the FFW service?

Patients who have been, or expect to be, off work for longer than four weeks attending a GP appointment to discuss whatever health issues they have and to seek advice about whether they should be at work, or be covered by a Med 3, are eligible for the new service. The GP can, if appropriate, refer the patient to FFW, as can the patient’s employer if they wish.

Once the patient has been assessed by an FFW caseworker (this will usually be a nurse, who will normally ask the patient questions over the phone), the caseworker will write a return-to-work plan for the patient, with advice and recommendations. If the patient consents, the caseworker will then share the plan with the patient’s GP and employer.

Q From a GP’s point of view, what are the differences between the new scheme and previous arrangements?

The main change is that GPs will probably need to ask their patients whether they have already been off work before they write a Med 3 (and, if so, for how long) if they want to use the service.

GPs will be expected to initiate the referral process, which does add to their workload, but once a return-to-work plan is in place, they will not need to provide further Med 3s to certify a patient’s absence.

Once the referral service is up and running, GPs should also see a reduction in requests for medical reports from employers, as this information should be available from the patient’s FFW caseworker. GPs who have been surveyed about the service have been very positive.¹

Q Should GPs keep writing Med 3s?

Yes, but only in the following cases:

– For self-employed patients.

– For patients who need less than four weeks off work.

– For patients who do not have a return-to-work plan, refuse to do the FFW scheme or do not consent to share the plan with their GP or employer.

– For patients who are not expected to return to work – for instance, in terminal illness – unless the patient can and wants to keep working. A referral to FFW should be made only if there is a reasonable likelihood of a return to work.

If the patient hasn’t returned to work after three months, FFW will discharge them back to the GP, who will then be responsible for further Med 3s.

Q What kind of problems will GPs face when the scheme launches?

I foresee three issues that are likely to arise over the first few months of the scheme.

First, GPs will need to know how long a patient has already been off work. Whereas before, a GP might have written a Med 3 for a period of, say, three weeks, they should now ask the patient how long they have already been off work and then add that to the period of certification and decide whether to refer to FFW.

Second, there may be increased demand for appointments if patients come back to their GP because they disagree with the return-to-work plan. GPs will probably need to liaise with the caseworker to resolve such issues.

In addition to these two day-to-day issues, GPs often do not have any direct influence on provision for occupational health services locally.

Dr Rob Hampton is a GP in Leicester and was the clinical lead for the 2010-13 Leicestershire Fit For Work pilots.

Karen Baxter is a partner at Lewis Silkin LLP.

Practice survival guide: what to do in April

1 Set up patient participation groups and ask new patients about their drinking habits if your practice doesn’t do this already, under the new GP contract for 2015/16
2 Prepare for changes to the new NHS Pension Scheme from this month (see
3 If you have a CQC rating, display it on your website/premises by 22 April
4 Complete the NHS workforce survey by 30 April


1 Fylan F et al. GPs’ perceptions of potential services to help employees on sick leave return to work: research report. London: Department of Work and Pensions; 2012