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Understanding fit notes

Why do we give fit-notes to patients who don’t have jobs?

Because a fit-note might entitle them to Employment and Support Allowance (ESA).

What’s that?

It’s a benefit paid to unemployed people who also have a chronic illness or disability – one that’s likely to hinder their ability to get a job.

How disabled do they have to be?

You should sign them off if, in your opinion, they are likely to be at a real disadvantage compared to the average jobseeker.

What sorts of jobs are we talking about here?

Anything like customer service, shelf-stacking, or clerical work

Okay. What is ESA worth?

The initial rate is up to £72 a week.

So why go to the bother of getting a fit-note?

In short, there are three reasons:

-The job centre can’t make an ESA recipient look for work.

-The amount of ESA received could increase at a later date once a Work Capability Assessment (WCA) has been carried out by the government’s main outsourcing company for disability assessments, Atos.

-ESA is known as a ‘passport benefit’: graduating from the initial rate to a higher rate after a WCA will make other benefits easier to get (receiving one of the two higher rates of ESA is officially recognised as a marker of significant disability).

What exactly is the role of Atos in all this?

In 2008, the Government introduced the WCA and contracted Atos to perform the test using doctors, nurses and physiotherapists recruited by Atos. After a WCA, Atos sends the government a report on the patient’s level of disability together with a recommendation on fitness for work, for use in deciding on eligibility for ESA.

So once I’ve issued a fit-note, that’s the end of the process as far as I’m concerned.

No. Atos might send you a form asking for more information.

Can I ignore it?

No. It’s a contractual obligation.

Can I charge the patient?

No. But if the patient asks you for a report at this stage, that’s different.

Why would a patient ask for a report now, if Atos is already doing it on their behalf?

Atos is not obliged to seek medical information; it will sometimes, depending on the case.

Tell me about this form I might have to complete.

It’s just one piece of A4.

On one side, they want to know the patient’s medical history and current treatment.

On the other side, they ask you to tick whether – as far as you know – the patient has problems with certain activities of daily living, and to add a few words as to why.

Finally, you state if you think they can travel to an examination centre by public transport or by taxi. If they can’t, they will probably get a home visit.

Okay, got it.

We haven’t quite finished. If your patient fails the WCA, they might appeal. The patient – but never Atos at this stage – might ask you for written evidence to support their appeal. The good news, from the point of view of your practice income, is that you can charge the patient a reasonable fee for this, because it is part of their legal challenge to the DWP’s decision on entitlement to ESA.

Any tips on what to write?

The simplest thing to do is write an up-to-date note and supply a print-out of the medical record – or even just the summary – which would genuinely be useful.

You are not expected to comment on ability to work: that’s for the tribunal to decide.

But when your patient has known problems with everyday tasks, it will help if you can spell out what those difficulties are.

It is also important to say whether you believe it is likely that the patient’s health would be at substantial risk if they were to be declared fit for work – that is a specific criterion of the process, over and above any functional problems with activities of daily living.

Is that all?

Yes, unless your patient is unsuccessful – in which case, if they take a turn for the worse, they might ask you for another fit-note. And the whole thing starts again.

Dr Greg Wood is a former GP and disability analyst for Atos, now a campaigner for WCA reform.