UK: Fit notes - What do they mean for employers and employees?

Last Updated: 7 May 2010
Article by Gagandeep Prasad

The problem

With an estimated 2.6 million Britons on sick leave or incapacity benefits, the cost of sickness to the country is reported to be in excess of £100 billion and 172 million working days every year. In an attempt to curb what many see as a 'sickness culture', traditional 'sick notes' were scrapped on 6 April this year and replaced with 'statements of fitness for work' or 'fit notes'.

Designed to open up a dialogue between the individual, their employer and their GP, 'fit notes' are the result of in-depth consultations between the Government, medical bodies and all levels of business.

But what exactly do these new notes mean for employers and employees alike and will they really result in a dramatic change in the nature of sickness absence?

The law

The new 'fit notes' are available to anyone who has been absent from work for 7 days or more, the same as under the old system. One crucial difference is that now, if the note is issued in the first 6 months of a medical condition, it can only last for 3 months before being reviewed by a GP.

The main change comes with how a GP can categorise their patient's ability to work. Under the old system, an individual would either be 'fit for work' or 'not fit for work'. On the new forms, GPs can now say that a patient is either 'not fit for work' or 'may be fit for work, taking account of the following advice...'. If someone is fit for work as normal, there is no need for them to provide a note.

This option for giving advice on the individual's ability to work will allow GPs to identify what aspects of work their patient may or may not be able to undertake. To assist in this, the forms have tick boxes for common ways to avoid full-scale absence. Examples include: a phased return to work; different hours; adaptations to the individual's duties and/or the workplace environment. The forms also provide space for the GP to give further information on the individual's condition and how this may impact on their work, as well as giving more detailed suggestions on how the employer may facilitate a return to work.

Expert advice

This new subjective system represents a big change and the Government has understandably been keen to promote its benefits. It is claimed that, by enabling employers to fully understand the position of their employees, they will be in a better position to allow an earlier return to the workplace, where before an employee would have simply been signed off as sick.

In theory, this is a positive step, but it also places a much greater burden on employers and indeed GPs.

Employers may be uncertain as to how to accommodate such employees and what adjustments should be made. This could result in tensions between the employer and the individual, particularly as the employer will have to bear the costs of any such adjustments.

GPs have traditionally erred on the side of caution when signing patients off work. Without a clear understanding of the workplace and the particular demands on both the employer and employee, it may be difficult for them to ascertain exactly what adjustments should and could be made. Further, it is intended that where employers are uncertain about what to do, they can speak to the GP for clarification; whilst a good idea in theory, in practice, GPs may be too busy to respond quickly and, when they do, may seek to charge the employer for their time.

There is also some concern that the new system will encourage employees to return to work before they are ready, to the detriment of their health. The Government is quick to refute this, saying that the new notes simply shift the emphasis from what employees are unable to do to what they can do.

To avoid the difficulties outlined above, Dr. Laurence Buckman, chairman of the BMA's GP Committee, says that employers have a duty to provide occupational health services. Most large businesses already have such provisions, but to assist smaller businesses, the Government has set up an occupational health adviceline to assist both employers and employees in organisations of up to 249 people; in Scotland, these lines are open to organisations of all sizes. There is also an adviceline for GPs in England to discuss individual cases.

To do checklist

  • Review the way in which your business works and identify any common ways in which employees may request a phased return to work.
  • Make employees aware of the new system and who they should speak to in the event of being given a 'fit note' that requires adaptations to the way in which they work.
  • Take steps to facilitate an open dialogue with employees returning to work from sick leave, to ensure that both parties can benefit from any practical advice from a GP.


To ensure that this new system benefits the employer and the employee, both sides need to take a flexible and pragmatic approach. Make sure that individuals at all levels of your business understand the new provisions and are prepared to take them on board.

Research has found that work is very beneficial for people's health. Failure to allow sick employees a phased return to work, could be counterproductive and result in a further decline in their health and potentially expose the business to risks of claims.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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