Background
Fit notes are issued to employees to evidence a request for sick pay from their employer and for supporting a claim for health-related benefits. They were first introduced in 2010 to replace the ‘sick note’. The aim was to ensure patients received advice about the benefits of returning to work, and employers had the information they need to make changes to facilitate an earlier return to work. The 2010 reforms included a new option to allow a GP to indicate that a patient ‘may be fit for work subject to the following advice’ and to provide general details of the functional effect of the individual’s condition and recommend common types of workplace adjustment: phased return to work, altered hours, amended duties and workplace adjustments.
Despite these aims, 93.8% of fit notes in 2023 were issued as ‘not fit for work’ and only 6.2% of fit notes issued between October 2022 and September 2023 included advice on how a patient might be fit for work. In a speech on welfare on Friday 19 April 2024, the Prime Minister said "We don’t just need to change the sick note, we need to change the sick note culture so the default becomes what work you can do – not what you can’t.”
The fit notes rules were amended in 2022 to allow a wider range of healthcare professionals (including registered nurses, occupational therapists, pharmacists and physiotherapists) to sign fit notes in addition to doctors. However, between April and September 2023, only 8.4% of fit notes were issued by these groups, with the vast majority still issued by GPs.
In November 2023, the government announced plans to consult on reform to the fit note system in 2024 and published information about WorkWell, a proposed pilot scheme (England only) announced in the Spring 2023 budget, backed by £64 million in funding, which aims to better integrate local employment and health support for disabled people and people with health conditions.
On 7 May 2024, the government announced the initiation of "WorkWell" pilots in 15 areas across England from October 2024. The voluntary service aims to provide a single assessment and gateway to local employment support and health services for people with health conditions or disabilities. Participants can self-refer or be referred by their employer, GP or the community sector, and will be supported by a Work and Health Coach to create a plan to overcome work-related health and social barriers. The pilots will also test the integration of the fit note process with WorkWell in some areas before informing the potential future rollout of a national WorkWell service.
What do we know so far about the proposals for reform?
The outgoing government wanted to develop and test a reformed fit note process in England that provides a more integrated work and employment support offer to help employers and employees to reduce sickness-related absence and free up valuable time for healthcare professionals. This included exploring shifting responsibility for issuing fit notes away from GPs to other “work and health professionals”. The proposed new process would include:
- a triage service,
- an assessment of someone’s ability to do their job, and
- the ability to refer people to more intensive work and health support.
The new model would recruit clinical and non-clinical professionals to conduct in-depth work and health conversations with patients. They would provide advice and guidance on how individuals might be able to start, stay in, or return to work with the support of their employer. The model would also explore how the wider health system can take responsibility for issuing the fit note, allowing primary care teams to use their time more efficiently and provide tailored health and employment support.
The impact of this new approach would be evaluated in trailblazer sites and used to inform future policy design. The reformed fit note process aims to integrate with WorkWell, providing a single, joined-up assessment and gateway into local employment support servicesand complementing the role of Occupational Health in ensuring employers understand and benefit from more expert work and health support.
What happens now? Is fit note reform still likely?
Whilst the call for evidence remains open, government departments are unable to take any steps during an election period that would compete with parliamentary candidates for the public’s attention. As this effectively acts as a publicity ban for any consultations still in process, departments are advised to take steps to make up for this detriment such as prolonging the consultation period and/or putting out extra publicity for the consultation after the election to revive interest (after consultation with any new Minister).
Although the Conservative Party has not yet announced its employment policies if it remains in power after the general election, it is expected that the current legislative agenda regarding employment law would continue if it formed the next government, most likely with an extended deadline for the call for evidence. However, if the Labour party forms the next government, things are less certain. Apart from pledging to extend statutory sick pay to all (by removing the lower earnings limit), Labour's Plan to Make Work Pay does not mention reform to the fit note system.
What does this mean for employers?
If the proposals in the call for evidence were to be taken forward, most employers would agree that a system offering more assistance in exploring ways to help employees get back to work would be a useful intervention. A common frustration with the current GP system is the lack of meaningful dialogue about whether an individual who was once signed off work is now fit and healthy enough to return to their duties and what an employer might do to facilitate that return to work.
However, it is not clear who these new 'specialist work and health professionals' would be and how individuals would access them to get a fit note. This is important because fit notes are needed on short notice to evidence absence. The risk of moving the assessment process away from primary healthcare professionals is that assessors may not be suitably trained/qualified to interpret a person's health information – or may not have access to the most up-to-date medical records. If not handled appropriately, genuinely sick employees may feel compelled or obliged to return to the office before they are well enough to do so which, in turn, could lead to disruption and even potential claims against employers.
There is also the fact that employees who see a medical doctor about their condition may receive medical advice suggesting that they stay away from work. It is not clear what would happen if the advice given by the new service (such as not issuing a fit note) contradicts the medical advice given by a doctor.
It is also unclear who would pay for the new system. With 11 million fit notes issued in 2023 alone, recruiting a new team of ‘specialist work and health professionals’ to issue that many fit notes each year would be expensive. Currently, employers pay if they want their employees to see a private occupational therapist to explore ways to get back into work after a period of sickness or injury. It is not clear whether that service would now be paid for, and, if not, how much choice employers would have about where employees would be sent and the attached cost.
The call for evidence invites employers to provide their views and experiences on the current fit note process and proposed changes until 8 July 2024. It is unclear whether this deadline might be extended after the general election on 4 July and what could happen next. If the Conservative party were to regain power, it is likely that the feedback gathered would inform the final design of the fit note reform and employers would have another opportunity to provide input during a consultation later in 2024 on specific policy proposals. Things are less certain if the Labour party were to gain power. In the meantime, Personnel Today has reported that the Society of Occupational Medicine has urged all major political parties to commit to introducing universal access to occupational health if voted in at the next general election, including, amongst other things, (a) a legal requirement for larger organisations to invest in occupational health services; (b) reforms to the fit note regime; and (c) investment in a national centre for work and health to generate evidence for employers. So, reform in this area could be on the agenda whatever the outcome of the general election.
