Table 3.

Frequently asked questions about the fitnote

Does my patient need a fitnote if they are only likely to be off for a week?No. Patients can self-certify for the first 7 calendar days of any period of sick leave.
Who can write a fitnote?Any doctor. The duty to provide a fitnote rests with the doctor who, at the time, has clinical responsibility for the patient. Some allied health professionals (AHP) can write an AHP health and work report which can be used with employers but does not give entitlement to benefit payments.
When should hospital doctors write fitnotes?When discharging a patient from hospital and recommending sick leave.
In outpatient clinics if sick leave is needed.
To prevent the patient attending a general practitioner appointment only for a fitnote.
What should I discuss with the patient?Their current health condition and what aspects of work it is affecting. Consider the following:
  • stamina eg better in the morning or the afternoon

  • mobility eg walking, bending and stooping

  • agility eg dexterity, posture and coordination

  • insight/stability eg mental state and mood

  • treatment eg side effects and duration

  • intellectual eg cognitive abilities

  • sensory eg hearing, vision and touch

  • the duration of their health condition and any likely fluctuation.

Regarding their current job: what are the hours worked, nature of work, type of industry, self-employed or employed, have they had sickness absence already in this year?Does their employer monitor sickness absence and does it have disciplinary procedures for exceeding days of sick leave?Are there any aspects of their job that they feel they could still do with some adjustment (if the employer made it possible)?Which aspects of their work are aggravating their health condition (if any)?
Does the fitnote have legal implications?No, it is only a statement of your advice about whether or not they may be fit to work. Employees and employers can ignore your advice. Employers are not bound to follow your advice. However, they should always perform a risk assessment before bringing anyone in receipt of a fitnote into their workplace and doing so is at their own liability.
How long should I give a fitnote for?As short a time as possible. The maximum the fitnote can be written during the first 6 months is 3 months but think in terms of days or a small number of weeks. Remember that prolonged sick leave significantly reduces the ability to ever return to work.
What does the fitnote have to do with benefits?The patient can use your fitnote as evidence for sick pay and benefit purposes
Can I say that my patient is NOT fit for work?Yes. Always consider if your patient could do work of some kind before advising that they are not fit for any work. Remember the long-term health risks of worklessness when advising your patient that they are not fit for work.
How do I know what advice to give about what they may be fit for?Ask the patient about their job and all its requirements. Can they do any aspects of their own role? If not, are there other roles in that workplace/company that they think they might be able to undertake if the employer was willing on a temporary basis?
What are the most common recommendations given to enable people with health conditions to stay at work?Reduction or change of working hours (later start times, earlier finish times).
Rotation of tasks with fellow employees.
Temporary reassignment to sedentary work.
Provision of car parking space nearer to the workplace.
Provision of equipment (eg light-weight laptop).
Temporary home-working.
Many adjustments are cheap and are based around employers being flexible with the employee.
What should my patient do with their fitnote?They should take it to their employer and use it as a basis for a discussion about possible accommodation of their needs in the workplace. Your advice is not binding on the employer and they can choose to seek their own advice.
If I give the advice and the employer cannot make these accommodations, what will happen?If the employer is unable to accommodate your advice, then they may treat it as a statement that the patient is not fit for work. You do not need to write another fitnote.
Don't people need to be 100% fit to be able to work?Absolutely not. We must bust this myth! Work can be part of rehabilitation from many health conditions (eg in a phased return to work).