'Fit note' is the informal name for a Statement of Fitness for Work. This is also referred to as a sick note, med cert, med 3 or doctor's note.
We've updated this information to reflect changes to who can issue a fit note.
From 1 July 2022, nurses, occupational therapists, pharmacists and physiotherapists can legally certify and issue fit notes. Previously only GPs or hospital doctors could do this.
The change will make it easier for people to get this advice certified by the most relevant healthcare professional and enable them to have better conversations about their work and health with their employer. It will also ease pressure on the workload for GPs.
Key changes to fit notes are:
When first conducting fit note certification, the Health Care Professionals (HCP) who are legally able to certify fit notes should complete the Health Education England elfh training modules on fit note certification and have a period of structured mentorship and support.
The HCP should be involved with the assessment, diagnosis or care planning of the patient the work and health conversation relates to or be able to form an assessment based on a written report by another HCP
Guidance for patients from the Department for Work and Pensions (DWP) explains that:
The fit note focuses on what patients are able to do in relation to their work. GPs, nurses, occupational therapists, pharmacists, and physiotherapists are able to consider the 'may be fit' option. This brings together clinical aspects of illness and how it affects function and ability to work.
Information from NHS England states that patients do not always need to see a GP in person to get a fit note. It depends on:
All GPs, nurses, occupational therapists, pharmacists, and physiotherapists can provide simple fitness for work advice. This can help patients return to work and aid their recovery. It is then up to a patient and their employer to discuss this advice and consider possible changes.
There is a general consensus that it is good practice for GPs and other healthcare professionals to:
Evidence that being in the right work is good for people's health is now well established. Being out of work can increase long-term health risks. Most people with long-term health conditions do work. If patients are likely to be absent from work, the advice from a GP in the fit note can have a major influence on their future wellbeing, particularly if people are absent from work for a long time.
GPs, nurses, occupational therapists, pharmacists, and physiotherapists should carefully consider whether to tell a patient that they are not fit for any type of work at all. This increases their longer-term health risks.
Guidance for GP practices
Guidance from the Department for Work and Pensions, Fit note: Guidance for GPs sets out how GPs, nurses, occupational therapists, pharmacists, and physiotherapists should:
When signing and sending fit notes electronically, it's important to consider:
When filling in a fit note, doctors need to consider a patient's functional capacity. As well as considering the patient's capacity to return to their own job, they also need to look at returning to work in general. This approach opens up ways to return to work that a patient may not have otherwise considered.