Completing the fitnote
The revised guidance on completing the Fit Note for GPs, employers and patients is available at www.dwp.gov.uk/fitnote It provides practical advice to help everyone involved in the sickness absence process to use the fit note to its full potential.
Figure 8 shows the advice provided by The Department for Work and Pensions6 (DWP) for GPs in completion of the ‘Fitnote’6.
Figure 8: DWP Guidance6 for GPs Completing the ‘Fitnote’6
Making an appropriate decision on how soon to return to work following a surgical procedure will need to involve clear lines of communication between the patient/employee, GP and employer. The GP can use the ‘Fitnote’6 to provide information on the functional effects’ of the patient’s condition (within the limits of the GP’s knowledge and expertise) and suggestions to aid return to work. This will help the employer and employee to make a more active contribution to recovery, as they have detailed knowledge of the job and workplace. Suggestions provided on the ‘Fitnote’6 are to Improve the likelihood of your patient keeping their job, by helping them to discuss ways they could be supported at work with their employer.’ When such suggestions cannot be implemented, the patient should be treated as not being fit for work, and do not need a new ‘‘Fitnote’6, unless the GP has stated that they wish to review their case.
When completing the ‘Fitnote’6 it is useful to remember that modified work is not always required and can in some cases create an obstacle to return to work, if modified work is not available to the patient4. However, in reaching a decision as to whether or not to make suggestions for modified work/conditions and as to what these might be, simple open-ended questions4 may help:
- “What’s your job like? What kinds of tasks do you do?”
- “How will this (health problem) affect your work?”
Such questions may then help the GP to ask more specific questions4 to address:
- The physical and mental demands of the job (eg Is the patient required to have face-to-face / over the telephone contact with clients/customers/pupils; drive/ travel; or use a computer/ dangerous machinery occasionally/regularly? and for how long at any one time?)
- Possible support and reactions of colleagues and line-managers.
- Any appropriate adjustments to working pattern / the job / the work premises, which may need to be made to assist the patient to return to work.
The Health and Safety Executive18 provide some examples of suggestions which can be made on the ‘Fitnote’6 to help a patient return to work. These are shown in Figure 9 below.
Figure 9: Examples of Suggestions which GPs can make to Employers on the ‘Fitnote’6 to Assist a Patient to Return to Work.
Adjustments to Working Arrangements:
- Phased returns to work to build up strength, for example building up from part-time to full-time hours over an agreed and appropriate period of time.
- Changes to individuals’ working hours to allow travel at quieter times, or flexible working to ease work/life balance.
- Help with transport to and from work, for example organising lifts to work, or finding out what help may be available to a disabled worker through Jobcentre Plus19
- Home working (providing a safe working environment can be maintained).
- Time off during working hours for rehabilitation assessment or treatment.
Adjustments to the Job:
- New or modified equipment and tools, including IT, modified keyboards etc.
- Modified workstations, furniture, and movement patterns.
- Additional training for workers to do their job, for example refresher courses.
- Modified instructions or reference manuals.
- Modified work patterns or management systems to reduce pressures and give the worker more control.
- Telephone conferences to reduce travel or if face-to-face meetings cause anxiety.
- Modified procedures for testing or assessment.
- Buddies, mentors or supervision for workers while they regain confidence back at work.
- Reallocating work within the person’s team.
Adjustments to Premises:
- Moving tasks to more accessible areas and closer to washing and toilet facilities.
- Adapting premises, for example providing a ramp for people who find steps difficult, improving lighting where sight-impaired people work, providing clear visual signs and alerts for deaf workers.
The Health at Work Advice Line20 (0800 107 0900) provides easy access to free confidential occupational health advice for patients / employers / GPs. Why not consider using it when grappling with a ‘return to work issue’ for a patient? Why not give the advice line number to a patient / employer grappling with a ‘return to work issue’. The advice line is open during office hours, however, if calling outside these times, a call-back service will be arranged.
Some patients, particularly those who work for small businesses, may report that their employer cannot afford to make such adjustments. Help with funding may be available through the patient’s local Jobcentre Plus19.
Consideration of Smoking and the Completion of the Fit Note
As a GP when completing the Fit Note for a patient it may be helpful to consider how a patient’s smoking can be managed on their return to work. Click for smoking cessation module24 www.mle.wales.nhs.uk/course or http://www.stopsmokingwales.com/ 0800 085 221914
An additional patient resource to support smoking cessation.
Patients may find that their employer can provide additional support for them in smoking cessation via workplace engagement with Healthy Working Wales; Corporate Health Standard Award22 (lifestyle component) and The Small Workplace Health Award http://www.healthyworkingwales.wales.nhs.uk/home
When completing the ‘Fitnote’6 the patient may state that they operate machinery at work. The Workboost Wales Advice Line21 (0845 609 6006) provides confidential free support to small Welsh businesses on workplace health and safety. It may be helpful to provide the patient with this telephone number, to pass on to their employer. This will help the employer deal with specific issues related to operation of machinery and health and safety.
Useful Telephone Numbers:
- The Health at Work Advice Line20 (0800 107 0900) – Occupational Health Advice
- The Workboost Wales Advice Line21 (0845 609 6006) – Health and Safety