"Fit Notes"

From 6 April 2010 there will be a number of changes to the sick note, or medical statement, that employees get from their GP to certify sickness absence.

Previously a sick note simply stated whether a doctor believed that a person should or should not be in work. The new medical statement will either indicate that a person is not fit for work, or that they might be fit for some work under certain circumstances. The doctor will also be able to suggest changes that would assist a return to work. There is no requirement for the GP to write anything apart from that the person is not fit for work and how long the person is "signed off" for. In most cases the patient and employer will see no change in the information that the medical statement gives.

In the future, the note will be completed and stored electronically by the GP rather than handwritten, although it will still be given directly to the worker to send to the employer.

There will be no change to the basic purpose of the medical statement and it will still be used by employees as confirmation of illness if claiming sick pay.

 

Background

The key to reducing long-term sickness absence has three components. The first is prevention of injury and illness, both in the workplace and outside of the workplace. Secondly early access to treatment and, if appropriate rehabilitation. Thirdly, good return to work policies which are worker-centred and aim to support the worker in the transition back to work.

The idea that a person is either too ill to work at all, or well enough to fulfill their full duties does not reflect the real experience of those who are recovering from a long-term illness who would often like the opportunity of returning in a phased or supported way.

UNISON have negotiated sickness absence policies that aim to ensure those on long term sickness absence are given the opportunity to have a graduated supported return to work. These policies also recognise however that the main barrier to a return to work after a lengthy absence is not necessarily physical, but can be psychological.

We have always seen return to work as being more than a medical issue. We see the relationship instead as a partnership between the GP, HR, line manager, worker and their representative. The principles behind the changes are therefore welcomed although there are concerns that GPs may not know enough about either occupational medicine, or the workplace to make an accurate judgment of what tasks a worker could perform if they go back to work before they are fully recovered. Many employers do not have sufficient occupational health advice to implement the recommendations of the GP. This is why UNISON workplace representatives such as safety reps and stewards will have a key role in supporting people where the doctor recommends an early return to work may be possible.

The New Process

The new medical statement will still be evidence. It confirms that an employee cannot work due to injury or illness, and normally will not be required until after the 7

 

th calendar day of sickness.

The present arrangements for Statutory Sick Pay (SSP) and any occupational sick pay scheme that an employee may have will not be changed. As at present, the form is advice that is given to the worker for the employer as evidence of illness for the purposes of sick pay. It is not binding.

What the changes will be

The form will now have two options. That the patient is "not fit for work" or that the patient "may be fit for work taking account of the following advice."

There will be four types of alterations listed which the GP can tick. These are:

A phased return to work

Altered hours

Amended duties

Workplace adaptations

There will be space for the doctor to provide more information on the condition and how it may affect what the worker do.

In most cases there will be nothing to recommend and, as at present, the worker will go back to work once the GP feels they are ready to. There will not however be an option for the GP to say that a person is "fit for work". The doctor will simply not issue a new medical certificate.

The doctor should only recommend a return to work if the person is not fully recovered after discussing it with the patient. The doctor should also make sure the patient is fully aware of what is being suggested.

The doctor is likely to propose a

 

phased return to work where someone is suffering from an illness that has left them fatigued. Phased return to work can also be recommended if there has been a long period of time away from work and a lack of confidence about returning full-time. It may also be used if a person has an injury where the doctor believes that their strength has to be built up gradually. Often a phased return to work may be proposed along with other changes such as amended duties.

Altered hours

is slightly different. Here the doctor will recommend that the pattern of working hours is changed. This may be recommended if the GP feels that the person may not be able to travel in rush hour public transport, or if shift working should be avoided.

The GP should recommend

 

amended duties where they believe that an employee cannot fully do their former work. But may be able to do their job if some duties are avoided or changed. This could include not doing any kind of lifting if recovering from a back injury, or avoiding any work with the public if a person is recovering from workplace stress.

Workplace adaptations

may be recommended if the GP believes that some physical adaptations are needed to help the person return to work. An example of this could be moving someone’s desk to the ground floor of a building if they have trouble with stairs.

In each of these cases the GP should base the recommendations on what the patient has told them about their workplace. The GP should discuss the proposals and implications fully with the patient.

The medical statement will then be given to the patient, as at present. The patient should then send it to the employer. It is good practice for the employer to then discuss the proposals with the employee and agree what changes will be made. If they disagree then the employer should not force the employee to come back until they feel comfortable with the changes proposed.

If in doubt the worker should ask their UNISON rep for advice and support.

In many cases, employers will have to get professional advice to help them decide on what action to take in relation to adaptations. Where they have no access to an occupational health service the employer may feel that they do not want to make the changes. In some cases the employer will not know who to go to for advice. The new national Occupational Health advice line pilot will provide occupational health advice from qualified healthcare professionals. In many instances this will resolve the issue but if further information is required the employer will be signposted from the advice line to the appropriate local or national agency.

 

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UNISON reps should always make sure that the employer seeks professional advice before proceeding with any adaptations.

The employer does not have to accept the advice on the medical statement. In this case the employer must accept the statement and the employee should be treated as though the doctor has advised "not fit for work". Many employers will try to say that the employee is ready to come back and is no longer "signed off". This is not the case and the government advice on this is clear. However union representatives will have to make sure that employers do not ignore the GP’s advice and still expect the employee to come back to work.

The employer must do a

 

revised risk assessment if they make any adaptations or changes to an employee’s duties. The risk assessment will ensure that any adaptations do not introduce new risks.

In addition, if the employee is disabled and covered by the Disability Discrimination Act then the new "fit note" procedures do not alter the duty on the employer to make reasonable adjustments regardless of what a GP recommends.

There are certain other groups where the medical statement cannot over-ride an employer’s responsibilities not to allow a person back to work when ill. This applies even if a GP recommends it. Included in this group are some workers in safety critical jobs and some transport workers where there are separate regulations.

Employers and workers know the workplace and what a job entails far better than a GP. If there is any possibility of allowing an employee to return before they are fully fit the employer should put the safety of the workforce before any recommendation(s) on a medical statement.

Where employers use the additional information on the revised medical certificate to facilitate an early return to work for those employees who want this they must be supported. It will also help to reduce sickness absence.

However if employers see it as a green light to try to force workers back to work before they are well enough to return, in the long run, it will only lead to increased sickness absence and increased conflict.

IF YOU NEED FURTHER ADVICE CONTACT 01413314451.