Fitness for work notes – a guide for managers

Background

From 6 April 2010 the sick note is changing to become a fit note. The sick notes that you are currently familiar with (or Medical Statement) are the forms issued by doctors to people when they are ill or injured. They provide advice about whether or not an individual with a medical condition is fit for work.

Many people with health conditions can, with some support from their employer, work as they recover from their illness. This helps the individual because for many people work can help recovery and also benefits the employer by reducing sickness absence; in current practice this is usually encapsulated within a ‘return to work’ plan.

Under the sick note system, doctors could only advise their patient on whether their health condition meant that they should not work. As a result many people, who could benefit from support whilst in work, would be advised that they could not work and their employers would not have had the opportunity to consider how they could help them achieve an earlier return to work.

To help more people get the support the need to get back to work, the new fit note system will mean that doctors can advise that a Brookes employee is either:

  • unfit for work; or
  • may be fit for work

A doctor will give a ‘may be fit for work’ statement if they think that their patient’s health condition may allow them to work if they get suitable support from their employer. If an employee is too ill to work, the doctor will advise this, just like with the current sick note.

In practice

The aim of the new regulations is to reduce sickness absence and support people with health conditions to stay in or return to work. It is hoped that the new approach will help inform discussions between individuals and their employers about whether there are any temporary changes to the work environment or role which could aid an earlier return to work.

See an example of the new statement.

GPs will be expected to give some generic advice, for example, general details of the functional effects of the individual’s condition. They will also have the option to indicate where their patient may benefit from common types of changes such as:

a phased return to work

  • altered hours
  • amended duties
  • workplace adaptations.

The maximum duration a medical statement can be issued for will reduce from 6 months to 3 months during the first six months of their health condition.

It is important to note that the GP’s advice is not binding and if no adjustments can be made then the note will stand as a sick note.

Many of our current practices will remain the same. Managers will continue to be informed by employees as soon as they are unfit for work, as per University policy. Managers are currently encouraged to maintain contact with any of their staff who are absent due to ill health and informally discuss their progress, likely duration of absence, possible return to work date and what, if any, measures may be needed to help support their member of staff when they return. This will not change.

The GPs advice will be the basis for a discussion with the individual on how best the University can support a return to work. The new scheme is very much focussed on longer term absence and the management of short term absence remains the same.

If you look at the sample note, you will see that it reads “I advise you that: you are not fit for work or you may be fit for work taking into account of the following advice: If available and with your employers agreement, you may benefit from: a phased return to work; altered hours; amended duties/work place adaptations.” The key words being ‘with your employer’s agreement’. The fit note is advice from the GP not a formal direction.

The occupational sick pay scheme we have at Brookes will remain unchanged and the Managing absence from work due to ill health policy will be updated and some new guidance for line managers in the section Managerial responsibilities for managing ill-health absence will be provided.

Guidance for line managers

After seven calendar days (including Saturdays and Sundays), the employee must obtain a doctors certificate and forward it to the Line Manager or Faculty/Directorate Administrator. When the manager receives one of these new notes it will either state ‘you are not fit for work’ or ‘you may be fit for work taking account of the following advice’.

If the line manager receives a statement stating ‘you may be fit for work’ they should discuss with the employee whether they can return to work despite their illness or injury. The line manager should consider the GP’s comments and discuss these with the employee and if they think it appropriate discuss with HR and/or make a formal management referral to Occupational Health.

If a return to work is possible the line manager should agree any temporary changes to the job role or hours and what support will be provided and for how long. This arrangement can be agreed between the line manager and the individual without any other parties involved if they feel it appropriate. Managers already have this discretion but should also be reassured that they are not expected to make medically informed decisions. It is to encourage managers to discuss simple and often common sense, short term adjustments to the work place for a member of their staff returning from sickness absence. Where adjustments may have to reflect long term underlying medical conditions, disability or may be medium term duration or longer, manager’s will continue to consider HR and Occupational Health for guidance and support.

If an Occupational Health appointment is scheduled for the future then the line manager may wish to agree a short term variation to the job role, based on the advice from the GP, until the OHA can make further recommendations.

Frequently asked questions

What should I do if the doctor has indicated ‘may be fit for work’?

The statement has been designed to give you the information needed to begin a discussion with an employee on whether they can return to work despite their illness or injury. You should consider the doctor’s comments and discuss this with your employee. If a return to work is possible you should agree any temporary changes to their job or hours and what support you will provide and for how long.

Is the statement binding?

No. This is about giving you greater flexibility and better information to manage sickness absence. It’s your choice after discussing the Statement with your employee, how to act on the doctor’s advice. When considering the doctor’s advice, you should always consider if the advice is consistent with any specific safety guidelines or regulations that the doctor may not be aware of.

If the doctor has advised that your employee ‘may be fit for work’, and you cannot make the adaptations or adjustments to help a return to work, you should explain the reasons for this to your employee and then use the Statement as if the doctor had advised ‘not fit for work’. Your employee does not need to go back to their doctor for a new Statement to confirm this.

Will I still be covered by my Employers’ Liability Compulsory Insurance (ELCI)?

Your liability insurance should not prevent employees who 'may be fit for work’, return to or remain in work. Also, you do not need a Medical Statement stating fitness for work for an employee to return to work. An employee does not necessarily need to be 100% fit to return to work. However, you will need to continue to manage your employees appropriately and carry out a risk assessment – based on the evidence from the doctor, your knowledge of the work and workplace and further support where necessary. If you have any concerns about the coverage of your insurance, you should contact your insurer.

How does this affect the Disability Discrimination Act?

If your employee has a condition covered under the Disability Discrimination Act (DDA), your obligations under the law have not changed. Speak to your link HR Manager for more information on the DDA and your responsibilities.

How long do any amended duties or workplace adaptations have to last for?

On the Statement a doctor will state the period of time their advice is for. When agreeing a return to work plan you should always be clear on the length of time any amended duties or support is for. In most cases this will be about temporary measures. If the employee cannot then return to their normal duties, you may need to discuss further or alternative temporary measures or, if needed, have a discussion on the long term effects of their health condition on their job, taking into account your responsibilities under the DDA. At all times, your link HR Manager and Occupational Health are ready to advise and assist in any aspect of this.

Can I request a Medical Statement advising that my employee is ‘fit for work’?

Unlike the sick note, the Statement of Fitness for Work does not include the option for doctors to advise someone that they are fully fit for work. You do not need to be fully fit to return to work and it is a myth that an employee needs to be ‘signed back’ to work by a doctor. In some cases, there are existing procedures to ensure someone is fit to carry out their role safely and these should be followed – for example with the DVLA rules for LGV/PCV drivers.

What should I do if an employee wants to return to work before the end of a ‘not fit for work’ Statement?

Sometimes your employee will be able to return to work before the end of a Statement period where a doctor has advised that they are not fit for work. This may be because the employee has recovered faster than the doctor expected, or the doctor did not know of ways in which you could support your employee to return to work.

If you agree with your employee that it is appropriate for them to return to work, you do not need to wait until the end of the Statement period for them to do so.

What should I do if I offer support to an employee to aid them to return to work and they disagree?

If you believe that on the basis of the advice from the doctor and your knowledge of the workplace, you can support your employee to return to work and they disagree with your proposal, your first option should always be to discuss the issues with your employee to find out why they believe they cannot return to work. There may be an aspect of their condition or the workplace that you have not considered.

If no agreement on your employee’s fitness for work can be reached, you may want to consult an Occupational Health Adviser and, if needed, you should consider a discussion with your link HR Manager. Your aim should be to ensure that both you and your employee are comfortable with the support that is being offered.

What should I do if I do not understand the advice on the Statement?

If you do not understand or are unsure on how to act on the advice on the Statement your first option is always to discuss the advice with your employee. They may be able to provide more information on the context of the advice. If you are still unsure you may want to consider advice from the Occupational Health team.

What do I need to do if the doctor has recommended an Occupational Health referral for my employee?

A doctor will recommend an Occupational Health assessment where they feel your employee’s condition is complex and/or work may be a contributory factor. It is your decision whether to act on this advice and in some cases you may be able to provide simple and practical support to your employee without needing additional expertise. However, for complex and work related conditions Occupational Health support should be seriously considered.

Updated April 2010