Sickness absence: Fit notes not best medicine

If you read nothing else, read this …

• Fit notes are seen as a positive step, but HR professionals are finding they add little to managing sickness absence.

• More GP training on occupational health is needed to make fit notes a more useful sickness absence management tool.

• Government-funded mediators could help resolve some long-term absence cases.

• More government investment is needed in occupational health professionals to support its health and work agenda.

Fit notes have yet to make an impact on sickness absence, but government initiatives can play their part in reshaping the workplace health and wellbeing environment

The way an employer tackles sickness absence will have a significant effect on the amount of time staff take off, but government initiatives can also shape the health and wellbeing environment.

The fit note is one government initiative that has the potential to bring benefits to both employers and employees. It was introduced in April 2010 to replace the sick note. Rather than stating that someone is too ill to work, it provides information on how the individual’s condition affects their ability to work and how they could return to work.

Dr Chris Sharp, consultant occupational physician and managing director at WorkFit, says it should change the emphasis from sickness to an employee’s ability to work. “It is transferring the responsibility for certification and management of a health condition from a straight doctor-patient relationship to a relationship between the employer and the employee with advice from the GP,” he says. “It is what occupational health practices have done for years.”

But the government’s plan seems to have gone awry, with many HR professionals saying the fit note has had little impact. Adam Brooke, employee benefits manager at JP Morgan, says the fit note has not changed the way the firm deals with sickness absence. “Fit notes go through to our occupational health department and are used as a starting point with the employee, but you then start working on whether there is a return-to-work programme you can put in place,” he says.

Gary Cox, employee relations and immigration manager, UK and Ireland, at American Express, adds: “The fit note has not helped us in any way. We already encourage a conversation with the employee and the fit note does not really add anything to that.”

Another criticism of fit notes is that they are too general. Amy Whitelock, senior policy and campaigns officer at Mind, says GPs too often lump everything under the banner of stress. “The employer does not know whether it is work-related stress, home issues or a mental health problem such as depression,” she says. “When this happens, the employer does not know what the right solution is.”

Reaction to fit notes

For some HR professionals, the reaction to fit notes has gone beyond finding them uninformative. Thomas Humphris, head office HR and UK reward director at Informa, says the company has sometimes disagreed with the recommendations made on a fit note. For example, when an Informa employee was returning to work after cancer, the fit note recommended they came back as normal.

“We did not think this was right, so we referred it to our occupational health department to review what the working day would entail,” says Humphris. “[It] suggested a phased return to work supported with flexible working practices. This worked well and we had weekly meetings with the employee to review their progress and eventually they returned to work full time. I suspect the GP was trying to instil enthusiasm by telling the individual they were well enough to return to a normal working day.”

But while larger employers may have access to occupational health practitioners who can override the information given on a fit note, this may not be the case for smaller organisations. Whitelock says: “Some small and medium-sized enterprises (SMEs) can access the government’s Fit for Work services and see some fantastic results in returning employees to work, but this support is not available nationally and many SMEs are at a loss as to what to do when they get a fit note.”

The reason for this confusion around fit notes is the amount of occupational health training given to GPs, says Sharp. “Doctors in training can expect to receive, at most, one hour’s occupational health training in their five years,” he says. “There was no training on fit notes other than the blurb on the Department for Work and Pensions’ website. GPs are not experts on employment employers are.”

Encouraging developments

But there are some encouraging developments that should help to make fit notes more useful. Sharp says effort has been put into helping GPs complete fit notes, such as an e-learning initiative by the Royal College of General Practitioners (RCGP). He also flags up the website, which is supported by the RCGP, the Faculty of Occupational Medicine and the Society of Occupational Medicine, and gives information from employers to help GPs.

“Other specialities, such as surgeons and oncologists, are being encouraged to produce leaflets to explain to employers and employees the consequences of treatment and when someone can go back to work,” says Sharp.

“In addition, GP training will make it mandatory to spend some time addressing occupational health issues.

Hopefully, this will put an end to the naive response employers are getting on fit notes.”

Ksenia Zheltoukhova, researcher at the Work Foundation, says that, over time, fit notes should deliver cultural change. “If more employers think about capacity rather than sickness, then that is already a change for the good,” she says. “The shift from managing sickness absence to prevention, job retention and early intervention is a welcome change.”

While efforts are being made to help the fit note fulfil its purpose, there are calls for the government to support UK employers in tackling sickness absence in other ways.

American Express’s Cox says that where an organisation has done everything it can, there is scope for a mediator to help bring the employee back according to a phased plan.

Whitelock says mediators are good at focusing on solutions rather than looking for blame. “The government needs to support this,” she says. “The Department for Business is looking at the use of mediators for tribunal situations, but they could also be useful in instances of long-term sickness absence.”

There is also a call for more investment in occupational health generally. Ann Dougan, marketing director at Cigna, says: “The government should be promoting more occupational health training to give us a range of professionals at different levels.”

Read more from the sickness absence roundtable