Me again, for my third post on the Government’s response to The Sickness Absence Review (SAR) last week.

In this post I will be looking at the concept, and latest direction of travel, of fit-notes for ill employees.

There was never any real doubt that fit-notes would form part of the SAR, as one of the principle authors of the report (Dame Carol Black), was also largely responsible for the introduction of fit-notes in 2010. But I am aware that many still don’t appreciate the difference between fit-notes and sick-notes, so it’s probably worth starting there, and then working forward to last week’s announcements.

Sick-notes were the traditional method of certifying the absence of an employee. The family Doctor, after a consultation with the patient, would sign a note stating that the employee was ‘unable to work’. Sometimes this included details of why, but rarely did it give any indication as to adjustments that could be made by the employer to facilitate a full, or partial, return to work.

This oversight in the process had the potential to increase, rather than reduce, sickness absence levels. It’s a generally accepted fact that the longer someone is unable to work, the less likely that they will be able to return to the their previous role (or sometimes any work at all). So this was clearly something that needed to be addressed.

Fit-notes, as the name suggests, are a more positive response to absence. If the employee is not fit for any form of work, then that will of course be stated by the GP. However, if they are capable of some work, then the GP will indicate this, and also give some general advice about what adjustments could be made to enable such a return to work.

This is clearly a step in the right direction. But whilst the concept has been generally welcomed by all three sides in the process (GP’s, employers, and employees), the tangible success of the fit-notes has been a little less easy to gauge.

Although only anecdotal evidence, I can certainly add my thoughts here. In my experience I see little evidence that employers are yet seeing the positive impact of fit-notes. From time to time I actually ask my (largely) HR audiences if they think that fit-notes have improved their company’s absence situation. Usually no more than one or two hands will be raised in support of the concept.

But why is this the case?

Key to the success of fit-notes are GP’s. And there are four specific hurdles for the GP to overcome here:

1) The GP is generally not an occupational-health professional

2) The GP is unlikely to have detailed knowledge of the employee’s job role and work circumstances

3) The GP only has limited time and resource to correct the gaps in knowledge suggested by (1) and (2) above

4) The GP’s principle relationship is with the patient and his/her family, not with the employer.

Both the SAR and the Government have recognised that the GP will be key to the success of this process. The Government are already working on new fit-note guidance, building on the ongoing research and evaluations of fit-notes to date. In addition, the Government has also already produced a guide to the benefits system for GP’s, and the recent report confirms that this will be updated to coincide with, and reflect, welfare reform changes.

So positive steps, but unlikely in themselves to significantly change the current employer’s perception of fit-notes.

For real progress to be made here, the key will be providing GP’s with an occupational-health referral mechanism which they can actively utilise. This service, which is to be christened the Independant Assessment Service (IAS), will be the subject of my next post in this series.

Best regards

Steve