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Are Fit Notes really Sick notes by another name?

Fit Note or Sick Note?

A “Fit Note” is a record of advice from your Doctor. But I wonder how many are used as they are actually intended? Are they really just Sick Notes by another name?”

Doctor, I’m stressed…

“Have you had trouble sleeping and concentrating?”

Uh huh..

Passing water more than usual?

Not really

Difficulty in switching off and relaxing?

Uh huh…

You are stressed. Take two weeks off work…here’s a sick, I mean “Fit” note.

Hmm… I know I am taking liberties here, but I need to get your attention somehow. And to be clear, I’m not having a go at GP’s- I’m very fond of mine, but I wonder how many sick notes are still being dished out? You know what I mean- “signed off on the sick”

Brace yourself as I swing the lantern a little…

In 2007 I had an operation on my shoulder, and because I did a particularly physical role at the time, I was “signed off” for over a month while I worked my way back to fitness.

After a week or two to get the tablets out of my system I was climbing the walls (not literally…my shoulder was just not up to it).  My cognitive ability was no worse than it was pre-op, and I was itching to do something…anything! But I couldn’t you see. Because of the sick note. The job wouldn’t entertain it for insurance reasons.

But in 2010 all that changed… The government realised that people could still do something while recovering from illness/injury- maybe not the exact same job they were doing, but may still be able to contribute meaningfully.

In fact, people living with mental health problems contributed £226 billion (12.2%) of the total UK GDP, and we probably lost another £25 billion because we didn’t manage others cases so well. There are other costs too, like staff and carers leaving the workforce, lost productivity, staff turnover, staff not able to access the workplace and absence were the result. Check out the link here.​

So they introduced the “Fit Note”…

Or to give it it’s full name, “The Statement of Fitness For Work”

Rather than documenting what a person can’t do or their inability to work, the focus is supposed to be on what they can do. The GP can tick the option “MAY BE FIT FOR WORK” with reasonable adjustments. 

I’m certainly not advocating dragging yourself in to work when you are unwell. The danger is we start to live to work, rather than work to live.

With 45% of all workplace absence being down to Stress, Depression and Anxiety the Fit Note could really come into it’s own.  

of all absence is Stress, Anxiety Depression related: HSE

11.7 million 

working days lost


days per case

It’s a Win-Win!

Good for patients, because they can challenge assumptions about their ability to work and it gets them back to work faster. Its a way to help thrive rather than just survive. In fact, in a survey from 2016, 86% of workers surveyed agreed that “work is a key factor in supporting and protecting my mental health.” 

Good for employers because, used properly they give information about what the employee CAN DO in the comments section.  

And good for GP’s, where it can guide conversations with patients about phased return to work, and help in challenging a patient’s perceptions of what they can and can’t do.

So when I had my other shoulder operated on in 2011 I was back after a couple of weeks… (wishing for the good old days of sick notes!!)

 And if I wanted to go back even earlier, I could have…

IMPORTANT: Your employee can go back to work at any time (including before the end of the fit note) without going back to see their doctor – even if their doctor has indicated that they need to assess them again. This will not breach your Employers Liability Compulsory Insurance, providing a suitable risk assessment has taken place if required. 

“Fit Note” Guidance for employers and line managers.

Increasingly GP’s are prescribing treatments other than tablets and bed rest which has to be encouraged. As public awareness around all things “mental health” increases, this will surely place even more pressure on a system already creaking. 

The most common reason for issuing a Fit Note since 2014 is “Mental Health and behavioral conditions” (31%). Fit notes for anxiety and stress rose from 503,000 in 15/16 to 573,000 in 16/17. 





Stress and Anxiety Fit Notes 

I have to wonder if they are being used as they should be. 

In closing…

We know that work is generally good for our overall wellbeing, and the best medical professionals know that. Complete bed rest may be appropriate in some cases, but the days of receiving a diagnosis and being sent home on gardening leave until you’re better should be long gone.

Your GP is not an expert in what you do specifically, but they can make recommendations about general working conditions, such as: Phased return, change in hours, or adjustments to the workplace.

The note is not legally binding of course, but provides a great way to test the mission value statement that “our people are at the very heart of what we do”.

Click on the links for more information if you are an Employer or Employee.