Making Fit Notes More Effective As Rishi Sunak Will Make It Harder To Get Sick Notes

26th April 2024

The prime minister claims benefits have become a "lifestyle choice" for some, causing a "spiralling" welfare bill.

If the Tories win the general election, Mr Sunak wants to make it harder for some patients to obtain a sick note.

Disability charities reacted with anger, with Scope branding the plans "a full-on assault on disabled people".

Prime Minister Rishi Sunak is expected to announce plans to review the fit note system for people who aren't well enough to work. The Society of Occupational Medicine (SOM) is calling for a review of fit notes by health professionals that are also trained in occupational health to support better use of fit notes.
Nick Pahl, CEO of the Society of Occupational Medicine (SOM), said:

"As the PM states, the fit note is not used to its full potential, and SOM would like to see a number of actions taken.

"One, comprehensive training in fit note use, combined with occupational health training, in clinical and medical curricula. Two, fit note certification acting as a triaged referral point to an occupational health professional to support return to work. Lack of skills in occupational health (OH), are barriers to using the fit note to its full potential in general practice. Three, only 50% of UK employees have access to OH and the Government needs to fund OH to support people with health issues to stay and return to work.

“Finally, fit notes generally focus on the ‘not fit' for work option, rather than the ‘maybe fit for work' section. Statistics show that over a third of fit notes are issued for five weeks or longer, by which time around 20% of people will never return to work. Through no fault of their own, people seeing their GP team often expect an all or nothing ‘sick note’. This makes it harder to manage expectations and come to a shared decision about using the ‘may be fit for work’ option. Discussing the merits of the ‘may be fit for work’ section, or a shorter review period before reassessment can be perceived as punitive by patients who expect to get ‘signed off’ and find it difficult to understand why their GP team would challenge this. That is why SOM is calling for tailored occupational health advice to be made available to patients who receive the fit note - with better use of the 'maybe fit' for work section."

The Prime Minister also followed up comments made by Mel Stride, MP, the Work and Pensions Secretary of State, stated his concern about the impact of mental health issues on work. He suggested the normal anxieties of life are not mental health issues. However, employees still require support from managers and, occupational health, if a health conversation is needed.

People who do have medically diagnosed mental health issues need support and a working environment where they can disclose their condition. For many, work is part of that support. We know good work is good for you. The UK can achieve both workplace productivity gains and good well-being for employees. NHS professionals should be resourced to have time to have work related conversations; and employers should offer evidence-based support to people.

A leading researcher in this area, Gwenllian Wynne-Jones, Professor of Nursing at Keele University, said, "There is a clear need for better support for those struggling at work though better access to OH. However, we must ensure that we don't disassociate the health system and healthcare professionals from supporting people to work. Effective management of sickness absence requires all stakeholders to be engaged in supporting people to manage their health work."

Almost 95% of fit notes are signed as ‘not fit’ without suggesting any adjustments or advice that could help keep patients working when living through a period of ill health.