Presentation T P7

T P7 (Poster Presentation):
What kind of ‘fit notes’ do UK General Practitioners issue to employed patients?

Presented by: Carol Coole

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Coole C1, Drummond A1, Nouri F1, Potgieter I1, Thompson L1, Watson PJ2

  1. University of Nottingham, UK
  2. University of Leicester, UK



Sickness absence is costly to the state and to employers, and can be detrimental to individuals. In the UK, employed people who do not feel well enough to work can self-certify for the first seven days of absence. Thereafter they have to obtain a sickness certificate from their General Practitioner (GP). In 2010, in order to facilitate work retention and timely return to work, and to reduce work disability and unnecessary sick leave, a new sickness certificate – the GP ‘fit note’ was introduced. GPs can use the fit note to advise that patients are ‘not fit’ or ‘may be fit’ for work. Fit notes can also be issued to people who are unemployed to support claims for welfare benefits. Where a patient is considered as ‘may be fit’ GPs are required to select one or more work modification options, and encouraged to add free text comments ‘including the functional effects' of the patient's condition. GPs are also required to state whether or not they need to re-assess the patient’s fitness for work. Recent evaluations and surveys suggest that fit notes are not meeting expectations, with fewer than 10% advising that a patient ‘may be’ fit for work. However, these studies did not report on fit notes issued only to employed patients, which is the focus of this current research.


Thirteen organisations of different sizes and sectors were recruited to the study. Anonymised copies of fit notes received by each organisation for a set period between June 2013 and February 2014 were sent to the research team. Data were analysed descriptively.


A total of 827 fit notes were available for analysis. Of these, 753 (91%) had the ‘not fit’ option selected, 55 (6.7%) had the ‘maybe fit’ option selected. The remainder had either both options selected (3; 0.4%), both boxes deleted (1; 0.1%) or neither option selected (15; 1.8%). Forty-seven of the ‘maybe’ fit notes, and 8 of the ‘not’ fit notes had a work modification option selected. Forty-nine of the ‘maybe’ fit notes and 40 of the ‘not fit’ notes included a comment in the free text box. A total of 317 (38.3%) fit notes had stated whether or not the GP needed to reassess the patient.


These findings indicate that GPs are not using the fit note as intended to facilitate employed patients in returning to and/or remaining at work.

Schedule Details

Tuesday September 30
12:45 - 13:45 Poster Viewing
Session: Social issues