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Rob Woollen

Rightway Employee Wellbeing Solutions

Wellness Manager

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The fit note – friend or foe?


Rob Woollen from Rightway Employee Wellbeing Solutions examines the new Med-3.

Unless you have been living under a rock for the last few months you will be aware that the new Med-3 form comes into play next week. Or does it? Some GPs are saying that whilst they have already ordered pads of the new ‘fit note’, they will be using up old stocks of Med-3 and Med-5 forms before they actually start issuing the new forms.

Responses to Dame Carol Black’s improved model of sick note have polarised the HR and occupational health community. Some have heralded its arrival with open arms, others are indifferent and, like any other change in policy it has its fair share of critics and cynics. This article will dispel some of the myths about the new form, and provide background information and opinion on its history and its future.

In her 2008 report, ‘Working for a Healthier Tomorrow’, Dame Carol Black identified the huge cost of sickness absence, both to employers and to the nation as a whole. Later that year, in the government response to the report, a number of key initiatives was proposed. One of the most wide-ranging was the reform of the medical statement of fitness for work (the existing Med-3/Med-5). The report established not only that it is not necessary to be 100% fit to work effectively, but also that work itself can form an important part of the process of recovery from illness and injury. With 20% of the working-age population having some kind of long-term medical problem it is clear that this new paradigm – that you can be "fit enough" to do some sort of work has the potential to make a huge difference.

So why the reform? What was wrong with the existing medical statements? The government felt that the current provision was too restrictive. GPs were faced with only two choices, to tell their patient to go to work, or to tell the employer that the patient could not work. The new statement is intended to open up dialogue between the patient and their employer, guided by advice from the examining physician. In addition, there is an extremely resilient myth that under the current scheme, it is not possible for an employee to return to work until the time stated on their sick note. This alone contributes significantly to the costs of sickness to the UK economy. From the author’s own discussions with GPs it is clear that the timescales given for return to work have only ever been estimations. There is no exact science to working out the length of recovery time (with the exception of certain musculoskeletal conditions). It is unfortunate then that so many working days have been lost to those with minor illnesses whose employers have refused them permission to return to work based on the estimated time given by a GP in a 10-minute consultation.

What do the supporters of the new note say? Those in favour of the new fit note feel that in the majority of cases this will facilitate either a quicker return to work, or quite often a reduction in cases of absence. Short-term absence accounts for over a third of all days lost, with the majority of this down to unspecified minor illness (such as colds, stomach aches and the like). In these relatively simple cases there are huge savings to be made immediately.

If only life was so simple. What about the more difficult cases such as stress or complicated medical conditions and injuries? Those championing the system say that the new note will allow many with these health conditions to continue to work by helping employers and employees to work together (with specialist help where appropriate) to consider options which make this practical, such as adjustments to tasks, environments or hours. The DWP guidance states that if these adaptations are not considered by the employer and the employee to be practical then the note reverts to a sick note and SSP (or Company Sick Pay) is paid as normal.

What about those who contest the new system? Challengers doubt that the majority of GPs have the specialist training in occupational medicine required to understand the functional requirements of different roles. They also fear that the new Med-3 will add an unnecessary administrative burden without a significant reduction in absence. They foresee cases in which employers feel forced to make adjustments to allow their staff to work which they are not competent to assess. Furthermore they doubt that GPs, in their role as patient advocates, will be inclined to assess people as "may be fit for work" if the patient does not want them to.

Some common myths explored

Employers will be forced to make expensive adjustments to allow people to work.
In fact the guidance is not binding in law. If the employer and employee cannot find mutually beneficial ways of working then a "may be fit for work" acts in just the same way as a sick note, including all eligibility for benefits.

Doctors signing people on as "may be fit" are violating their relationship with the patient.
Evidence shows overwhelmingly that work is good for people. Well-designed jobs build self confidence, increase financial security and provide a sense of meaning and worth. Those off work for more than six months have an 80% chance of being off work for five years! GPs will act in the best interests of their patients, and if this involves discussing the possibilities of working then will want to do this.

Employer’s Liability Insurance is not valid if the employee is not completely fit.
As long as you have carried out a risk assessment of the role, taking into account the medical information given by the employee, your insurance should be valid. So says Ben Wilmot of the CIPD after a statement from the Association of British Insurers.

Employees need to be signed back "on" to work by their GP before returning to normal duties from a period of absence or adjusted working.

There is a space on the new Med-3 for the GP to state that they wish to see the patient again before they return to work. In most cases they will not wish to see the patient again, and in all cases they will not issue a note stating that the employee is fit for work.

There is no occupational health support for those who do not have existing arrangements.
The government recently launched an occupational health advice line for small businesses. This free advice line provides expert support and information on helping people with health conditions to remain in work. In addition, all local Job Centre Plus locations have disability employment advisors who are glad to help employers to consider options for keeping people in work as well as finding work for the unemployed.

The author’s opinion

I think the fit note is one of the most positive moves in recent times in the field of absence management. In the vast majority of cases, it will reduce incidences of absenteeism, or facilitate a quicker return to work. It is a complete shift in culture. Instead of employees being told that they cannot do their jobs, they will be encouraged to enter into dialogue about what they can do, and what we can do to help them do it. They will feel valued if we are able to take time to understand their needs, and will feel fulfilled in producing useful work whilst partially incapacitated. The results for employers will be lower costs of absence, a more motivated workforce and better client relationships through continuity of service.

Of course there will be those cases where we feel consciously incompetent to deal with and assess adjustments to the workplace. However the new Med-3 allows for this and is able to seamlessly return to its original form as a sick note in these instances. We are not being asked to act as specialist medical assessors (although increasing numbers of us have access to these), nor to put our own business at risk. It is at the employer’s discretion whether or not to allow the employee to work. There will be cases where the GP has elected not to give us sufficient information about the condition (they have the right to do this) as they fell revealing it will compromise their patient’s health. In these cases you can only be reasonably expected to act on the information you have available.

One thing we are recommending to our clients at present is that we review their sickness absence (or attendance) policies and ensure that they take account of the new procedures. For many this is a good time to review the entire policy and ensure that they are as comprehensive as possible and written carefully to promote attendance.

A final point: I have asked for clarification from the DWP on how the fit note will work where a phased return to work or reduced hours are recommended. There is potential for lower-paid workers to end up working almost for nothing if benefits are removed whilst they work short hours.

3 Responses

  1. Confirmation from DWP

    I spoke again to the DWP last week (apologies for late reply – I have had a lot of personal things to deal with this week).

    Their answer this time was slightly different from the last one and will affect small employers who are likely to reclaim SSP in a given period. Rather than clog up this post, I have summarised the final response with worked examples on a pdf which can be downloaded from this link


  2. DWP response

    I had a response from the DWP regarding employees’ rights to SSP when on a phased return to work.

    They stated what I feared. There will be no change to the entitlement for those working reduced hours, either as a temporary measure, or as part of a phased return to work.

    So what does this mean in practice? Well as previously, if you receive SSP and then return to work, you will be eligible for SSP for any further absence linked to the original period of absence without being subject to waiting days (as long as the gap is less than 8 weeks). So a person who agrees to work only 2 days per week would be eligible for SSP for the other 3 days up to the maximum amount.

    However the thing I was hoping would change has not. If you agree that the employee should work reduced hours, by working shorter hours in each day, then they will not be eligible for SSP at all. It is counted as a working day whether you work one hour or twelve.

    So think careful when agreeing adjustments to people’s working patterns. Working 8 hours in one day would allow them to claim SSP for the other 4 days (assuming a normal 5-day week). However working 5 hours over 5 days would not allow them to do this. In cases such as recovery from some MSDs, and particularly stress, I had hoped that they would back up the Fit Note with a method of assessing your eligibility based on the proportion of your normal hours worked.


    Obviously this will only affect certain cases, and only really adversely affect those who are on lower incomes. But it will place barriers in front of some who should be encouraged to return to work without having to calculate the cost to themselves.


  3. Doctor helpline – Fit Note

    The benefit of those signed up to health cash plans, such as HSF, means that members can ring up and speak to a qualified GP 24 hours a say, and get quick advice on when they can return to work or help answer any medical questions. 


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Rob Woollen

Wellness Manager

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