Fit notes are a statement given by the doctor to provide evidence on behalf of a patient about the advice they have given about their fitness for work.
The GP will record details of the functional effects of their patient’s condition, so the patient and their employer can consider ways to help them return to work.
Given the current pressures on general practice, fit notes, or sick notes, as they are often referred to, take up a considerable amount of time.
The sick note is for an employer and is part of the work contract between an employer and the employee. It is difficult to see where a GP's involvement should begin and end.
It is also very variable in terms of the expectations of an employer; someone may require one for a minor ailment while others will only need them for more serious long-term leaves of absence. There is no clear guidance governing this and as a result, we can often become inundated writing notes on behalf of patients for their employers.
It is also worth considering who should actually be signing the notes. It would certainly be more sensible for the cardiologist to say how long the patient should be off work after a heart attack or for the orthopaedic surgeon to state how long a broken bone will take to heal but should other health professionals also be allowed to sign sick notes?
In some cases it may be easier for the practice nurse who is dressing a wound on a daily basis to give an opinion as to how long that patient needs to be away from work. Similarly, a physiotherapist who is dealing with a case of low back pain will be better placed to say when their patient may go back to a job that may involve heavy lifting.
The chair of the BMA’s GP committee, Dr Richard Dr Richard Vautrey, summed this up quite well when he recently said: “At a time when admin has become increasingly burdensome in general practice, compounding existing workload issues, it makes perfect sense for the healthcare professional seeing the patient, to issue fit notes where needed, removing the added layer of bureaucracy involved in getting it signed off by an individual GP.”
There is no reason why an employer should not accept a sick note that is signed by the person most likely to have knowledge of the current disability.
They would surely be best place to make the call on when that patient can return to normal work. The patient should also have a voice in this procedure.
They know best the strains and stresses of their particular job, the workplace adaptions that may need to be put in place and whether a gradual or phased return to work would be more appropriate. They know whether they need a period of reduced hours before going back to full time work and any particular environmental factors that will likely influence their return.
This whole business of sick/fit notes needs to be put on a more sensible basis which will reduce the administrative burden on employer, employee and the GP. A dose of common sense would help everyone.
* Dr Mary McCarthy is chair of the local medical committee and represents Shropshire, North Staffordshire and South Staffordshire on the General Practitioners Committee of the BMA. She has worked at Belvidere Surgery in Shrewsbury for more than 20 years.