From sick to fit –
The new statement of fitness for work
By Dr Mark Devlin
What is a ‘fit note’?
On 6th April 2010 the traditional ‘sick note’ was replaced by the all new improved ‘fit note’. Though initially hailed as a radical change in practice this is, to a degree, spin in that the new fit note, otherwise known as the ‘Med 3’ form or ‘Statement of Fitness for Work’ form, is an amalgamation of previous forms: Med 3,4,5,6 and RM7, which have until now provided similar information and are to be withdrawn.
How does the new ‘fit note’ differ from the old ‘sick note’?
The new ‘fit note’ reflects a change in emphasis from the ‘sick note’ which was felt, for some employees, to be an obstacle to return to work and contrasts with the new form’s tacit encouragement to continue working if at all possible. Musculoskeletal disorders affect more than one million people in the UK, costing society £7.4 billion per year, with 9.5 million lost working days.
The new Med 3 form still requires a doctor’s signature, though completion is based on case assessment rather than the previous requirement for examination. Assessment can be based not only on a face to face consultation but also telephone consultations and consideration of written reports from doctors or allied health professionals such as physiotherapists. Hospital doctors may also issue certification on discharge from hospital or as part of ongoing out-patient review, thus avoiding a patient’s unnecessary contact with their GP “just to get a sick note”. A form is not required until the employee has been absent from work for more than 7 calendar days due to ill health.
The requirement to be “signed on” to return to work has been removed with the employer taking responsibility as to return and for whether the advice for a conditional return to work is feasible. However, recommendation for doctor review at the end of the sickness period is still provided for. If an employee’s conditions of employment are dependent on adherence to the qualifying criteria of an official regulatory body, that organisation's formal notification procedures still apply prior to a return to work, eg HGV drivers still need to fulfill DVLA criteria.
Why has the old ‘sick note’ been replaced?
The need for change was prompted by the increasing evidence of harmful effects of long term unemployment beyond the obvious financial loss. Continued absence from work due to ill health is associated with loss of both physical and mental wellbeing, increased use of healthcare and social work services and a rise in mortality. The longer an individual’s absence from work, the more unlikely their return. The previous forms did not allow for highlighting that an individual does not require 100% fitness to complete their normal duties to be of value to an employer. Employment can help preserve physical fitness, as reflected in the advice to those with back pain to keep mobile and foster confidence and independence over and above the avoidance of the socially isolating consequence of poverty.
What does the form include?
Although the form continues to provide for a complete inability to return to work there is a new option of “you may be fit for work taking account of the following advice” which includes:
• a phased return to work
• amended duties
• altered hours
• workplace adaptations
Further recommendations can be made and the functional effects of illness recorded under the ‘comments’ section. The form reflects advice given by a doctor to their patient and is not binding on an employer to follow the recommendations given.
The doctor issuing the Med 3 requires neither to be trained in Occupational Health nor carry out an in depth work based assessment. Indeed the value to the employer of arranging a formal ergonomic work based assessment may be a possible recommendation in the Comment section, being potentially highly relevant to complex rheumatoid cases. Advice to employers under the “may be fit” section is likely to be general such as:
• unable to sit for prolonged periods
• unable to climb stairs
• use of hands limited
• may require time off work to attend out-patient appointments
as opposed to specific instructions such as:
• only to work after 11am
• needs a new chair
• buy a laptop
If an employer is unable to provide sufficient support for those who “may be fit for work” then the employee is regarded as “not fit for work” and no additional certification is required.
Duration of absence can be specified by date if return to work is expected within 4 days of assessment, or by time period limited to a maximum of 3 months within the first 6 months of sickness.
What happens if the sickness/ inability to work is more long-term?
In the case of long term absence, application for Employment and Support Allowance, the replacement for Incapacity Benefit, will almost inevitably generate a request for a prompt official medical assessment. Again the question will be not what can’t you do, but given the appropriate set of circumstances what could you do?
What help is available when planning a return to work?
More advice on planning a return to work can be obtained from disability employment advisers at the Jobcentre Plus and may involve application of either the Workstep or Access to Work Programmes. Assistance may be available to overcome some of an employer’s difficulties in providing workplace adaptations to aid those with musculoskeletal issues returning to work. Those who continue to experience difficulties in obtaining support from their employer may decide to approach their Trade Union or the Advisory, Conciliation and Arbitration Service (ACAS).
Despite the positive aspects of the new “fit note”, little is gained without sufficient access to appropriate services such as physiotherapy, podiatry and psychological support within a reasonable timeframe. Nothing changes if the comments section merely notes “on three month waiting list for physiotherapy”. It also remains vital that for those with rheumatoid, early diagnosis leads to early treatment, which preserves function and maintains employment.
References and sources of further information: