Fit Notes

Changes to the law means that occupational therapists are now able to issue fit notes, but what does this mean, and how is it beneficial to patients?

On 1 July 2022, a legislative change meant that a number of allied health professionals - including occupational therapists - could start certifying fit notes for patients. Before that date, only doctors could issue fit notes, and the change is something that a number of bodies representing these professional bodies, including the Royal College of Occupational Therapists, have been lobbying for. In fact, an RCOT study published in August 2020 by Nouri et al, which saw the researchers interview 12 health professionals to examine the role OTs and other allied health professionals could take in issuing fit notes, found that both patients and GPs were on board with OTs issuing fit notes, with GPs noting that appointments for fit notes were “a waste of their time and expertise” when OTs, who better understand workplaces, were better placed to complete the assessment. RCOT have celebrated the change, noting that it will have a “really positive impact on health services across the UK,” with patients now able to receive more bespoke advice using the myriad expertise of occupational therapists. What then could this new legislation mean for you, and what are the benefits of the change?

The legislation changes mean that nurses, occupational therapists, pharmacists, and physiotherapists can now issue fit notes in addition to doctors, as was the case before the change in law. Per RCOT, the change covers all qualified occupational therapists at point of registration with the HCPC in Scotland, England and Wales, with the College noting that Northern Ireland “will be able to adopt the changes if wished.” Student OTs working within GP surgeries, for example, are not able to issue fit notes.

Let’s get down to basics: what is a fit note? Sometimes called a Statement of Fitness for Work or Med3, it’s a certificate that, before 1 July of this year, was issued by a GP to state that a patient is not able to return to or start work for reasons related to their health. They’re useful for people who have to take sickness leave from work (any absence over seven days requires a fit note) or people who wish to claim some benefits. Fit notes can also establish what needs to be done to help a person return to work - this could be a phased return to work, or lay out the workplace adaptions that are needed to ensure a person is able to return. IS THE FIT NOTE ISSUED ON PAPER?

Before April 2022, this was absolutely the case - GPs had what was functionally a big notepad of fit notes that they had to sign manually, or had to print them out and sign it. In advance of the changes to legislation, the need for a handwritten signature was removed, so now a digital certification template has been created that’s present within the IT systems of all GPs that makes it really simple to access and issue.

The government’s own guidance states that the change recognises the importance of the input that other healthcare professionals - nurses, OTs, physiotherapists and pharmacists - play in supporting patients in the delivery of healthcare. Multidisciplinary teams’ support of patients in healthcare settings includes people who may wish to return to work but require assessment, guidance and support, and that’s where the expertise of healthcare professionals like occupational therapists can shine. RCOT also believes that this change could see the strain being taken off of doctors, and may result in a reduction in demand and waiting time for GPs, which will help them focus on other medical matters.

Indeed there is! Hosted on E-Learning for Healthcare, a programme called The Fit Note has been created in collaboration with the Royal College of General Practitioners, the Chartered Society of Physiotherapy, the Royal College of Occupational Therapists, the Royal College of Nursing, and the Royal Pharmaceutical Society. It’ll support relevant healthcare professionals through a case study approach that will explore common potential scenarios that illustrate what might be seen in a GP surgery. The training has four sessions and a final assessment which provides information on the aims and importance of fit notes, legislation and guidance, making recommendations, and the application of fit notes. It should take between two and four hours to complete, and is available on e-lfh.org.uk.

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