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Is the GP 'fit note' fit for purpose?

Institution of Occupational Safety and Health

3 min read Partner content

GPs require better training in using the fit note, according to new research by The University of Nottingham.

Rehabilitation research experts commissioned by the Institution of Occupational Safety and Health (IOSH) found that fit notes were not being used to their full potential by doctors, patients and employers to manage sick leave.

The study was conducted to examine how the fit notes were being used and whether the system is an efficient replacement for the old sickness certificates.   
Sickness certificates were replaced in 2010 by the GP fit note which was designed to encourage doctors to help patients stay at work or return to work as soon as they are able. Recommendations can be made on work modifications such as changes in working hours or phased returns, allowing a return to work tailored to the patient’s specific needs. 
The research team recruited GPs, patients and employers and collected 932 anonymised copies of current fit notes. The participants also completed questionnaires about the outcome and usefulness of these fit notes, and were interviewed about their views and experiences of the system. This information was analysed by the research team, then presented to a panel of experts in a consensus study to produce a list of judgements and recommendations. 
The results broadly show that, at present, the fit note is not being used as intended. The study concludes that the issues raised need to be urgently addressed by those involved in commissioning, completing, and processing the fit notes if the management of sick leave and return to work is to be improved. 
Dr Carol Coole, Senior Research Fellow in the University’s School of Health Sciences, said: “Sickness absence from work has huge financial consequences for the state, employers and the employee. Previous research has shown unnecessary absence can be harmful to an employee’s health and wellbeing so it is in everyone’s interest to improve the situation. Our recommendations suggest that there should be better education and training in fit note use, as well as tighter management of the process and communication between surgeries, patients and employers.

“These changes would allow people with health problems to more often stay at work, return to work sooner or be helped to return through changes in hours, tasks, conditions or environment.” 
IOSH is the world’s largest professional health and safety organisation, with over 44,000 members worldwide. 

Jane White, Head of Research and Information Services at IOSH, said: “Our research has shown that the GP fit note has the potential to do much more and play a pivotal role in helping people stay in work or get back to work as soon as they can. 
“We are keen to see changes to the fit note and processes which will lead to practical and significant improvements for all involved and this research and the recommendations pave the way to help us do that.”

The study has produced a wide range of recommendations, including the content of an exemplar ‘ideal’ fit note’ from the perspective of employers, employees and GPs, specific training for employers and GPs and best practice in the completion, timing, sharing and application of fit notes. 
To view the fit note reports, visit


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