Early Bird Update – Sickness Absence

Who can sign a fit note now?

Our recent series of Early Birds seminars dealt with the topic of sickness absence, including recent changes to the rules relating to statements of fitness for work (‘fit notes’).

With effect from 1 July 2022, new regulations took effect to allow a wider range of healthcare professionals (HCPs) to sign fit notes.

Fit notes are required if sickness absences last seven or more days, for the purposes of claiming statutory sick pay (SSP) and certain other social security benefits. These could previously only be signed by doctors, but as a result of the Social Security (Medical Evidence) and Statutory Sick Pay (Medical Evidence) (Amendment) (No 2) Regulations 2022, registered nurses, occupational therapists, pharmacists and physiotherapists are now permitted to sign fit notes, as well as doctors. The intention behind this change is to reduce the workload for GPs.

As a result of previous changes taking effect on 6 April 2022, fit notes can now be digitally signed, although for the time being and until all the necessary IT systems are upgraded the old version signed in ink is still valid.

Is there any guidance available?

There is a new guidance note setting out in detail the requirements that must be met by HCPs before they can sign fit notes: Who can issue fit notes: guidance for healthcare professionals and their employers. Existing guidance on fit notes has been updated to reflect the change, including guidance for employers and line managers.

The guidance makes it clear that HCPs must undertake the necessary ‘Elearning for healthcare’ module on fit notes before they start to issue them, and must undertake a period of structured mentorship and support afterwards. The issuing of fit notes must be within the HCP’s scope of practice, and it must be an agreed part of their role. Guidance from the HCP’s relevant professional body will also apply.

In order to issue a fit note, the HCP must be involved in the assessment, diagnosis or care plan of the patient, or be able to form an assessment based on a written report by another HCP.

Can high street chemists issue fit notes?

No. This is not part of the NHS services provided by community pharmacies, and they do not have access to fit notes. Only pharmacists working in multidisciplinary teams within general practices or hospitals, who are able to assess patients’ fitness for work, will have access to the official Med3 form.

According to the guidance: “The intention is that ‘where’ the fit note is certified will remain the same but there will be a wider range of healthcare professionals ‘who’ are able to certify the notes”

Can employers challenge a fit note?

If a fit note does not include the HCP’s name (or signature on the older version), it should not be accepted by an employer. Otherwise, it should generally be treated as evidence for sick pay purposes, unless there is good reason to think that an employee’s absence is not genuine. If this is suspected, employers should seek further advice on the employee’s fitness to work from another healthcare professional, such as an occupational health adviser.

Any recommendations on the fit note to help the employee return to work, such as adjusted hours or duties, are not binding on the employer. They are advisory only and the employer may choose not to accept them, provided they can justify why the recommendations are not suitable in the circumstances.