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Working with the Fit Note

The old 'sick note' has been replaced with the fit note.

With the sick note, doctors could only advise their patient on whether their health condition meant that they should or should not work. In practice this meant many people who could benefit from working while recovering were advised that they could not work.

The fit note changes all that, and for the better!

Now the doctor can say ‘you may be fit for work taking account of the following advice’. The key idea is that the focus is firmly on what the person can do, not what they cannot do.


The Fit Note

Fit Note Sample

Of course the doctor can still say the person is not fit for work if there is a medical necessity. But with common health problems sick leave is often not needed - even if it is needed it should only be for a few days.


The fit note may be used to avoid sick leave for somebody who is actually able to Stay at Work if they get suitable support. It can also be used to help someone Return to Work in timely fashion, again, with the right support. How the workplace responds to the fit note is critical to successful Stay at Work or Return to Work.


The fit note gives you the confidence to make simple adjustments that can help the person recover while working. Importantly, these adjustments should be made in agreement with the worker. Employers do not have to act on the doctor’s recommendations, but it would be foolhardy not to try everything possible to accommodate the worker.


What advice might the doctor give?


The fit note lets the doctor give advice to the workplace on the sort of things that need to be done to help the person to Stay at Work or Return to Work - temporary modifications to the job or the way it’s organised.


There are four basic options for the doctor’s advice:

  • a phased return to work

  • amended duties

  • altered hours

  • workplace adaptations


The doctor will tick one or more of these. There is a box for the doctor to make additional comments offering more detail on the kind of things that may help. Remember, though, that the doctor does not know much about the actual work or workplace, and this section may be blank. So, you as the employer will need to work out with the worker just what adjustments can be made.


What to do about it – translating the medical advice


Below are some examples of the sort of adjustments that have been found to be helpful. Some are more helpful for physical problems, while others are effective for mental health problems and people who feel stressed. It is down to the line manager and the worker to figure out the best adjustments to make, and how long to make them for.


A phased return to work

  • Gradually increase hours

  • Alternate days

  • Start back on a Wednesday

  • Selected duties


Amended duties

  • Achievable goals, scheduled at start of day

  • Reduce pace of work

  • Reduce task frequency

  • Increase task variety

  • Co-worker as buddy


Altered hours

  • Flexible start/finish times

  • Reduced work hours/days

  • Additional rest breaks

  • Allow work at home


Workplace adaptations

  • Reduce reaching

  • Provide seating

  • Reduce weights

  • Different department


Who does what, when?


Different people in different organisations will be responsible for receiving the fit note. In large organisations it might be the personnel department, whilst in SMEs it could be the boss. But, the people who actually make it happen will usually be the line manager and the worker.

It is crucial to have a system for working with the fit note. Someone needs to be responsible for identifying when a fit note is received. It might be when the worker has been off work and is returning or it may be while they are still at work – i.e. struggling with a work-relevant health problem. The worker and line manager need to be put together at the earliest opportunity to select the best adjustments and make them happen.


Remember, doctors only issue a fit note after seven days of sickness absence. For shorter periods of sickness absence, workers can self-certify. There is usually little point in waiting until the worker sees the doctor for a fit note before you do something. The same principles of early discussion and accommodation will generally apply during that self-certification period.

If you are uncertain whether staying at (modified) work is the right thing, you may want to suggest the worker checks with the doctor. What you may not realise is that the doctor will value your input. You can let the doctor know the sort of adjustments that are available, and what adjustments you and the worker think are going to be helpful. Unless you do this, doctors can usually only guess what someone's job actually involves. Of course, you need to do this with the worker’s permission.

The fit note is a great opportunity for the key players – line manager; worker; doctor – to liaise and make recovering while working a reality. This helps the worker because work can often be part of the recovery, and it also benefits the employer by reducing sickness absence.

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