The fit note replaced the sick note on April 6, 2010. The regulations allow doctors to inform the employer if the patient is fit for any work, with employer support.

The doctor might suggest changes that could make it possible for the employee to return to work. This could include a phased return, altered hours or amended duties such as lighter duties or being allowed to sit down. In the case of those who have been off work for some time, the doctor could recommend workplace adaptations.

The employer needs to consider these suggestions, but does not necessarily have to implement all of them.

What you need to do

In the majority of cases you will continue to receive a certificate saying the employee is either fit or not fit for work. However, in some circumstances where the doctor considers a return to work on a gradual or revised basis might help the employee’s recovery, they will tick the box on the form saying they consider the employee fit for some work.  In such cases the GP will already have had a conversation with the employee about what they consider would be a good way to re-introduce them into work.

You need to meet with the employee and discuss what is possible for a phased return to work or any amendments to the work to fit in with the GP’s recommendations.  Remember, the fit note was designed to try and get people back to work sooner.  You do not have to agree to major changes if they do not suit your business, but you must have a good business case for not agreeing to these changes.

Make sure your managers and supervisors are aware of their responsibilities in this area. You should also take precautions to ensure they understand that a returning employee may have some limitations on what they can do initially.

For more information see our Managing Sickness Absence Factsheet

What we think this will mean

I suspect the fit note will help employees on long-term sick into a phased return. Hopefully, it will also help the long-term sick back to work when what they need is additional support from their employer. (See Cary Cooper’s blog post Is the Fit Note Working? to share your experiences).

A lot will of course depend on the co-operation of the employee in wanting to return to work once they are beginning to make a recovery. It will also be critical how you reassure them that appropriate support will be given during this transitional period.

As for the success of the system as a whole, we will have to wait and see. Much will depend on the co-operation between all three parties: the patient, the GP and the employer.

I suspect small businesses are probably wrong to worry excessively about this – a recent survey suggested 35 per cent of small business believe the fit note will have a very negative impact on the business.

However, within a week of the fit note’s luanch, two clients had phoned to ask how the new form works. Both queries seem to indicate that in some cases GPs are unsure about the form and how it should be used. Hopefully just teething troubles.

Download our Managing Sickness Absence Factsheet to find out more.

Under the new system coming into force in April 2010, GPs will not be asked to determine whether a worker is 100 per cent fit to return to work. Instead, the onus will be on employers to determine what a patient declared ‘may be fit for some work’ could or could not do at work.

But I can’t see the new system significantly changing behaviours, especially of doctors who are so crucial to the picture. GPs are reluctant to get involved in discussions about work. They make a decision that someone is unfit to work or well enough to go back to work, but they do not want to, or really cannot, get involved in the gradations of how much work an individual could or could not do.

That is not going to change. (For a different view hear Royal College of General Practitioners’ chairman’s podcast on fit notes.)

And ever fearful of litigation, few employers are likely to significantly alter their approach to long-term sickness absence as a result of the new scheme. (See Employers Risk DDA Claims Under New Fit Note Rules for more.)

For an idea of how these schemes already work in practice in the public sector – or don’t – see Signal Consulting Jane Pound’s Worried Well.

In short, I don’t believe the fit note scheme will affect more than a very small percentage of absences. It is essentially a bit of propaganda to try and massage the rates of unemployment verus long-term sickness.

The idea on the table was that instead of saying someone was totally unfit for work, it might instead be stated what they could do with adaptations to the workplace, or on the basis of part-time or shorter working days.

For me there are considerable issues here. While admirable in its intention, I’m not sure this is the right solution.

For larger organisations with occupational health services, it might be possible to have a proactive involvement regarding a phased return to work. But for the smaller business, it could be an administrative nightmare.

As well as costs associated with making changes to accommodate a partially fit employee, there is also tremendous scope for disputes about workplace adjustments. That is a lot of effort for what might only be a short-term need.

There is also concern GPs, increasingly pressurised to provide such certificates to cut the number of long-term sick, might feel patient relationships are undermined as a result of closer liaison between themselves and patients’ employers.

Similarly, patients might feel pushed into returning to work too early for their own good.

The whole history of sick notes is a contentious one. GPs used to have to issue sick notes after three days’ of absence. This was subsequently increased to seven days following pressure from the British Medical Association. Increasingly, however, GPs are saying the existing system is not fit for purpose.

Whether the fit notes scheme will help is still somewhat suspect.

If approved – most likely in the autumn when the incidence of the pandemic is expected to increase – employees will need to fill in a self-certification form to cover any absence up to fourteen days (currently seven days). So until further notice, the seven days for self-certification still applies.

But there is concern the extension could provide an incentive for some people to take more time off than they need. So what can you do to stop this happening?

The main thing is to ensure staff understand your policy on sick leave reporting. As with any employment policy, the key is to make sure everyone knows what the policy is and the reason for it. Staff must also know the policy is applied fairly and consistently.

So how should your policy change to reflect self-certification?

A simple solution to deter employees from taking unnecessary or excessive leave might be a return to work interview for everyone returning from any period of absence.

The interview need not be overly formal or onerous. However, it should be done for everyone returning from sick leave, irrespective of whether or not they had swine flu. Held in private and handled in a sensitive and professional manner, the interview should:

• Welcome the employee back to work.
• Ensure they are fully fit to return to work.
• Identify the reason for the absence and confirm the length of absence.
• Identify and address any problem (work-related or otherwise) that may be causing or contributing to the absence.
• Investigate or identify any adjustments to the workplace, hours or duties that may reduce or eliminate future absences.
• Agree immediate priorities.
• Update the employee about developments.

By making this a routine event, everyone will be aware their absence has been noted. But as important, it will make it clear you care about the employee’s welfare and are glad to see they have returned to work.

If people feel valued they are more likely to return to work as they get better rather than taking the full 14 days.

See also our 10 Steps to Prepare for Swine Flu

So even if you have an employee who has been transferred to a long-term sickness cover insurance-based scheme, when and if they do return (or retire) they should still be paid for accrued holiday in that year.

What is not clear at this stage is whether it is just for the final year of their employment.  The argument would be that they have been paid fully for the years in question which would include a number of weeks’ holiday pay.

The issue is less clear as to what length of time the payment could be backdated to – a potentially costly additional cost for hard-pressed businesses of whatever size.

See Managing Sickness Absence Factsheet and Holiday Entitlement Factsheet for more.

• Encouraging health and wellbeing in the workplace.
• Writing an absence policy.
• Arranging sick pay.
• Managing long-term sickness absence.

Download our free Managing Sickness Absence Factsheet