· 2 min read · Features

Fit Note dilemma and loss of employment due to long-term sickness


The recent report for Legal & General around GP observations for patients being sacked whilst off sick, is an opportunity to re-introduce the ethos of Health Work and wellbeing.

The Fit Note is a tool to aid Health Work and Wellbeing and enables job retention by starting a dialogue between employee and employer, about what might need to happen in the workplace for an individual to remain productive. It can be a platform for good employee engagement.

Sometimes, especially around mental wellbeing issues, it is a simple conversation with a manager, or boss that will enable a person to find the resilience to stay at work and be productive. A feeling of reciprocity is allowed and people respond to the human value of honest communications around who 'needs' what:

the employee will have some 'health needs' that have to be met

and the employer can offer support in return for reciprocal agreement from the employee that 'business needs' will be met.

The field of Employment/Vocational Support is strong in the delivery of welfare reform programmes and in health arenas. I have designed a Wellness In Work Plan (that follows the Recovery initiatives of Cope's WRAP, Wellness Recovery Action Plan for mental health). It is a simple tool to start discussions between people. It is not prescriptive and is flexible enough to match anyone's needs, whoever they are.

Currently social care commissioners pick up the bill for Employment Support to clients with health conditions, so if a person has mental health issues for instance, and is part of secondary care, then provision is there for vocational and employment support, paid for by social care.

When patients/employees have access to employment/vocational support one outcome is less visits to a GP or other health practitioner. Mostly, the social model rather than the medical model is effective in job retention.

I have co-designed a Fit Note Integrated Pathway to Employment Support for GP's and their patients who are employed, leading to a dialogue with employers about the health and wellbeing of their staff (which will mean the health and wellbeing of their business ultimately); (and for patients who are workless and in the benefits systems, support to help them navigate their aspirations to work/education/training).

However, this support should be available to everyone with health issues and GP's should be able to make direct referrals to an employment/vocational specialist in their locality.

But who is to pay for this support? Not social care. There needs to be a serious conversation between emerging Local Enterprise Partnership's and the business communities that hopefully make up 50% membership; Local Authorities and their Public Health partners; and GP commissioners.

Business communities, Health and Local Authority economic interest groups should consider a purse that will invest in Employment/Vocational Support.

The business case will be

  • savings in health (less visits to GP or other health practitioner)
  • effective job retention and productivity via the emerging employee engagement
  • less need for recruitment and training so helping local economy sustainability
  • less welfare benefit uptake (which Local Authorities will have a huge interest in due to their parallel obligation to employment generation and support for areas of deprivation)

An investment in Health Work and Wellbeing and a holistic plan for Employment Support can encourage a vibrant economy. Such an 'early intervention' structure will build trust and relationship in communities or localities that learn their needs will be met, holistically, if they ever become vulnerable to health issues and the threat of job loss.

Lynn Marchant, lead for Kent Mindful Employerand Creating Bridges