· 2 min read · Features

The flaws of the fit note system


Proposals to introduce fit notes in place of the current sick notes system have been the subject of intense debate among HR professionals, the medical world and businesses throughout the UK. Plans were announced last March to overhaul the sick note system entirely and replace it with a fit note system to help people back to work. Fit notes would outline the tasks a worker could perform, instead of certificates signing them off work altogether. The plans came as it was announced that ill health was costing the economy 100 billion a year.

Social Security rules state GPs must give an accurate diagnosis of the patient's disorder as a reason why they have advised the patient to refrain from work. 

However, the rules also go on to say that there are times when GPs can legally refrain from giving a true diagnosis if they feel it is not in their patient's interest to do so. One of these times could be where a doctor may believe it would harm their patient if the real reason were disclosed to the patient's employer.  

Employers must have confidence

This loophole in the system could set doctors and employers against each other when in fact they should be working together. Although it is not known how many doctors have used the loophole to protect their patients, there have been cases where the true diagnosis has only been disclosed part-way through disciplinary proceedings taken in relation to the untrue diagnosis. If the true reason is legally allowed to be withheld, then the system falls apart.

Another case I'm familiar with, involved an employee who was signed off with ‘work- related stress'.  When they were called into a meeting to discuss what the firm could do to help, the employee stated that this in fact was not the true reason for their absence. In fact, it was the doctor's suggestion to quote this but in reality they had signed the employee off to give them time to deal with the domestic problems that had really caused the stress.

When I brought my concerns to the attention of the General Medical Council they were alarmed as the loophole actually brought doctors into conflict with their professional conduct rules, which state that they must at all times be honest and open in any reports they prepare.

Back pain fit notes may not work

A recent survey questioned 440 GPs in Nottinghamshire and found that few doctors currently took any responsibility for managing the work issues of patients with back issues. They felt that fit notes instead of sick notes may be unrealistic, at least in the case of back pain. Only a third said they filled in the remarks section on sick notes to advise employers. This clearly shows that employers and doctors are not working together.

Diagnosis opt-out

Although, clearly, the opt-out was not designed to mislead employers, it has been adopted by some doctors as a way to protect patients from what they see as unscrupulous employers who might react negatively if they give the true reason for the employees absence. There are measures in place such as the Employment Rights Act and other employment legislation that are there to protect employees from any discrimination by employers. Therefore doctors do not need to take on this role.

The journal, Family Practice, reported that considerable training and a change in culture will be needed for GPs to take on this role and provide fit notes that will be beneficial to the patient and the employer. The system will only work if employers are confident in what the doctors are telling them. Giving a vague diagnosis could mislead the employer as demonstrated by the examples above and result in a patient not being given the correct support. Confidence and trust is vital before this system can be implemented. 

Brian Rogers is operations director at law firm Lewis Hymanson Small