Council for Work & Health

Changes from 1 July 2022 on health professionals who can provide a fit note

5th July 2022

From 1st July 2022, fit notes can now be certified and issued by registered nurses, occupational therapists, pharmacists and physiotherapists, in addition to doctors.  In the Government guidance for employers[1], the Department for Work and Pensions (DWP) makes clear that not all individuals within these professions will be suitably experienced and qualified to certify and issue fit notes, so will only do so where they have the relevant training and knowledge to make an assessment of a person’s fitness to work.

 

The organisations that form the Council for Work and Health include doctors, nurses, occupational therapists and physiotherapists, and other professionals with training and knowledge who can advise on health and work, and who can also advise on training for those now providing fit notes.

 

Unless they themselves are working in the NHS, doctors, nurses, occupational therapists and physiotherapists working in occupational health will not usually have access to paper or digital versions of the ‘Med3’, which is the form these health professions working in NHS primary care will use, or the F Med 10, which these professionals working in NHS hospitals may now use.  Other forms of medical evidence, including private medical certificates, occupational health reports and an Allied Healthcare Professionals Advisory Fitness for Work Report can be accepted as medical evidence in the same way as a fit note, subject to the employer’s agreement.  DWP go on to advise that in this instance the employer does not need to ask their employee to obtain further fit notes from their GP.

 

Other aspects of the guidance have not changed, but the following are areas in this guidance where over recent years we have come across some misunderstanding:

 

  • The employee can come back to work at any time, even if this is before their fit note expires.  They do not need to go back to their healthcare professional first.

 

  • The fit note belongs to the employee and they should keep the original.  The employer may decide to take a copy for their records (this is usual).

 

  • People do not need to be signed back to work and there is no option on the fit note to do so.  If the employee’s healthcare professional assesses that they are fit for work, they will not be issued with a fit note.

 

  • For a limited number of jobs, there are separate procedures to ensure someone is fit to carry out their role.  The HR, occupational health or legal department should know if this applies to the employer’s organisation.

 

  • If the organisation has a separate policy which requires someone to obtain medical evidence that they are fit for work, this should be arranged through an occupational health specialist[2].

 

  • The fit note is not binding on the employer. The assessment about whether the employee is not fit for work or may be fit for work (and any other advice in the fit note) is classed as advice, and it is for employers to determine whether or not to accept it.   The employer is within their rights to gather other evidence about their employee’s fitness for work from other healthcare professionals (such as an occupational health professional). The employer can choose to give this other evidence precedence over the advice in the fit note.

 

  • For complex or possible work related conditions, support from occupational health specialists should be seriously considered.

 

  • For more information, the employer could consider advice from an occupational health specialist.  The employer can also write to the treating healthcare professional for more information, although they may have to pay for this service and healthcare professionals may not be able to respond immediately.

 

 

[1] Guidance for employers on the fit note (updated 1 Jul 2022) at: https://www.gov.uk/government/publications/fit-note-guidance-for-employers-and-line-managers

[2] Government guidance on the further support provided by occupational health services at: https://www.gov.uk/government/publications/fit-note-guidance-for-employers-and-line-managers/getting-the-most-out-of-the-fit-note-guidance-for-employers-and-line-managers#further-support

 

Changes to the professionals who can provide a Fit Note

13th June 2022

The Government have announced today (13 June 2022) that with effect from 1st July 2022 legislation is being introduced across Great Britain that will allow more healthcare professionals to certify fit notes to patients. Information on the Fit Note can be found at: https://www.gov.uk/government/publications/fit-note-guidance-for-employers-and-line-managers/getting-the-most-out-of-the-fit-note-guidance-for-employers-and-line-managers

 

Currently only doctors can legally certify fit notes, but the Department for Work and Pensions (DWP) is now changing the legislation to allow a further four professions to do this.  These professions are nurses, occupational therapists, physiotherapists, and pharmacists.

 

The Council for Work and Health welcomes this move.

 

We would also endorse the comment that has been made by DWP that not everybody working within these professions should issue fit notes.  We agree that health professionals providing fit notes should be working in a suitable environment and have the necessary skills and training to have work and health conversations with patients.  This task needs to be within their professional scope of practice, and we note that new guidance and training has been developed which will help professionals to identify if this task is suitable for them.

 

The Council will be pleased to offer guidance on appropriate training and other advice for these groups of professionals who may now be in a position to offer advice on fitness for work.  The Fit Note represents the first line of advice; professionals represented within the Council’s membership are able to provide more specialised and a breadth of advice to employers on fitness for work.

 

The Council brings together the bodies which represent the wide range of professions that deliver health, safety and wellbeing services at work, as well as other bodies with a close interest in health and work, which include DWP.  The Society of Occupational Medicine (SOM) and the Faculty of Occupational Medicine (FOM) are  members of the Council, whose membership includes most doctors working in occupational medicine practice.  The Council also has representation from the Royal College of General Practitioners (RCGP).  The Council includes those bodies representing the health professionals who as well as doctors will now be able to sign Fit Notes, including the Royal College of Nursing (RCN), the Faculty of Occupational Health Nursing (FOHN), the Association of Occupational Health and Wellbeing Professionals (iOH), the Royal College of Occupational Therapists, the Chartered Society of Physiotherapists and the Association of Chartered Physiotherapists in Occupational Health and Ergonomics (ACPOHE).

 

We would highlight that there are many other health professionals that make a substantial contribution to health and work, also represented on the Council.  These and the other bodies with a close interest in health and work are detailed on the members page of our website at: https://www.councilforworkandhealth.org.uk/about/our-members/

 

 

 

 

The mental health and wellbeing of UK university employees

16th November 2021

The findings of our three national surveys of UK university employees (conducted between 2008 and 2014) found that the overall level of work-related wellbeing was poor. Most of the psychosocial hazards included in the Health and Safety Executive (HSE) Management Standards framework increased over time, particularly job demands, control, role and relationships, and the extent of self-reported mental health problems also gave cause for concern. Earlier this year, we were commissioned by Education Support to revisit the wellbeing of university staff and identify their support needs.

Our sample comprised 2,046 academic and academic-related employees working in UK universities. As well as revisiting the HSE hazards and other key sources of strain, we also examined employees’ perceptions of the psychosocial safety climate of their institutions, mental health and work-life balance. Some key findings include:

  • The psychosocial safety climate was typically perceived to be poor – more so than in studies of other organisations. More than three-quarters of the sample (78%) strongly disagreed or disagreed that their psychological health is considered as important as productivity.
  • University employees continue to report lower wellbeing than average for all the HSE’s psychosocial hazard categories. Job demands, support from managers and colleagues, working relationships and role clarity were all identified as requiring urgent action.  The HSE framework recognises that job control can help employees manage the demands of their work, but this has also been steadily eroding among university staff over the years.
  • The overall level of mental wellbeing found was considerably lower than population norms.Using a well-validated measure (the Warwick Edinburgh Mental Wellbeing Scale), less than one-third of respondents (29%) achieved scores indicating average mental health with more than half (53%) showing signs of probable depression. Moreover, many were showing signs of burnout, with 29% feeling emotionally drained from their work daily.
  • The pandemic was generally thought to have intensified workload pressure with key difficulties including the challenges of working online, inflexible deadlines and managing students’ expectations and wellbeing.
  • More than six respondents in ten (62%) reported regularly working over 40 hours a week and 22% at least 50 hours. Unsurprisingly, work-life balance was poor, with 36% indicating that they always, or almost always, neglect their personal needs due to work demands.
  • Respondents who reported poorer wellbeing relating to job demands, control, support, relationships and role and who worked longer hours were at greater risk of poor mental health, burnout and work-life conflict.
  • The support that was most commonly available to help employees manage their work demands tended to be at the individual level (e.g. stress management training and mental health first aid), whereas the initiatives considered to be most effective were at the organisational level (e.g. tackling stress at source, input into decision-making and feeling appreciated and respected).
  • Common barriers to accessing support for wellbeing were lack of time due to a heavy workload and an inflexible schedule and little information on what was available.
  • Seeking help for work-related stress and mental health can be stigmatised in UK universities More than half of the sample (59%) feared being seen as weak if they sought support for their wellbeing, with just over seven out of ten (71%) agreeing or strongly agreeing that it would harm their career.
  • Although respondents generally considered counselling and coaching to be helpful in supporting their wellbeing, they expressed some concerns about limited availability and a lack of insight among practitioners into their work pressures.
  • Respondents who reported being able to access a wider range of support initiatives tended to perceive a more positive psychosocial safety climate at their institution. They were also at lesser risk of mental health problems and burnout and had a better work-life balance.

 

In our report, we provide recommendations to improve the support available to university employees and ensure it is fit for purpose. These actions will help institutions meet the challenges of the COVID-19 outbreak and ‘build back better’ in terms of a healthy and satisfied workforce. The full report can be found here.

 

Professor Gail Kinman, CWH Director and Visiting Professor of Occupational Health Psychology, Birkbeck University of London and Dr. Siobhan Wray, Associate Professor, University of Lincoln.

 

 

 

 

A personalised supportive approach with practical advice on reasonable adjustments in the workplace to  guide the employer can help individuals achieve a successful return to work and remain in work  

Alison Biggs Chair of Royal College of Occupational Therapists Specialist Section - Work