Fit note

Why is the sick note being changed?

It is generally believed that in some cases, an individual could return to work early if support is made available and certain conditions, adaptations and adjustments are met by the employer. It is felt that this would be more beneficial than staying at home. Some workplaces will already have policies in place that allow for such arrangements.

PCS’s view on the reform of the sick note in 2009 was submitted when the government consulted on the proposed changes.

What are the changes?

From 6 April 2010, the sick note changes. The old sick note said whether a person should be off sick or was able to return to work. The new sick note (or ‘fit note’) will say:

  • whether the person should be off work completely OR
  • if they may be fit to do some work if certain changes made.

There will no longer be an option to say the person is fit.

It will also be completed and stored electronically by the general practitioner (GP or doctor) for their records, but a printed version will be given directly to the worker to send to the employer.

There is no change to the basic purpose of the medical statement and it will still be used by employees as confirmation of illness if claiming sick pay.

It is likely that in most cases the patient and employer will see no change in the information that the medical statement gives.

What is not changing?

  • A sick note is still needed after 7 days for statutory sick pay (SSP)
  • It will still give a brief indication of the illness or condition
  • In most cases it will still simply say the person is not fit for work
  • The sick note will still given to the patient and not directly to the employer
  • It will still be given to the patient in paper form and not e-mailed.

The new sick note

The form will now have two options: that the patient is 'not fit for work', or that the patient 'may be fit for work taking account of the following advice.'

There will be four types of alterations listed which the GP can tick. These are:

  1. a phased return to work
  2. altered hours
  3. amended duties
  4. workplace adaptations.

There will be space for the doctor to provide more information on the condition and how it may affect what they do.

What if the employee does not agree with what is in the medical statement?

The sick note should not contain any unnecessary medical information beyond a simple diagnosis, as at present. Ideally the employee should have discussed any concerns with their GP but if that has not happened, or the employee has concerns at a later date then they should go back to their GP. It may be necessary to have a further discussion about the type or work and workplace.

If the GP is unwilling to change what make changes then, in some circumstances, the patient may want to seek a second opinion.

Alternatively, if they cannot get the sick note changed, the employee may wish to raise their concerns with their employer. They should also be encouraged to discuss the issue with their union representative about what form support will take and when it will be put into place.

An employee should not be forced or pressurised back to work before they are ready, as this will delay the recovery to full health. 

What if the employer does not take action?

If the employer does not take action then the employee should not return to work. The sick note will continue to cover the employee. Government advice states clearly that if the employer cannot make the changes then the employee should be considered to be unfit for work until they are fully fit or the changes are made.

If the employee goes back to work without the recommended changes being made, there is a very good chance that s/he will go off on sick leave again, possibly for an even longer period of time. The employer will be responsible for this.

Union reps can play a key role here in ensuring that workers do not go back until the recommendations on the statement are in place. If they return to work, a risk assessment must be carried out by the employer, and ideally with the safety rep.

If the employer is in doubt, they should seek advice from a welfare officer, an occupational health provider, ergonomist, or similar service provider.

What happens if the employer makes changes but the employee does not agree with what is proposed?

It may happen that an employee will be happy with what a GP recommends but disagree with how this is interpreted by their employer. The union rep can help in cases like this, and where necessary, help the employee put in a grievance. An employee should not have to return to work until they are satisfied that the recommendations have been fully implemented and should not suffer any detriment or be penalised for doing so.

What happens if the employer makes changes which the employee agrees with but after a while the illness or injury is getting worse?

In the first instance, the employee should go back to their GP and explain that their condition has got worse even with the changes which were recommended. The GP may then either issue a new statement saying the worker is not fit for work at all at this stage, or revise the recommendations on the statement by possibly recommending further changes.

Safety reps should ensure the employer does a risk assessment if any changes are made prior to and after the employee’s return to work.

What happens if the employer says that the employee can come back at reduced duties but at reduced pay?

An employer cannot simply change the contract of an employee and reduce their pay. The employee should be employed under the same conditions as before they went on sick leave, but with modifications to assist their transition to work. Where an employer does seek to use recommendations in a medical certificate to alter a person’s pay or conditions, their representative should seek advice from their union. If a person is on statutory sick pay, reduced sick pay, or benefits and they return on reduced hours you should seek to ensure they are no worse off as a result.

Do sickness absence procedures need to be changed?

Sickness absence policies should be reviewed to make sure they mention the new arrangements and comply with good practice. It is unlikely that many changes will be needed. However, it should be made clear:

  • who is responsible for making the changes as recommended by GPs 
  • the process is based on consensus between with the employee and employer
  • the grievance procedures can be used to deal with any disputes.

What are the implications for occupational sick pay schemes?

Normally there will be no implications for occupational sick pay but, in some cases, where a person returns on a part time basis or returns and then goes off sick again then the scheme may not be clear about what happens to them.

That is why all occupational sick pay schemes need to be reviewed and renegotiated to ensure that there is a “no detriment” clause. This should ensure that anyone who does return part time is no less off than if they were still on sick leave.

In addition occupational sick pay schemes should make it clear that a person who is back at work on reduced duties or altered hours is no longer counted as being on sick leave for that period.

What are the implications for SSP or benefits?

The regulations on SSP will not be changed. If a doctor recommends that a person may be able to return to work subject to certain alterations and these are not made, then the worker should still receive SSP.

However, if a person returns to work on reduced hours and receives only part-time wages they may be worse off if they are no longer be eligible for SSP and, if they have been on long-term sick leave, may lose other benefits.

If in doubt the member should seek advice from a benefits advisor or advice bureau.

Again, reps should seek to negotiate a “no-detriment clause” to ensure that no-one is worse off by having to return to work or work reduced hours.

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