An evaluation of the Statement of Fitness for Work (fit note): a survey of employees

DWP Research Report No 840: A report of research carried out by the Office for National Statistics on behalf of the Department for Work and Pensions

Summary

Background

The Government introduced the Statement of Fitness for Work or ‘fit note’ in April 2010, to replace the previous medical statement (known as the ‘sick note’). GPs use fit notes to assess whether their patient ‘may be fit for work’ or is ‘not fit for work’. The patient and their employer can discuss the advice on the fit note to identify possible changes that could facilitate a return to work.

Methods

The Fit Note Survey was carried out by the Office for National Statistics (ONS) between January and June 2012. The sample used was comprised of 1,398 eligible adults consenting to be interviewed. The survey included only individuals who were over the age of 16, in employment, and who had had a period of sickness absence from work that was covered by a fit note in the last 12 months. Individuals were interviewed mainly by telephone. Respondents were asked to recall any discussions relating to their sickness absence with their GP and employer in the last 12 months.

Key findings

Respondents were asked to rate how helpful the fit note was:

• seventy-one per cent of respondents agreed that the fit note was helpful;
• around two-thirds of respondents agreed that the fit note and discussions with their GP helped them to discuss changes with their employer;
• around half of respondents agreed that the fit note and discussions with their GP made a difference to their employer’s willingness to make changes to help them return to work;
• the majority of respondents agreed both that GPs and employers had understood the types of changes in work that would be helpful to them (70 and 82 per cent respectively).

The survey found that the likelihood of someone receiving a fit note is related to a number of characteristics, the most significant being whether they were disabled. Other key characteristics included occupational classification, sector worked in, sex and age.

Overall, the majority of individuals returned to work following their sickness absence (82 per cent). It was also found that: non-disabled respondents were most likely to return to work (88 per cent); most sickness absences lasted between eight and 14 days; and mental health conditions were the most common health condition specified on fit notes, followed by injuries and other musculoskeletal conditions.

Ninety-six per cent of first (or only) fit notes and 81 per cent of secondary fit notes recorded that the individual was ‘not fit for work’. When fit notes had advised that an individual ‘may be fit for work’, 78 per cent ticked the box suggesting a phased return to work, 52 per cent suggested amended duties, 49 per cent altered hours and 21 per cent workplace adaptations.

Around three-quarters of the total changes discussed by respondents with their employers were consequently made by respondents’ employers. The most common change made by employers was modified days or reduced working hours (59%).

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