FIT NOTES: THE BASICS
***PLEASE NOTE: This transcript was produced using AI and has NOT been checked thoroughly for errors.

Why talk about Fit Notes?

 [00:00:06] Munir Adam: Hi, it's Munir Adam here and welcome back to Primary Care uk. And this is our second mid-month mini episode. And in this episode we're gonna be talking about fit notes and covering the basics. 

[00:00:18] Marium: Hello everyone, my name is Marium and I'll be joining Munir today for the podcast. So I'm a physician associate based in London, and I'm joining the podcast to represent the PAs and talk about our profession, so people to become more aware of the role and how it integrates in primary care.

So I am excited for the season. So yeah, what's the topic today Munir? 

[00:00:39] Munir Adam: Yeah, so Fit notes. Um, I have to say a bit of a boring topic really, isn't it? I mean, as a GP I've been dealing with Fit notes and they used to be called sick notes. Now they're called Fit notes, and I've been doing that for years. And I have to say, it's not exactly the highlight of my job.

I'm not even sure why I actually agreed to cover this. 

[00:00:56] Marium: Hmm. I disagree with you there, Munir. Actually, I think it's a really interesting topic and matter of fact, you should be glad because there's a lot more healthcare professionals taking on that role now to do the sick, uh, sick notes in primary care.

So the thing is we don't often get taught on Fit notes as a healthcare professional, and we tend to learn them through our experience. 

So guys, today we will be talking about Fit notes. What are Fit notes? And we have Dr. Saira, and Sarah who's a clinical pharmacist. So I'm sure it'll be interesting discussion today, and I'm sure we'll learn loads on this topic.

[00:01:32] Munir Adam: Sure. Okay. But you know, what we really need is to be discussing the challenges and the difficulties that we face sometimes when patients actually ask us about Fit notes, you know, when they put requests, Doctor. I need a note to be three months off work or whatever. And those challenges now, how to deal with them, that's what I would wanna know.

[00:01:50] Marium: Well, let's hold up their Munir because you need to be patient. I know it's, an important topic to discuss the challenges, but that will be covered later on in the month. But first, we need to cover the basic, and that's really important. 

[00:02:02] Munir Adam: Fair enough. Yeah. And I must admit, even as an experienced GP, I did learn one thing that I didn't know, and I'll tell you what that is at the end.

So yeah, it's possible that even listeners who are GPs might not necessarily know everything that's covered today. So, um, yeah. Let's have a listen. 

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[00:02:33] Sarah: Hello and welcome to our first ever podcast, a collaboration between Nottinghamshire Alliance Training Hub and Primary Care UK. This is very exciting. So my name is Sarah Partridge and I'm a clinical pharmacist. And I noticed that in July 2022 legislation changed and we as pharmacists and also nurses and physiotherapists and occupational therapists could all sign Fit Notes, but I don't really know where to start.

So I'm really fortunate today to have an expert with me. I'll let her introduce herself.

[00:03:15] Saira: Thank you, Sarah. Hello everybody. My name is Dr. Saira Jawaid. I'm a GP in Nottingham. I have a special interest in medical education. I'm a GP associate for Nottinghamshire Alliance Training Hub, and also have a role as a quality assurance training program director for primary care. So welcome everybody.

Why legislation changed

[00:03:33] Sarah: So Saira, do you know why the legislation changed in July, 2022?

[00:03:40] Saira: Yeah, so that's a good point. As per Department of Work and Pensions, the idea behind the change of legislation is to include multi-professional teams to get more practical and qualitative information, rather than only symptoms and diagnosis. So the information should include functionality of the patient as well.

So for example their strength, their mobility, hearing, vision, sensory impact what activities can't be done and for how long whether they would need further appointments. So Department of Work and Pension does expect these information to be on there. So perhaps they didn't get as detailed information from GPs and hence therapists and other professionals can do them as well now,

[00:04:22] Sarah: Brilliant. So it's actually enabling us to do more, which is probably a good thing cuz we're now part of like massive, multidisciplinary teams and actually we all need to be involved to give the best care. So go back to basics. What is a Fit Note?

[00:04:38] Saira: Okay, so it's a method by which healthcare professionals advise the patients on the impact of their health condition, so how it affects their ability to work, as well as provide medical evidence to employers. It can also be used to support a claim for health related benefits through Department of Work and pensions.

[00:04:56] Sarah: Brilliant. And so, I mean, I'd always historically heard them as sick notes. So what's the difference?

[00:05:02] Saira: It is the same thing. It used to be called sick note and now it's commonly called Fit Note to focus more on what patients can do. But the official terminology is medical certificate of fitness. But people do call it commonly Fit Note, which is fine.

Approach to Fit Notes

[00:05:17] Sarah: Okay. So it's trying to maybe give more power to the patient thinking that they kind of should be working, I presume. Okay. So we can write Fit Notes. Why do we issue them?

[00:05:28] Saira: Okay, so there are two purposes of why we issue a medical certificate of fitness. So one is unfit for work and second is maybe fit for work. So those are the two boxes that you would see on the Fit Note that you have to choose from.

[00:05:45] Sarah: And when will we choose the maybe fit for work?.

[00:05:48] Saira: Yeah. So, I suppose, there are on the sick note, there are four boxes that you can tick, and those are the four possible adjustments that you can choose for the patient. So one is phased return, second is amended duties, third is amended hours, and the fourth is workplace adaptations. So just to give you some examples.

So you, you have to obviously agree with the patient, have a discussion with them. So phase return would be something like you start on less hours and then build up gradually With amended duties, you can, again, it talks about the functionality and strength, et cetera. So things like avoiding manual handling or heavy weight lifting.

And then you have a amended hours where, for instance, some patients might not be suitable for night shifts or driving in the dark. So you can write that in there. And then certain people, because if their certain conditions may need workplace adaptations, for an employer to look at things like adaptations at desk or keyboard.

So that will be when you'll choose maybe fit for work. And obviously there's that other box as well, isn't there where we said unfit for work as well.

[00:06:53] Sarah: Yeah, so I suppose it's trying to support people to go to work if like at all possible.

[00:06:59] Saira: Yeah. So I think that'll be the best thing, isn't it, for them as, as well as for the employers that you try and encourage them to work where possible, but they may not be able to do their full-time job as they were doing prior to the medical condition that they have.

[00:07:14] Sarah: Okay, so I've got a patient, I want to issue them a Fit Note. So like when do we issue them?

[00:07:22] Saira: So I think there is a timeframe that you have to remember, and I think that is issued after the seven days of sickness absence. So they can, patients can self-certify before that but after, if they've been off for seven days or five working days in some condition, so then you have to issue the certificate and you can do maximum for three months, in the first six months. You may not need to, obviously you would assess the condition, but in terms of maximum timeline, it's only three months that you can do in first six months. But after six months, it can be any duration, including doing it indefinite for certain conditions. So if a person has got severe learning disability, for instance, or any other condition where you think they may not possibly be able to go to work. You can even do it indefinitely. But that's all to consider depending on the situation. The other important thing when it comes to timing, I would say is you can't do a future date. You can't say, okay, the Fit Note would start from. The state, you have to do it from the day of assessment. 

Retrospective might be possible. So for instance, if you've got a and e accident, emergency, or any other hospital admission where you know the patient's been in and they've come to GP, you could possibly retrospectively sign the sick note, but you could definitely not do the future today. 

I would say on that point, one point comes to mind is that patients can return to work before even their Fit Note ends. So if they feel well enough, then, they can go back to work. They don't have to follow till the Fit Note ends, but if they do need longer than the date issued for, there will need another review for that.

[00:08:56] Sarah: And a quick question around that. So if they come back before the fit note ends, do they have to speak to the GP or is it okay? They still go to work?

[00:09:05] Saira: Yeah, that's what I was saying, that they don't need a Fit Note for the return to work. There is no such thing as, you know, cuz some people do get confused and they think okay perhaps somebody gave it to me for two weeks. I'm actually feeling well after one week and they may phone up to say, oh, do I need another certificate to say that they're okay to return?

And that's not the case. The total duration is sort of a, an estimate of when they might be able to go back, but if they do feel well enough to go back before the end date, they don't need to contact anybody. They can just go back to work. Does that answer your question?

[00:09:37] Sarah: I think so. And if, for example you wanna go back early, but you want to go back on a phase, so to work part-time, would you need a new fit note for that?

[00:09:47] Saira: Yes, definitely. So any four of the amendments that we talked about in maybe fit? They do need a document from the professionals. So yes, they will need to, so after a week they feel better, but like you said you know, they're not able to go resume their usual activities.

They will need to have another review and say, okay, we can go back to phase return. Or it may be that you need adaptations at work or amended hours, et cetera. So yes, you will need that review.

[00:10:14] Sarah: Brilliant. So I think I've got my head around that. I kind of understand when we issue them, when we may use maybe fit for work and the kind of timeframe. So first seven days, self certification, and then after that maximum of three months. And then after that it can be any length of time including indefinite for a very small group of patients.

[00:10:35] Saira: Yes.

Practical aspects to issuing

[00:10:37] Sarah: So from a practical perspective how do we do them in practice? I've never even gone on the computer and tried to find it on system one or anything like that.

[00:10:45] Saira: So obviously each system may have its own ways of how you bring up the foot node, but generally, , the way it looks is the same. So you have a box of medical condition, so you need to describe that. You know, the diagnosis, but also symptoms or the condition that you're issuing it for.

And then you have two boxes on there, which one of it is not fit for work and the second is maybe fit for work. So then you would choose that depending on your assessment. So you need. the situation. So what is the nature of their job, for instance, and how this condition may affect their ability to work.

And also important what patients are expecting, you know, what timeframe are they expecting? And sometimes it's important to know health beliefs as well. So do they expect to be cured before they can go back to work? Because that's not always needed. And have, they ever had a previous fit note, for example, and what have their experiences been in the past?

So taking sort of all the history and, you know, how social history is and how their condition is affecting them. And, you, you sort of based on that you either choose not fit for work or maybe fit for work. And then with regards to maybe fit for work, we've always, we've already covered that section of the four possible adjustments that you make.

 And then the next box would be the time, so the date to be issued, from and when. And then, yeah, so the modern electronic way, you don't even need to actually formally do the signature, handwritten signature or anything. It populates your name. So that can be sent electronically via text or email to patients, which makes it quite easy.

Cause if they're sick, they don't need to come to the reception, to ask for a physical copy.

[00:12:19] Sarah: Brilliant. Right? So I run a respiratory clinic, so it might be good for me to be able to issue Fit Notes. 

Training

[00:12:27] Sarah: Can I just start doing them or is there any training that I need to do?

[00:12:31] Saira: Yeah, so that's a really good point. There is a mandatory training for, from eLFH, which is the e-Learning for Healthcare. And that is compulsory for everyone to do it before they can issue it. There's also a very good guidance. on goff.uk website, which is called Getting the Most Outta Fit Note guidance for healthcare Professionals.

So that's available there, and I recommend everybody reading that. There is some guidance from Department of Work and Pensions as well. But I think the most important thing I feel is the supervision at workplace when you're first starting them and you have to become competent and confident in doing them before you, you would be able to issue them.

Does that make sense? Would you say?

[00:13:11] Sarah: Yeah, so you kind of have to treat it like an individual competency, like if I was upskilling in a different prescribing area. So that makes perfect sense. So what I need to do really is to go away complete that, e-Learning for Health module that you'll kindly send me the link to. And then before I use in practice, well, we'll come back here and we'll have a little bit more of a talk about it, but I'll also have to find a mentor within my practice who can possibly watch me do a few to make sure that I've kind of got the concept correct which is really good.

It makes me feel a my mind at ease because I'm not having to do it straight away. , I know that there should be support and training before I go away and do it.

[00:13:52] Saira: Absolutely. Yeah. I think we should definitely do another podcast soon about, what challenges you may have in doing, you know, the fit nodes and what barriers you may face. So yeah, so I think that's a good idea to do the basics on the e-LFH and take it from there.

[00:14:07] Sarah: Thanks Saira. I agree with all those points, so I need to go away and do that e-learning training for health. and then I'm sure when doing that training I'll come up with loads and loads of questions and things like that. And it'd probably be when I know a bit more in the context, it'd probably really good to hear about the potential barriers and difficulties that I might face when doing fit notes.

So I'll go away, do that, and then hopefully see you next month. Thank you so much for all your time today.

[00:14:37] Saira: Great. Thank you for having me, Sarah. It's a pleasure. And I'll look forward to seeing you soon.

Final comments

[00:14:46] Marium: so, well Munir, any comments? What do you think of that episode? 

[00:14:49] Munir Adam: I knew most of it already. But one thing I didn't know, as I mentioned at the start, there was one thing and what is historically, whenever I've given Fit notes, I've always said to the patient, this is what your employer must do, and if they deviate from it at all, then they're gonna be in real trouble.

Hmm. Actually, looking back, maybe I had a bit of an over-inflated view of the power that we have when we issuing this certificate, but of course that's not the case, as was pointed out. 

[00:15:15] Marium: Definitely. I agree. 

I think as a physician associate, we can't sign Fit notes. What we can do, however, make assessments and make some recommendation for our doctor to sign the Fit Note off after a discussion with the clinical supervisor.

I do really appreciate Dr. Saira, um, outlining the Fit notes policies and pathway in a very clear manner. And do you know what I really found really helpful was the recommendation, the e-learning module for the learning. So I think overall I found it very informative. 

[00:15:48] Munir Adam: Hmm. Well I'm glad you did. Well, that's it really, cuz this is just a mini episode.

So do you wanna do the final bits? 

[00:15:56] Marium: Sure I could. So well, yeah, that's it for today, folks. We hope you found the discussion helpful. We are grateful to Saira and Sarah from Nottinghamshire Alliance Training Hub, and they will be back next month as we go into some of the trickier situations that might arise when dealing with Fit notes requests.

[00:16:14] Munir Adam: That will be on the 15th of the month. But before that, on the first, we'll continue our journey on time management as Ed Pooley joins us again to tell us about difficult encounters. 

[00:16:26] Marium: Amazing. I look forward to that episode. Meanwhile, do leave us your reviews and rating on Apple Podcasts or wherever, and until next time, keep well and keep safe.