Has the fit note reduced general practice sickness certification rates?

Occup Med (Lond). 2015 Apr;65(3):182-9. doi: 10.1093/occmed/kqu207. Epub 2015 Mar 3.


Background: In 2010, the fit note replaced the sick note to help focus on what people are capable of doing, rather than signing patients 'off sick'.

Aims: To compare proportions of work-related ill-health issued with sickness certification pre- and post-fit note introduction and assess sickness absence trends.

Methods: General practitioners (GPs) report data on work-related ill-health and sickness absence via The Health and Occupation Research network in General Practice. The proportion of cases issued with sickness certification 4 years before and 3 years after the fit note introduction were compared. Changes in certification incidence rate ratios were measured over time.

Results: Participating GPs reported 5517 cases of work-related ill-health. Pre-fit note introduction 50% of cases were certified sick. There was no change in the proportion of cases certified sick in the first year post-fit note, despite 13% of cases classified as 'maybe fit'. However, in the second year, the proportion of cases certified sick had reduced significantly (41%) and a larger proportion (19%) was advised on workplace adjustments. In the third year post-introduction, there was a slight rise in the proportion of cases certified sick; therefore, although there was a fall of 2% per annum in certification rates, this was not significant.

Conclusions: In the first year post-fit note introduction, modifications to work were recommended for people who would previously have been declared fit. Trends analyses showed a slight decrease in the certification rate, possibly indicating GPs will become more practised in advising on workplace adjustments.

Keywords: Fit note; general practice; occupational health; rehabilitation; return to work; workplace adjustments..

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel
  • Certification / statistics & numerical data*
  • General Practice / methods
  • Health Communication / methods*
  • Humans
  • Physician-Patient Relations
  • Qualitative Research
  • Return to Work*
  • Sick Leave / trends*
  • United Kingdom
  • Workplace / standards