GPs’ long-standing role in the sickness certification process in the UK has recently been under greater scrutiny due to policy focusing on the cost of sickness leave and the health benefits of keeping people in work. While the original certification policy was concerned primarily with incapacity and ensuring that claims for benefits were valid, recent policies place more emphasis on patients’ capacity to remain in work. Most GPs will recognise that taking a break from stressful or inappropriate employment may aid recovery for some but that staying in work may also be beneficial.1 This editorial, informed by recent guidance and evidence, will consider the key issues pertinent to sickness certification decision making and the new Fit for Work referral scheme;2 an optional resource for individuals who are employed, but are either currently unable to work or struggling.
FIT NOTES AND THE FIT FOR WORK INITIATIVE
Fit notes replaced sick notes in April 2010 with much fanfare, but there is mixed evidence as to whether substantive changes have occurred. Qualitative research suggests that some doctors have used fit notes to stress the benefits of work and that patients have stated that they do not object to such conversations. Employers have also found the detailed comments by GPs within the fit notes useful, particularly when the ‘may be fit for work’ box is ticked.3 However, the box is only ticked on 6.4% of certificates (range by practice, 1–15%)4 and a recent report investigating the use of fit notes concluded that while they have not achieved all their objectives, progress is being made.5
The launch of the Fit for Work initiative coincides with the publication of the first two …