INTRODUCTION
The Statement for Fitness for Work (or ‘fit note’) was introduced by the Department for Work and Pensions in April 2010 to replace the medical statement (Med 3 and Med 5), which had been in use since 1948. Rather than simply stating that the patient is unfit for work and assessing how long he or she should remain absent, the fit note provides the GP with an additional option of stating that the patient is fit for work if certain adjustments are made.
The rationale for this change was put forward in Dame Carol Black’s review of the health of the working population.1 The Black review identified that one barrier to a healthy working population is the assumption that illness is incompatible with work and that work impedes recovery. The review recommended the introduction of a new fit note, which would focus on what people can do rather than what they can’t. This should prevent individuals from moving into long-term sickness absence and reduce the migration of people from work onto benefits.
The research evidence concerning the role of work in health is clear — well-designed and well-managed work is good for health, and can play an important part in recovery. However, research evidence alone is not sufficient to change practice.2,3 Bringing about evidence-based change in practice is influenced by a number of factors, including the nature of the change, the practitioners adopting it, and the environment they work in.4
This article describes the evidence behind the introduction of the fit note, considers some of the implementation issues that have been reported since its introduction, and discusses ways to further embed the change in GP practice.
THE BACKGROUND TO THE FIT NOTE
The health benefits of work
The evidence showing that worklessness is harmful to health, and how maintaining someone in employment can be good for …