Quality standard

Quality statement 3: Statement of fitness for work ('fit note')

Quality statement

Employees have information in their statement of fitness for work about how their reason for sickness absence or their treatment might affect them on their return to work.

Rationale

Employers have an important role in helping their employees return to and stay in work after a period of sickness absence. To provide personalised and appropriate support the employers need information that can help them understand the reasons for the absence and what kind of support the employee may need. Healthcare professionals can use the 'may be fit for work' option in the 'fit note' when appropriate to include advice for adjustments that may support the employee's return to work, including a phased return to work, altered working hours, amended duties, and workplace adaptations. The fit note also allows them to make additional comments and add detail that can help the employer to support the employee to return to work. This information should be provided in clear, non-technical language for employees and employers to use.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence that statements of fitness for work include information on how an employee's reason for sickness absence or their treatment might affect them at work.

Data source: Local data collection, for example local audit of statements of fitness for work issued.

Process

Proportion of statements of fitness for work making use of the 'may be fit for work' option that include 'may be fit for work' advice.

Numerator – the number in the denominator that include 'may be fit for work' advice.

Denominator – the number of statements of fitness for work making use of the 'may be fit for work' option.

Data source: NHS Digital's fit notes issued by GP practices covers information on the proportion of fit notes making use of 'may be fit for work' broken down by the advice selected.

Outcome

a) Employee satisfaction with adjustments and support on their return to work.

Data source: Local data collection, for example employee surveys.

b) Rates of recurrent sickness absence.

Data source: Local data collection, for example HR management systems.

What the quality statement means for different audiences

Organisations (senior management teams, including the chief executive, and departmental managers) ensure that systems are in place for acknowledging and making appropriate use of the information in an employee's statement of fitness for work. They ensure that systems are in place to help employers understand the employee's reason for sickness absence and what support they might need when they return to work.

Healthcare professionals (GPs and hospital doctors) consider what information about a person's condition or treatment might affect their return to work and include this in the relevant sections of their statement of fitness for work. They include information that will help employers understand the reason for sickness absence and what adjustments may be needed to help the employee return to and stay in work when appropriate.

Line managers ensure that any information included in an employee's statement of fitness for work is recorded and used appropriately, in line with systems in place in their organisation. They use the information to understand the reason for the employee's sickness absence and what support they might need to put in place. This can be a starting point in discussions with the employee about the required support and what adjustments might help them return to work.

Employees have information included in their 'fit note' from their GP or hospital doctor about how their health or treatments might affect their return to work. Their line manager acknowledges, records and uses this information to start conversations about what arrangements could be put in place to help them return to work when they feel ready.

Definitions of terms used in this quality statement

Evidence of sickness absence

Employees can be asked to produce evidence of their reason for sickness absence if they are ill for more than 7 days in a row. Employers have flexibility over what evidence they accept. If the employee has been assessed by their GP or doctor, they may have been provided with a statement of fitness for work ('fit note') advising whether they are 'not fit for work' or 'may be fit for work'.

[Adapted from HMRC's guidance on Statutory Sick Pay: employee fitness to work]