The Department of Health and Social Care (DHSC) and the Department for Work and Pensions (DWP) have amended legislation to enable nurses, occupational therapists, pharmacists and physiotherapists to certify fit notes as of 1 July 2022. According to the legislation, these healthcare providers (HCPs) will be able to legally certify a fit note, which can enable an individual to access health-related benefits and provide eligibility evidence for statutory sick pay, although they are not required to do so.
The government said that, before undertaking health and work conversations and certifying fit notes, HCPs should consider their scope of practice and ensure they have the relevant skills, knowledge and experience.
This decision was agreed following engagement with and advice from the DHSC, chief allied health profession officers, chief nursing officers, chief pharmaceutical officers, professional bodies, regulators, and policy officials across all four UK nations.
Modern healthcare reflects that HCPs from a range of disciplines now play a central role in leading the delivery of healthcare and support for patients to enable them to manage their health and wellbeing. Increasingly this applies to enabling people to safely remain in or return to work wherever possible, and to manage their own health and wellbeing. Whilst multi-professional working has seen some HCPs with the relevant skills and experience support work and health conversations, until July 2022 only doctors (registered medical practitioners) were legally permitted to certify fit notes.
Enabling a wider range of HCPs to certify fit notes offers benefits for patients and the healthcare system and better recognises innovations in using a multi-disciplinary workforce to support patients. These HCPs can engage more directly with patients on matters of work and health without having to re-route requests to certify fit notes through doctors. The aim of this change is to provide a faster system for patients, improve continuity of care, reduce bureaucracy in the healthcare system, and fully utilise the skills of relevant HCPs. It is also expected that patients and employers will benefit.
This change follows public engagement and research on the policy by DWP, several papers and a report published on the topic over the past few years, as well as broad public support.
A statement of fitness for work, commonly known as a fit note, is a form of medical evidence that can enable an individual to access health-related benefits or evidence eligibility for statutory sick pay (SSP). Its purpose, format and requirements are set out in regulations which cover England, Wales and Scotland. The fit note contains options to assess a person as ‘not fit for work’ or ‘may be fit for work taking account of the following advice’.
The legislation requires the HCP to undertake an assessment to complete a fit note. An assessment is defined as a consultation between the patient and HCP or consideration of a written report by another health professional. The fit note provides advice about the functional effects of a patient’s condition on their fitness for work but it does not require the HCP to have specialist knowledge of workplaces or occupational health or to suggest possible changes to a patient’s workplace or job.
As employers will have policies and provisions that refer specifically to fit notes from doctors, they should review their sickness policies in staff handbooks and sickness provisions in their contracts of employment and update them as necessary.