GP fit notes could be replaced with a ‘non-clinical case management service’ funded by employers, which would help ‘take pressure off GPs’, according to a Government-commissioned review.
It argued that this ‘would not replace the GP’s role’ when it comes to clinical support, but it would focus on how best to support a disabled employee or employee with a health condition ‘to thrive in work’.
The 10-month review, carried out by Sir Charlie Mayfield, was commissioned jointly by the work and pensions and business and trade secretaries, and heard from hundreds of organisations, including the RCGP and the BMA, with evidence from employers, disabled people and clinicians.
It found that one in five working-age adults are now out of the labour force – 800,000 more than in 2019 due to health reasons.
According to NICE, musculoskeletal conditions and common mental health conditions are the most frequent causes of long-term sickness absence among employees in England.
Most of the time, health remains a personal matter between the employee and the NHS, ‘only surfacing when someone goes to their GP’, the Mayfield report said.
But at this point the fit note becomes ‘central and is often problematic’ with GPs being asked to assess both treatment needs and work capacity, despite ‘most lacking occupational health training’ and time to get into ‘sufficient detail’.
According to the review, 93% of fit notes in England deem the patient ‘not fit for work’ and are ‘often extended without further consultation’, and this can be exacerbated by long waiting lists and delays in getting support, adjustments or treatment.
The report said: ‘We recommend the widespread adoption of a Workplace Health Provision (WHP): a non-clinical case management service that supports employees and line managers across the healthy working lifecycle.
‘Funded by employers and building initially from existing resources, the WHP will offer support and advice, early intervention, good case management, and targeted early-stage treatment pathways.
‘Over time, we envisage the provision becoming certified, being integrated with the NHS app and reducing – or even replacing – the need for the current fit note.’
The WHP would initially build from ‘existing provision’ already available through social prescribers, NHS work initiatives, occupational health, income protection and private insurers.
However, the report said that GPs should ‘retain overall clinical responsibility’ and should ‘remain a referral point’ where clinical support is required.
It added: ‘Our ambition is that the WHP would take the pressure off our GPs and healthcare professionals, freeing up their valuable time to be spent on diagnosing and treating patients.’
It said that GPs themselves told the review that the current fit note system is ineffective as GPs ‘often lack detailed knowledge of workplace environments’, may not have occupational health training and that long-term certification ‘drains GP capacity’.
The report added that it is ‘vital’ that GPs and healthcare professionals are ‘closely involved’ in the development of the WHP, to test different approaches, understand the impacts on the fit note, and to trial clinical oversight mechanisms which include options for second opinions.
In response to the report, the Government said it will partner with employers to ‘reshape’ how health issues and disabilities are managed in the workplace with the launch of employer-led ‘vanguards’.
The ‘vanguards’ – including employers such as British Airways, Mayoral Combined Authorities, and small and medium-sized enterprises (SMEs) – are ‘early adopters’ who will develop workplace health approaches over the next three years in light of the report.
‘Vanguards’ should also be piloting new approaches in prevention and interventions for key cohorts, such as young people with physical and mental health conditions or who are neurodivergent, or older workers with MSK, the report said.
And it added: ‘Too often, employees who develop health conditions quickly detach from their workplace, exacerbated by fear and the disconnection that comes from long periods signed off with fit notes. Instead, we want policies that maintain contact and build trust, improving return-to-work outcomes.’
The RCGP said GPs should still have the option to continue to issue short-term (up to 3 weeks) fit notes and retain some involvement in longer-term care and oversight of patients’ overall health ‘where appropriate’, as this would avoid associated bureaucracy and duplication.
RCGP chair Professor Kamila Hawthorne said: ‘With workforce and workload pressures across general practice, the responsibility associated with the issuing and management of long-term certification can consume valuable GP time, and we are not always best placed to provide the wider care, including occupational health support and communication with employers, that patients often need, so this move makes sense.
‘The college also urges Government to ensure that reforms are developed and evaluated carefully, with input from healthcare professionals, occupational health experts, and patients, to ensure that the system supports recovery, protects patient safety, and helps make best use of GP time. We stand ready to work with the Government to ensure that any future reforms to the fit note system work for GPs and patients.’
Earlier this year, Government-commissioned research found that there has been limited take-up of healthcare professionals other than GPs writing fit notes since the new legislation was introduced in 2022.
It comes after the Government announced it is extending its scheme to embed job coaches in GP practices to provide intensive employment advice to 40,000 more sick or disabled people.
Nine more areas in England – including Oxfordshire, Devon, the South Midlands and West Sussex and Brighton – will be putting specialist employment advisers in GP surgeries through the Connect to Work scheme.
A version of this story first appeared on our sister title Pulse.
