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GPs may no longer have to issue fit notes under Government reforms

by Rima Evans and Eliza Parr
22 April 2024

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Responsibility for fit notes may move away from ‘already stretched’ GPs and be given to specialist work and health professionals in a bid to stop people being signed off by ‘default’, the Prime Minister has announced.

In a speech made at the end of last week, Rishi Sunak said the ‘sick note culture’ needs to change, so that the system ‘recognises’ and ‘encourages’ the benefits of work.

He said the Government wanted to stop people being written off as ‘not fit for work’ by default and instead see a system overhaul where each fit note conversation focuses on what people can do with the right support in place, rather than what they can’t do.

Almost 11 million fit notes were issued last year in England, with 94% of those signed ‘not fit for work’, Mr Sunak said, adding that a large proportion of these are repeat fit notes issued without any advice.

A Government review has now been launched starting with a UK-wide ‘call for evidence’ that seeks out views from clinical and non-clinical professionals, patients and employers on how the process currently works and what improvements can be made.

Different models of issuing fit notes are already being tested in pilots underway across the country, which the consultation will seek to build on.

As part of this, Mr Sunak explained, the Government will ‘test shifting the responsibility for assessment from GPs and giving it to specialist work and health professionals who have the dedicated time to provide an objective assessment of someone’s ability to work and the tailored support they need to do so.’  

This will not only help create a system better tailored to an individual’s health and work needs but should also ‘free up valuable time for GPs and primary care teams’, ministers added in the call to evidence document.

Information and opinion gathered in the call for evidence will ‘act as a prelude to a full consultation on specific policy proposals’, which will be launched later in 2024.

RCGP chair Professor Kamila Hawthorne said the college is ‘supportive’ of, and intends to respond to, the consultation on who is best placed to issue fit notes, given the workforce and workload pressures GPs currently face.

She said: ‘We know that in the main working can be beneficial for patients’ health, and GPs and our teams will already encourage people to work, or to return to work if they have been off sick, where it is safe and appropriate for them to do so.

‘When making a decision to issue a fit note, the health and wellbeing of an individual patient must always be a GP or other healthcare professional’s principal concern.’

Professor Hawthorne highlighted that if others take on responsibility for fit notes, the ‘best interests of the patient’ must remain the ‘priority’ in assessing ability to work.

‘Any initiative should be piloted, and subject to rigorous evaluation in terms of its benefit for patients, especially the most vulnerable, and identifying unintended consequences, before any wider roll out is considered,’ she added.

The call for evidence closes on 8 July 2024 and can be accessed here.