The Department for Work and Pensions and the Department of Health and Social Care have issued a call for evidence to explore reforming the fit note process. The purpose of the call for evidence (which closes on 8 July) is to provide a better understanding of how the government can enable those with long-term health conditions to access timely work and health support.
While some people can return to work without additional support following the issue of a fit note for short illness, the government notes that others may require a more detailed assessment and discussion about their work and health, including signposting to more intensive support where appropriate.
The government states that it wants to develop and test a reformed fit note process in England that provides a more integrated work and employment support offer to help employers and employees to reduce sickness-related absence and, in turn, free up time for healthcare professionals. Last Autumn the Chancellor announced £24 million to begin designing and implementing "trailblazers" in a number of different integrated care systems (ICSs) in England, to test offering better triage, signposting and support to those who have received a fit note for a prolonged period of time.
WorkWell services will provide a single, joined-up assessment and gateway into local employment support services, to help people manage their health condition and get back to work sooner. This is part of a government programme "to support disabled people and people with health conditions to start, stay and succeed in work". This programme will include a new voluntary supported employment programme called Universal Support which will provide wraparound support to 100,000 people a year once fully rolled out, and the introduction of Employment Advisers in Musculoskeletal services.
The idea is to develop a new process that brings healthcare and employment systems together to support people who are at risk of falling out of work, or who have already fallen out of the work, due to ill health. The government states in the call for evidence that the core components of the new process it is testing are:
- A triage service that supports people seeking a fit note into a pathway that best suits their individual health and employment needs.
- An assessment of someone's ability to do their job, and a work and health conversation with a healthcare professional or with a work and health adviser.
- The ability to refer people to more intensive work and health support and assist employers in accessing expert work and health support through Occupational Health Services, where appropriate.
The government states that it believes these core components will produce a fit note service that facilitates faster and simpler work and health support.
Employers and individuals are invited to comment on the current fit note process, whether it meets their needs, what can be improved and if any additional information provided by a "may be fit for work" fit note could support employees' return to work from sickness absence. The government notes that between October 2022 and September 2023 across England in primary care, only 6.2% of fit notes were issued as "may be fit for work taking account of the following advice", and that this percentage has remained relatively stable since data was first collected in 2016. This means that over 10 million fit notes a year are issued without any such advice which results in a missed opportunity to help people get the support they need to remain in work.
The call for evidence also asks clinicians and non-clinical professionals about how to improve the fit note process and the conversation about work and health, as well as how to improve the information provided on the fit note for patients and employers.
