Be clear on competency when providing ‘fit notes’

Keep within clinical competence in making workplace recommendations on medical ‘fit notes’

New regulations replacing medical ‘sick notes’ with new ‘fit notes’ are due to come into force UK-wide on 6 April 2010 subject to approval by Parliament

The Statutory Sick Pay (Medical Evidence) (Amendment) Regulations 2010 introduces a new electronic Med 3 form (Statement of Fitness to Work) replacing the existing Med 3 and Med 5 forms and combining them into one. The Med 4 is no longer required.

It will allow doctors to record information to help inform discussion between individuals and their employers about whether there are any changes to the employee’s work environment or job role which could help in achieving an earlier return to work.

Specifically the new statement will include an option to allow a doctor to provide an assessment of an individual’s fitness for work. Doctors will be able to indicate with a tick in the box if a patient is ‘fit for work’, ‘unfit for work’ or ‘may be fit for some work now'.

Opting to classify a patient as ‘may be fit for some work now’ will require a doctor to provide general details of the functional effect of the individual’s condition and to suggest conditions in which the patient might return to work, including altered hours, amended duties or workplace adaptations.

The example given in the consultation document is where an individual has moderate lower back pain. A doctor may suggest that the patient will be unable to lift heavy objects and should be given the opportunity to change position or take breaks regularly.

Employers will not be bound to implement suggestions by a doctor for workplace changes that would facilitate a return to work; the provision of change will be at the discretion of the employer and with the agreement of the employee. Employers must, however, continue to meet their obligations under the Disability Discrimination Act.

This move is supported by RCGP chairman Professor Steve Field in a Healthcare Republic podcast saying that it allowed GPs to make a positive intervention and help patients avoid long-term sick leave and developing further health problems.

We would advise and encourage GP’s, to bear in mind patient confidentiality and consent when completing the new forms and to have an open discussion with their patients so that agreement can be reached as to what to put on the form .The legislation allows that the medical condition may be specified less precisely where, in the doctor’s opinion, disclosure of the precise condition would be prejudicial to the patient’s well being, or the patient’s position with their employer.

We would also advise that GPs exercise a degree of caution and do not give opinions out-with their clinical competency. GP’s are not experts in occupational health medicine and we would caution against giving anything other than the most general recommendations for alteration to work place conditions.

If you are in any doubt please contact a medical adviser who will be happy to assist you with your query.

ACTION: Take to care to keep within clinical competence in making workplace recommendations on medical ‘fit notes’ and ensure against unwarranted disclosures of patient details.

Dr Susan Gibson-Smith, medico-legal adviser, MDDUS