Academic journal article Perspectives in Public Health

Completion of Fit Notes by GPs: A Mixed Methods Study

Academic journal article Perspectives in Public Health

Completion of Fit Notes by GPs: A Mixed Methods Study

Article excerpt


Sickness certification is a common activity in general practice in the United Kingdom, as, apart from the first seven days of absence, the general practitioner (GP) is responsible for certification, until 28 weeks of absence has been reached.1 Certification practice is under increasing scrutiny due to the personal, social and economic costs of sickness absence and work disability and a growing working-age population.2,3 in 2010, with these issues in mind, the UK government introduced the 'fit note'.4 The purpose of the fit note is to reduce avoidable sickness absence and facilitate return-to-work of those with health problems.4 whereas previously GPs were required to state that a patient was either able to work or not, GPs now have the option of advising that a patient is 'not fit' or that they 'may be fit' for work if appropriate work adjustments can be made. if the 'may be fit' option is selected, GPs are required to advise on one or more of the following modifications: a phased return to work, altered hours, amended duties, and workplace adaptations. GPs should then enter a free-text comment, including the functional effects of the condition, and are advised it may also be useful to enter free-text comments when the patient is 'not fit' for work. There is no longer a 'fit' for work option; instead, the GP is mandated to state whether or not they need to assess the patient again on expiry of the fit note. An electronic version of the fit note was to be rolled out by early 2013.5

Although the fit note has been generally welcomed by employers and clinicians, studies have indicated that the completion of fit notes is not meeting expectations. A quantitative study of fit note comments6 revealed a wide variation in use and that few described the functional effects of the condition. A survey of completed fit notes conducted by the Department for work and Pensions (DwP)7 demonstrated that fewer than 7% had the 'may be fit' option selected, and that modification options, free-text comments and reassessment information were often missing. A survey of employers8 reported that few electronic versions are received and that free-text advice is often absent or vague; however, this information was based on general recall rather than specific cases. No studies have examined why GPs are not completing fit notes as intended.

The aim of this study therefore was to examine a series of actual fit notes completed by GPs for employed patients, and their reflections and experiences of fit note completion.


ethical approval was obtained from Northampton research ethics Committee. The study formed part of a larger investigation of the fit note, described elsewhere.9

A mixed-methods design was used. Data were collected via fit note copies and individual interviews. The aim was to recruit ten GPs representing a range of socio-economic settings. A variety of sampling methods were employed. written consent was obtained.

GPs were asked to record the first ten 'new' fit notes issued to employed patients (i.e. not continuations of previously issued fit notes), including a minimum of five 'may be fit' notes. Participants sent a copy of each fit note to the research team, having deleted all patient/practice/GP details. A total of six weeks after issuing the fit note, participants were sent a postal questionnaire to rate, and comment on, their completion of each fit note. At the end of the data collection period, each GP took part in a face-to-face interview to explore their experiences and perceptions of the fit note. interviews were digitally recorded. The topics for the interview guide were initially selected by the research team and study steering group which included two GPs, a patient representative and employer representative. The guide allowed for new topics to be added as the interviews progressed.

Quantitative data were analysed descriptively. Questionnaire comments were analysed using thematic content analysis. …

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