Rank: Forum user 
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Hi all
I recently had a conversation with my own GP after major surgery and was introduced to the fit note. What I found interesting here is that the GP is now being asked to make the decision of an Occupational Health Doctor without the sufficient skills and knowledge to make a decision on what you should and shouldn't be able to do while at work.
Although they will be quite comfortable dealing with simple issues this may cause and issue for us safety practitioners further down the line when a GP suggests light duties.
We as a business does not provide light duties and therefore the individual would be forced to stay sick for longer. We do try to provide alternate work but this is very rarely possible.
Is anyone else seeing this as a potential issue for the future?
Thanks in advance
David
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Rank: Forum user
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If I wanted advice on what I can and cannot do after major surgery I'd be getting advice from the specialist who operated on me. If I were a doctor/GP I'd be a offended that you don't think me qualified to have an opinion on the condition/abilities of one of my patients.
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Rank: Super forum user 
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There are of course likely to be implications for employers and employees alike. At the moment I am in favour of the idea and for many employers and employees I think that overall the fit note will be a positive thing.
The life of a GP is to make serious clinical decisions on a daily basis, but the decision as to whether someone returns rto work isn't the GPs alone, even though they have signed the MAY be 'fite note'. To my mind the decision is a joint one between a number of parties, the GP, employee, employer, maybe the employers OH service, and potentially other people and agencies as well. In the more simple cases I would suggest that with a few quick enquiries as to the persons type of work that the GP can form a sensible opinion as to the possibility of someone returning to work and provide some sensible guidance on how that might be achieved. I think that they have in efefct been doing that all along.
Ok, so we are having to think a little more cunningly but I for one welcome the fit note and have so far found it to be a sensible and positive way ahead.
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Rank: Forum user
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The post was not so much about me but more about how this affects safety practitioners when dealing with long term sick due to accidents and injuries.
The GP himself said he was uncomfrotable giving occupational advise as he didn't feel this was his specialism. Hence general practitioner
Some people seem only content to nit pick on peoples words on this forum which is why i haven't used it for such a long time
It disapoints me that people can't be bothered to even read the post if they have similar concerns not just to gripe for the sake of it
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Rank: Forum user
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Thanks fro your constructive response Phil
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Rank: Forum user
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Our company has already found that GP's are inconsistent with advice given, and in a few cases are suggesting time off where we can accomodate light duties, or suggesting reduced hours for musculoskeletal strains where perhaps light duties are more appropriate (not suggested along with reduced hours).
Remember however that the GP is giving advice, not a 'be all and end all' statement.
We use the doctors advice as well as speaking with our employees and utilising OHSAS in some cases.
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Rank: Forum user
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oh yeah - and further to my comments - while the advice from the GP may not always be accurate - it's understandable as they don't work with the company or see all the duties somebody carrys out.
In all though - the note is a positive step to get people back to work and I'm all for it. Much better than the negative conotations the 'sick line' had.
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Rank: Forum user
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Thanks, I agree it is definatley a step in the right direction and it will make GP's tackle some of the people who undoubtedly use the GP as a means to take longer off than can sometimes be required.
I think used correctly it is a good thing. Whwn we have issues relating to occupational health issues we utitise the expertise of Occ Nurses and where need be Occ Doctor which has proven very effective.
Good feedback though
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Rank: Super forum user
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Rank: Forum user
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Great stuff
Thanks very much
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Rank: Forum user
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David - let me say first that I was not trying to insult you (even though that seems to be what I achieved). I was merely trying to be succinct and to the point (I'm trying to avoid rambling, although perhaps I'll have to go back to it).
To get back to the sick note, I just feel that this thread is overcomplicating the issue of who needs to be consulted before someone goes back to work. A person is either fit to work or not. If not then restrictions need to be clear and GPs should refer patients to occ health physicians who can provide more detail through discussing the type of work etc.
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Rank: Guest
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David, firstly i agree with Phil's comments.
Only 10% of G.P's have had any training in how to use the fit note, it has been introduced to stop people ending up on long term sick absence and therefore maybe getting trapped in the benefit system.
Phil is correct it can benefit both employer and employee, however there are occasions that the fit note will not work, for example if you worked in a call centre and were suffering with larengitus your G.P. could Recommended that you are fit for work with some reasonable adjustments put in place, your employer however may not have any other duties for you to do, in those circumstances you would then stay off sick until your voice returned, but if you were working in the same place and had a problem with your back, a reasonable adjustment might be a specialist chair, in those circumstances you would be able to attend your workplace if the chair was provided.
The G.P does not have to give occupational health advice as he/she cannot be aware of everyones workplace or the ergonomics, so the fit note is only a guide to help employees and employers to stay in work if at all possible.
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Rank: Super forum user
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Mick Noonan wrote:David - let me say first that I was not trying to insult you (even though that seems to be what I achieved). I was merely trying to be succinct and to the point (I'm trying to avoid rambling, although perhaps I'll have to go back to it).
To get back to the sick note, I just feel that this thread is overcomplicating the issue of who needs to be consulted before someone goes back to work. A person is either fit to work or not. If not then restrictions need to be clear and GPs should refer patients to occ health physicians who can provide more detail through discussing the type of work etc.
I can't think that this this being complicated or over complicated. I have always considered that any return to work, rehabilitation etc has to be a colloborative approach between as many people as is NECESSARY, and as the situation determines. There is NO one size fits all, some will need very little time, effort, thought, or additional measures and some will need more depending on the individual circumstances.
I don't understand the comment "A person is either fit to work or not"! Surely the whole point of the fit note idea is to move away from the draconian, senseless and wasteful approach of old. It would be equally wastful to refer everybody to OH when many situations could be accomodated without this. Many people who have in the past have wanted to work, and contribute to their work, their workmates, society and their own self esteem have been prevented from doing so under the old scheme. To my mind ours is an 'enabling' role and this is just the sort of thing that we should be embracing, supporting and contributing to as far as possible.
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Rank: Forum user
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Absolutely right Phil and- I don't agree it's a simple case of a person is either fit or unfit to work. That is why we as employers can make adjustments to a persons work with guidance and medical opinion of GPs who can indicate "fit for some work" and what that might entail. I must admit I have seen several different examples of this so far - most GPs have really embraced the concept, however we did have one GP say that couldn't issue a fit note as they didn't have any of the new forms!! However IMO I think that we should welcome this change and do all we can to embrace and support it.
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Rank: Forum user
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Let me be clear, the decision regarding the fitness of a patient to go back to work is that of the GP and while s/he may seek help or advice for whatever party s/he chooses the buck stops with the GP. That's what I mean by "a person is either fit to work or not". Please don't misconstrue this as my being flippant. I welcome the fit note, what it represents and look forward to its being brought in (or considered) to the ROI.
I simply worry that it may become clouded or complicated by those who would use it for their own benefit instead of the good of the patient. Employers may interpret (or misinterpret) the GPs' assessment differently to the employee.
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Rank: Forum user 
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An interesting topic.
I have just had an operation and received the 'Fit Note' from the consultant who performed the operation.
Although she didn't actually tick box 4 or 5 on the form!
So she couldn't actually make the decision in my view, although we discussed what my occupation was before I went under the knife.
Consultation with the employer is the way forward I think, with both parties agreeing what the patient can or can't do.
The type of work that I do, could mean I could perform different duties within the organisation, and that I feel is the whole perpose of the 'Fit Note'.
But I got 4 weeks off anyway!
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Rank: Super forum user
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Sorry, I do NOT believe that the decision is that of the GP alone, and nor do I think that the 'buck' stops with them either. While it is not my intention to be provactive, I think that to suggest that the responsibility and accountability rests solely with the GP is a nonsense. IMVHO I suggest that this has never really been the case and since the introduction of the 'fit note' there is a more 'obvious' requirement to take a more colloborative and holistic problem solving approach.
For the first 7 days of sickness the decision about whether or not an individual is fit to work or not, is NORMALLY taken by - the individual. Thereafter, it is often a joint decision between the individual and the GP, and I suggest that the ADVICE that someone 'may be fit', the decision then becomes a joint decision between a number of different people/'agencies' such as the GP, the individual, HR, H&S, manager, OH, etc etc. It may be a simple descion requiring little thought and only minor intervention, or something more.
In saying all of that, we are still getting some of the old Med 3 and we are getting a little bit of allsorts on the new Med 3. We have even had a new Med3 that signed someone off as NOT being fit but the GP nevertheless used the narrative box to give us notice that the person/patient would subsequently need a phased return etc etc. We had already figured that out for ourselves but the GPs note was IMO a useful 'heads up'.
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Rank: Forum user
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I disagree Phil, the GP is the one who completes the "fit note" and is therefore the "responsible" person. After the GP sets down the conditioins of a return to work then, and IMO only then, will the other decision making groups come together to determine the finer points of how best to get the individual back to work.
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Rank: Forum user
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Rank: Super forum user
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Mick - I fear we will have to agree to disagree. I don't want a tit for tat or to go at logger heads over it.
If you look at the guidance using the link that I provided above you will see that the whole concept is to take a colloboratiove approach, and shared responsibility for the managament of sickness absence. The GP does not set down 'conditions' but provides ADVICE allowing the employee and employer scope to chose the best method to facilitate the advice. The responsibility is a shared one, and can't reasonably fall upon the GP alone; that would go against the whole concept of what the fit note system is trying to achieve.
For example. A Dr signs a MAY be fit note, requiring an OH referall (I have one on my desk right now!). The OH physician sees the individual and they agree that a return to work is permissible (with or without adjustments). You seem to be suggesting that the GP would still be held ultimately responsible for the OH physicians opinion, advice etc. Does that make any sense at all or is there any logic in such a proposition? I for one don't think so.
Looking at the guidance - Page 17 - is the advice on the med 3 binding? Answer = No. It is the employers choice on how to act on the advice of the Dr. A Dr may well be the specialist on the medical side of things but I think most GPs would concede that most employers are the 'experts' when it comes to the employment related aspects of the return to work.
page 19 also explodes another myth. People CAN return to work before the end of a NOT fit note, because they have got better quicker than the Dr expected and they DON'T have to go back to the Dr for a FIT note, indeed such a note does not exist under the new scheme.
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Rank: Forum user
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I have to agree with Phil. Part of the problem is that another poster alluded to is that so few GP's have been trained to understand how to use the fit note.
We have a OH Doctor and he had told us we have to take the fit note as a starting point - seeing what the GP says - then working with OH to ensure the employee is placed as fits their needs. The GP does not have a crystal ball and cannot - unless he has visited the premises - know what the workplace is like so his stement has to be seen as a generalisation. We have to be fiar had some who have been a bit more specific - such as must not work with chemicals, not lift over 5kg which is unusual.
I think as it is new we are all in a learning curve and such a post is so useful for us all to get issues out in the open we may not have come across. Most reasonable employers would have been doing things like staggered returns to work, light duites etc anyway. We too allow people to come to work beofr ethe note expires - again on the adivce of our Dr and heres an even more interesting thing - insurers are ok with that!!! So often we get told - oo you cant do that insruance wont cover that person - I have checked with our company and they have checked all the small print too!!!
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Rank: Forum user
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Wow...isnt it strange how every one has their views on the topics....as for thr GP/Specailist/surgeon/OCC Health/Co rules.. it all becomes a little blurred and subjective (bit like all the different views on Health and Safety).
We could take the route of if a "person" is deemed responsible enough to declare themselves "unfit " without medical advise for work with a self certificate.
They can declare they are "fit" for work with the advice of a GP/consultant.
If there any outstsanding issues with the return to work
the company should refer the person for a medical to an independant GP/Consultant/OCC health then the person could be deemed "fit" for work in what ever capacity is decided
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Rank: Forum user
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Phil, I think we’re looking at the same think only from different angles. I am simply making the point that the responsibility lies with the GP and nobody else. Once the GP completes the fit note then the other groups can get together and formulate a “back to work” plan but this will be based on the assessment provided therein. If an OHP is required by the GP then fine, however we now need to know if the OHP takes over responsibility for the case in full (medically) or does he “simply” extrapolate from the information provided by the GP and apply it to the workplace in question.
The individual can declare themselves personally fit to work, and ignore the assessment of the GP/OHP, but then they waive the right to successfully sue the GP/OHP should a subsequent injury occur at work.
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