Completion of the Statement of Fitness for Work

Key recommendations

• Doctors should be aware of the strong links between work and health:
  • work is generally good for individuals's health and wellbeing
  • unemployment is generally harmful to health and can lead to increased morbidity and poorer physical and mental health
  • work can be therapeutic and helps promote recovery and rehabilitation.
• Doctors should consider in the treatment of patients the effects of worklessness. Prolonged periods off work can lead to slower recovery and can put patients at risk of developing (secondary) mental health conditions associated with worklessness.
• Provision of the Form Med 3, Statement of Fitness for Work (the fit note) is not solely the role of the general practitioner (GP). Where appropriate, doctors should provide them to patients for whom they have clinical responsibility. For example:
  • an outpatient clinic (where the GP does not retain responsibility), such as a fracture clinic
  • where the patient is undergoing a course of hospital-based treatment, such as chemotherapy (ie is not just referred for a one-off expert opinion);
  • on discharge from hospital after a stay as an impatient or for day surgery
  • after treatment in accident and emergency.
• When completing a fit note, doctors should always consider first if the patient could return to work in some way before advising that they are not fit for work.
• Many conditions can be accomodated at work with simple adjustments or support measures from an employer. Doctors should support this by considering work outcomes for patients of working age and providing advice on if, and how, a return to work could be managed on a fit note.
• Returning to, or remaining in, work should be considered as an important clinical outcome of any treatment of patients of working age.
• Where possible, when completing a fit note or advising on fitness for work, doctors should consider any evidence- or consensus-based guidelines on return to work that are available for the condition/procedure.
• Where work may be a contributor to the patient's condition or the health and work issues are complex, doctors should include in their comments on a fit note a recommendation that an occupational health assessment be considered.
• Doctors should refer to available vocational rehabilitation services for patients that would benefit form more tailored support.