Table 1 Delphi statements where consensus was achieved
From: Recommendations to facilitate the ideal fit note: are they achievable in practice?
Statement | % of respondents who agreed | Number of respondents | |
|---|---|---|---|
General format and application | |||
1 | Electronic/computer-generated fit notes should be standardised. | 88.2 % | 17 |
2 | Electronic/computer-generated fit notes must exactly match the hard copy fit notes. | 94.1 % | 17 |
3 | Fit notes should include a section stating whether or not the patient is employed. | 82.3 % | 17 |
4 | The electronic/computer-generated fit note should have drop-down prompts for the GP, giving examples of the information they are expected to provide. | 100 % | 17 |
5 | The comments section should be separate from the work modification tick boxes to encourage GPs to comment on 'not fit' notes as well as 'may be fit' notes. | 76.4 % | 17 |
6 | GPs should be able to access a second (independent) opinion of a patient’s fitness to work. | 100 % | 17 |
7 | The DWP should actively promote the use of electronic/computer-generated fit notes. | 100 % | 17 |
8 | The DWP should actively monitor the use of fit notes. | 88.2 % | 15 |
9 | Completion of all fields of the electronic/computer-generated fit note should be mandatory. | 82.3 % | 17 |
10 | Electronic/ computer-generated notes must require the GP to select either the 'may be fit' or ‘not fit’ option. | 82.3 % | 17 |
11 | GPs should have the option of selecting both fitness to work options ('not fit' and 'may be fit') if they qualify these choices with clear dates, duration and advice. | 76.4 % | 17 |
12 | It is for the employer in conjunction with the employee, to consider and act on - or reject - the advice that they receive. | 76.4 % | 17 |
13 | Other healthcare professionals with relevant training and competency should be able to complete fit notes. | 88.2 % | 17 |
14 | If a patient has another job with different demands, the GP should complete the fit note to cover each job. | 76.4 % | 17 |
15 | GPs need to understand the details of their patient’s work tasks in order to comment on the ‘functional effects’ of the patient’s condition. | 82.3 % | 17 |
16 | Fit notes should include a section stating whether or not the patient is employed/ self-employed/ unemployed | 75 % | 16 |
17 | The review section should be amended to a default statement ‘I will not need to assess your fitness for work again at the end of this period’ with the option to amend this if required. | 75 % | 16 |
18 | There should be local audits of fit notes to ensure that fit notes are completed according to most up-to-date DWP guidelines. | 82.5 % | 16 |
19 | Other healthcare professionals with relevant training and competency, who complete fit notes, should be Any Qualified Providers who have clinical data sharing set-up locally with GP systems. | 75 % | 16 |
20 | GPs should provide as much information about the health condition on the fit note, relevant to their return to work, as the patient will consent to. | 93.8 % | 16 |
Completion of the fit note | |||
21 | Fit notes should be completed electronically. | 82.3 % | 17 |
22 | Each section of the fit note must be completed. | 82.3 % | 17 |
23 | The content of each section of the fit note must be discussed and completed with the patient’s knowledge and agreement. | 88.2 % | 17 |
24 | If a patient has more than one condition affecting their ability to work, information and advice on the fit note should clearly distinguish to which condition this refers. | 82.3 % | 17 |
25 | If medical terminology is used on a fit note, then a lay person’s version should also be provided e.g., CVA (stroke). | 94.1 % | 17 |
26 | If a patient’s health condition is work-related (partially or fully) the GP should specify this on the fit note, with the patient’s consent. | 76.5 % | 17 |
27 | If a patient has had, or is undergoing surgery, and with the patient’s consent, the GP should use the fit note to advise on expected post-operative complications and restrictions. | 88.2 % | 17 |
28 | GPs should clarify the duration of recommended modifications on a fit note where possible. | 94.1 % | 17 |
29 | GPs must complete the comments section of the fit note on both ‘not fit’ and ‘may be fit’ notes. | 76.5 % | 17 |
30 | GPs must ensure there is no ambiguity as to the return to work date on the fit note. | 76.5 % | 17 |
31 | If a patient’s symptoms are aggravated by work, then the GP should specify this on the fit note, with the patient’s consent. | 88.2 % | 17 |
32 | With the patent’s consent, information on planned tests and treatment interventions impacting on the patient’s ability to work should be included on the fit note, with timescales where known. | 82.3 % | 17 |
33 | Where possible, and with the patient consent, GPs should include information on the fit note as to the likely duration of reduced work capacity. | 88.2 % | 17 |
34 | GPs should avoid using non-specific advice on work adjustments on a fit note e.g., light duties. | 88.2 % | 17 |
35 | GPs should have the most up-to-date DWP fit note guidance available on their website and/or at their surgery. | 88.2 % | 17 |
36 | When completing a fit note, the option of ‘may be fit’ should always be considered initially. | 75 % | 16 |
Management of the fit note | |||
37 | GPs must ask all employed patients whether there is anything about their health condition that makes it difficult to work, and if so, what this is. | 82.4 % | 17 |
38 | GPs should state how the patient’s condition affects their ability to work (i.e., the functional effects of the condition) on both ‘not fit’ and ‘may be fit’ notes. | 82.4 % | 17 |
39 | GPs must conform to the most recent fit note guidance published by the DWP. | 82.4 % | 17 |
40 | It should be possible for patients to access the same GP for ongoing fit note consultations | 76.5 % | 17 |
41 | GPs should ask the patient the extent of their employer’s occupational health provision and involvement when completing the fit note. | 88.2 % | 17 |
42 | The option should be available, with patient consent, for fit notes to be emailed to the employer. | 94.1 % | 17 |
43 | Employers must conform to the most recent DWP fit note guidance. | 88.2 % | 17 |
44 | Organisations must have a timely mechanism for dealing with ‘may be fit’ notes. | 94.1 % | 17 |
45 | Employers should ensure that sickness absence monitoring schemes do not discourage employees from returning to work before the expiry of their fit note, if they feel able. | 94.1 % | 17 |
46 | There should be a defined period within which GPs complete reports requested by an employer or the employer’s occupational health provider. | 88.2 % | 17 |
47 | Patients should not be discouraged from consulting their GP about a health problem that impacts on their ability to work during self-certificated sickness absence. | 94.1 % | 17 |
48 | GPs should be able to write a fit note during the self-certification period, free of charge. | 82.3 % | 17 |
49 | The use of email to send fit notes to patients’ employers should be piloted before a final decision is made. | 88.2 % | 17 |
50 | The DWP should provide more detailed guidance to employers on best practice in the management of the fit note through their organisation. | 94.1 % | 17 |
51 | Employers should have the most up-to-date DWP guidance available for employees on their website and/or at the workplace. | 76.4 % | 17 |
52 | Reports requested from the GP by an employer or the employer’s occupational health provider should be completed within two weeks of the request being made. | 88.2 % | 17 |
53 | Where reports are requested from the GP by an employer or the employer’s occupational health provider, there should be a standard fee. | 82.3 % | 17 |
54 | Patients who seek consultation with their GP about a health problem affecting their ability to work should be able to request a face-to-face consultation. | 87.5 % | 16 |
55 | Employees should contact their employer to discuss a 'may be fit' note within two working days of being issued with one. | 87.5 % | 16 |
Communication about the fit note | |||
56 | Fit notes should include GP contact details (phone, email) to facilitate discussion of the patient’s return to work should the employer wish to do so, and with the employee’s consent. | 94.1 % | 17 |
57 | Employers should contact the GP by phone or email, with employee consent, if they have questions about the employee’s fit note. | 88.2 % | 17 |
58 | Employers must ensure strict confidentiality in their management of fit note information. | 100 % | 17 |
59 | Where necessary, and with patient consent, GPs should communicate with their patient’s employer to seek more information on the employee’s job and possible modifications. | 82.4 % | 17 |
60 | Patients should be the primary channel of information between their GP and employer concerning the fit note. | 88.2 % | 17 |
61 | Records of any contacts made between the employer and the employee’s GP should be sent to the employee (with the employee’s consent). | 88.2 % | 17 |
62 | Employees should be consulted as to which members of staff within their organization will see the content of their fit note. | 82.3 % | 17 |
Training | |||
63 | GP fit note training should be incorporated into official GP training events (e.g., Practice Learning Time). | 100 % | 17 |
64 | GP fit note training should be mandatory. | 88.2 % | 17 |
65 | Employers must inform their workforce about how their organisation manages the fit note. | 88.2 % | 17 |
66 | Employers must inform individuals as to any impact that work modifications advised on a fit note might have on their pay. | 94.1 % | 17 |
67 | Training in the use of the fit note should include GPs, employers and patient/employee representatives so that each can hear the others’ viewpoint. | 100 % | 17 |