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Statement of Fitness for Work (‘Fit Note’)

A Statement of Fitness for Work (‘Fit Note’) is provided by an employee's doctor , nurse, occupational therapist,  physiotherapist or pharmacist (“healthcare professional” [1]).  Fit notes were introduced in 2010 to replace ‘Sick Notes’.  An employee will be given a fit note only if the healthcare professional considers his or her fitness for work to be impaired.  If someone is fit for work, he or she will not be given a fit note.  Under the old sick note system, doctors stated either that individuals should "refrain from work" or "need not refrain from work".  However, the fit note can state either that an individual "may be fit for work" taking into account the healthcare professional's opinion and advice stated on the note, or that the individual is "not fit for work".

[1] This does not include the University Occupational Health Service.

Fit notes record details of the functional effects of a patient’s condition so that employees and employers can facilitate a return to work.  A fit note gives healthcare professionals the opportunity to highlight one of the following four options to help facilitate an employee’s return to work:

  • A phased return;
  • Amended job duties;
  • Altered hours of work; and
  • Workplace adaptations.

The healthcare professional may also write in any other option that he or she believes may be appropriate in the circumstances and can add any other relevant information.  In cases of long-term sickness absence, the manager should consider gaining more specific advice via a medical report.  The employer is responsible for ensuring that any adjustments suggested by a healthcare professional are suitable and do not pose a risk to the employee.  Managers should therefore seek advice from Occupational Health if they are presented with a fit note that contains specific medical advice or recommendations.

There is no legal obligation on an employer to comply with any recommendation made on a doctor’s fit note.  Equally, any changes to an employee’s hours or job duties, whether temporary or permanent, should be made only with the agreement of the employee, and the manager and employee should agree how long the changes will last.  Nevertheless, managers should carefully consider what the employee’s healthcare professional has written and give fair consideration to whether any of the changes recommended by the doctor can be accommodated.  It may be that the employee can return to work earlier than would have otherwise been the case if a particular change is implemented.  If the University is unable to facilitate the recommended change(s), the manager should explain this to the employee and treat the employee as unfit to carry out his or her normal job.

The healthcare professional can issue a fit note for a maximum duration of three months during the first six months of an employee’s ill-health or condition.  If the manager and employee agree that the employee is able to return to work sooner than indicated in the fit note, the employee does not need to return to the healthcare professional for formal confirmation.  Depending on the nature of illness, the manager may wish to seek advice from Occupational Health if they are concerned that the employee may not be well enough to return to work.

Where there is concern about the reason for, or frequency of, the sickness absence, employees may be required to provide a fit note for each absence regardless of duration. If an employee’s healthcare professional refuses to provide a fit note in these circumstances, the manager is advised to contact Occupational Health for advice.

Half Day Sickness Absences

All occurrences of sickness absences, including half days, must be recorded on CHRIS.  If an employee attends work but is unable to stay for more than half of their normal working day, this must be recorded as a half day of sick leave.

If an employee goes home unwell after being at work for more than half of their working day, this would not be recorded as a half day of sick leave.  The sickness absence would start the following day if the employee is still unwell and unable to attend work.

Return to Work Discussions

Conducting return to work discussions is a key part of managing all sickness absence, whether formally or informally.  Managers are encouraged to hold return to work discussions with employees after each occurrence of sickness absence, particularly in the case of long-term sickness absence.  Employees may also request return to work discussions with their manager prior to or upon their return to work from sickness absence.

Return to work discussions should be conducted in accordance with the following principles:

  • Handled consistently and sensitively;
  • Informal;
  • Held in a confidential environment free from interruptions;
  • Structured and factual; and
  • Carried out in a supportive and positive way.

In preparation for a return to work discussion taking place, the manager should ensure that:

  • Sufficient time has been set aside for the discussion, with arrangements made for a private meeting room or office to ensure confidentiality;
  • Sickness absence records, fit notes, and Occupational Health reports have been gathered as appropriate; and
  • Consideration has been given to any supplementary questions that may be appropriate.

The return to work discussion should be held in a constructive and supportive way.

The manager and employee should discuss any actions that may need to be taken after the meeting, for example:

  • Reasonable adjustments, such as a phased return to work;
  • A workplace assessment;
  • Occupational Health referral;
  • An attendance target, specifying by how much and by what date; and
  • An improvement in reporting absence.

After the meeting, the manager should confirm the discussions and follow up any actions, for example:

  • A record of the meeting should be made;
  • Where appropriate, a management referral form should be sent to Occupational Health;
  • Arrange any other help or support that can be provided (i.e. Access to Work);
  • Ensure any reasonable adjustments are actioned; and
  • Review adjustments after an agreed period and remove or continue as required.

Setting and Reviewing Attendance Targets

One of the main tools used in effective absence management is the accurate measurement of the absence of employees due to sickness, particularly in the case of frequent short-term sickness absence.  This measurement can then be used for monitoring purposes, including when deciding on the need for, or setting, an attendance target.  An attendance target is a specific level of sickness absence that the employer sets as a goal to reduce the level of absence.  For example, an attendance target might be the number of days' absence per employee at the University over a 12-month period.  Having a target in place will not reduce absence in its own right, but works as part of an overall absence management programme.

When considering the use of attendance targets, managers will, in consultation with the relevant HR Business Manager or their team, need to take into account the individual circumstances of the case, any advice received from Occupational Health, the impact of any underlying medical condition or disability, and any reasonable adjustments that need to be put in place to enable the employee to improve their attendance.  In the event that an attendance target is set, the employee should be made aware of how their attendance will be reviewed and over what period.

Pregnancy-related sickness absence should be recorded separately and should not be taken into account when looking at attendance targets.

Pregnancy-Related Sickness Absence

If an employee has a pregnancy-related illness, the manager should consider how this could affect them doing their job and should feel free to discuss this with the employee concerned, as in many cases simple adjustments can be quickly discussed and agreed.

Medical information should still be obtained and these absences should be recorded as ‘pregnancy-related’ where appropriate, and dealt with carefully in consultation with the relevant HR Business Manager or their team.  These illnesses are normally of a temporary nature and the law gives extra rights and protection to pregnant employees.  Illness may also trigger an early start to maternity leave.  Please refer to the Maternity Policy for more information.

It is good practice for department risk assessments to be undertaken to identify any risks that might affect women who become pregnant.  Further advice on pregnancy and risk assessments is available from Occupational Health.