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sick note changes from April 6th 2010 - how to use the updated sick note (fit note)

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On 6 April 2010, the current Forms Med 3 and Med 5 will be replaced with a single revised Statement of Fitness for Work

General points:

  • NHS General Practitioners are required to issue, free of charge, a Statement of Fitness for Work to patients for whom they provide clinical care
  • other doctors are also required to issue Statements where appropriate to patients for whom they provide clinical care
  • you do not need to issue a Statement to a patient until they have been off work for more than 7 calendar days
  • the Statement may be issued:
    • on the day that you assessed your patient;
    • on a date after you assessed your patient if you consider that it would have been reasonable to issue a Statement on the day of the assessment; or
    • after consideration of a written report from another doctor or registered health care professional


  • 1) date on which you assessed your patient
    • that is the date on which you either undertake or undertook:
      • a face to face consultation;
      • a telephone consultation; or
      • the consideration of a written report from another doctor or registered healthcare professional
    • Statement may be issued:
      • on the day that you assessed your patient;
      • on a date after you assessed your patient if you consider that it would have been reasonable to issue a Statement on the day of the assessment; or
      • after consideration of a written report from another doctor or registered health care professional

  • 2) condition or conditions that affect your patient's fitness for work
    • this should be as accurate a diagnosis as possible, unless you consider that providing a precise diagnosis would be harmful to your patient's wellbeing or compromise your patient's position with their employer

  • 3) tick this box if your assessment of your patient is that they have or had a health condition that prevents or prevented them from working for a stated period of time

  • 4) tick this box if your assessment is that your patient's condition does not necessarily stop them from returning to work
    • However, they may, for example, not be able to complete all of their normal duties or could benefit from amended working hours

  • 5) the four tick boxes represent common approaches to aid a return to work. Where the 'may be fit for work' box has been ticked, you can tick one or more of these optional tick boxes if you feel it could help your patient return to work. This list is not exhaustive and other approaches can be suggested in the comments box
    • advice in comments box if fit for work
      • when advising patients that they 'may be fit for work', the advice in the comments box should describe the limitation(s) that the person may have and should not be too prescriptive about the solution(s). For example, you might advise that a person with lower back pain "cannot sit for long periods of time" rather than "should be provided with a better chair" or that a person with travel-related anxiety might benefit from "avoiding travel in peak hours" rather than "should work between 10am and 4pm"
      • similarly, if your patient will need a specialist referral that may need time off work to attend, it will be helpful to your patient and their employer to note this in the comments box. For example, you might advise that your patient "has been referred for physiotherapy which may require time off to attend"

  • 6) where the 'may be fit for work' box has been ticked, you must complete this section with information on the functional effects of your patient's condition. The information you provide here will be key for your patient and for their employer when they are considering if and how they can facilitate a return to work. In circumstances where you feel the issues are complex or where you feel work itself may be a contributor to your patient's condition you may wish to include in your comments a recommendation that an occupational health assessment be considered

  • 7) specify here how long the advice is for. This will be from the date of assessment. During the first 6 months of sickness this can be up to a maximum of 3 months. After the first 6 months of incapacity, a Statement can be issued for any clinically appropriate period up to 'an indefinite period'

  • 8) use this section to indicate the period the advice covers when you need to state a specific start and end date on the Statement. You will need to use this section when;
    • the Statement covers a period based on a previous assessment for which no Statement has been issued; or
    • the Statement is for less than 14 days and you do not need to see your patient again; or
    • you believe it will be helpful to state a specific date for your patient to return to work as a motivating factor in their recovery

  • 9) state here if you need to assess your patient's fitness for work again at the end of the Statement period. If you request to see your patient again and in the subsequent consultation you feel they are able to return to work without any functional limitations, you do not need to issue to them with a new Statement

Notes:

  • form RM7 has been withdrawn from use. This form allowed certifying doctors to request an independent medical assessment of their patient if the patient was making a claim to benefit. This process is no longer necessary because the majority of patients making a new claim to Employment and Support Allowance undergo a medical assessment within a short period of time after making the claim to benefit

  • form Med 6 has been withdrawn from use. This form allowed certifying doctors to inform the Department for Work and Pensions that a less precise diagnosis had been completed on a Statement. This process is no longer necessary because the majority of patients making a new claim to Employment and Support Allowance undergo a medical assessment within a short period of time after making the claim to benefit. If your patient is employed then the Department for Work and Pensions does not require this information. If you feel making an accurate diagnosis would be harmful to your patient's wellbeing or compromise their position with their employer, for example because it would cause significant discrimination to them in the workplace, then it is acceptable to agree with your patient to enter a less precise diagnosis

  • forms Med 4 has been withdrawn (in addition to Med 6 and RM 7). The changes to the benefit system whereby 'Employment and Support Allowance' (ESA) has replaced Incapacity Benefit (IB) means these forms are no longer needed

  • form Med 10 used as evidence of a period as an inpatient is still in use and the rules and processes for this remain unaltered.

Reference:

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