Fit Notes (MED3) and Sick Leave

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Introduction

A fit note (officially called a Statement of Fitness for Work) can be issued by a trained healthcare professional (nurses, occupational therapists, pharmacists, physiotherapists and doctors) to inform employers of a patient’s illness, which may prevent them from working entirely or working to their previous extent.

A fit note is sometimes called aΒ sick note,Β doctor’s letter orΒ MED3 (as this is the form’s code).Β 

Fit notes can be used for phased returns to work, altered hours, amended duties and workplace adaptations. They can also be used for patients to claim sickness-related benefits from the Department for Work and Pensions (DWP).Β 

Patients off work with illness for seven calendar days or less can ‘self-certify’ and do not require a fit note. Self-certification can be done verbally or in writing, depending on the employer’s policy. The SC2 form can also be used.

You might also be interested in our collection of 800+ OSCE Stations that cover clinical examination, procedures, communication skills and data interpretation.

Writing a fit note

A fit note can be issued in primary or secondary care:

  • General practice: for patients with acute or chronic diseases unable to work
  • Hospital inpatients: when preparing for discharge, the patient may need a post-admission or post-operative recovery period, which a fit note should cover. The hospital inpatient stay should be covered by the hospital inpatient form (MED10), signed by a hospital staff member. The MED10 form is accepted like a fit note as it will state the period of the health condition or disability it covers.
  • Emergency department: when an illness or injury will prevent work for a recovery period (e.g. infective illness, fracture)
  • Outpatient clinics: when an illness or injury will prevent work for a recovery period (e.g. flare of a chronic condition)

The fit note can be handwritten or electronic. Electronic copies can be printed or signed digitally and then sent directly to the patient via email/SMS text message.

What should a fit note include?

A fit note should include the following details:

  • Patient name
  • The date that the patient was assessed, which is the same day as the fit note was written
  • Clinical reason for the fit note being written, usually their diagnosis and/or the procedure carried out
  • Advising if ‘Not fit for work‘ or β€˜May be fit for work’, which should include specific advice about how that may be achieved, using free text and/or the checkboxes marked: β€˜a phased return to work, ‘altered hours’, ‘amended duties’ and ‘workplace adaptations’
  • Dates this fit note applies from and until; or how long you expect the note to last for (e.g. β€˜for 4 weeks’)
  • Healthcare professional’s name and place of work
  • A signature on handwritten notes; electronic fit notes generate a unique QR code that can be used to check their validity
Figure 1. An example of a fit note

What do I need to consider?

The healthcare professional must perform a clinical assessment and gather patient information before writing a fit note.

Consider the job role of the patient: what does their current illness/injury prevent them from doing?

In the free text box, include as much information as possible to help the patient’s employer.

If an employer cannot meet the terms of a β€œmay be fit to work”, it automatically becomes a β€œnot fit for work” certificate and doesn’t need re-doing.

Check specific dates. You can backdate fit notes if needed. Healthcare professionals cannot forward-date a MED3 but can overlap dates if a new fit note is required before the current one expires.

Example case

Scenario

A delivery driver has sustained a sporting injury and fractured her left femur. Following hospital admission, she underwent orthopaedic surgery. Since the operation, she has remained on the hospital ward for observation, pain management and initial physiotherapy support.

She has recovered well and is now mobilising with crutches. Your consultant has advised it will likely take several months for her femur to heal completely. She is being discharged from the ward today with a planned outpatient clinic follow-up in 6 weeks. You have been asked to write a fit note.

Fit note

If there is an option for her to work in a part-time sedentary back office role for the company, you could advise ‘you may be fit for work taking account of the following advice’ with ‘amended duties’. If this back office role is not an option, she cannot drive her van and lift heavy parcels, so you would advise ‘you are not fit for work’. In the the comments box, include details of her injury and the operation undertaken.

The fit note can be backdated from the date of the injury. In this example, the fit note could be written until the date of the outpatient clinic appointment- she can then be clinically re-assessed by the orthopaedic team, and a new up-to-date fit note can be issued.


Sick pay

A patient will get statutory sick pay (SSP) when they cannot work due to illness for at least four days in a row (including non-working days). This is Β£109.40 per week for up to 28 weeks.

If an employer pays ‘contractual sick pay’ (CSP), patients may be able to get this alongside the SSP.

An employer can request a fit note from their employee if they are off work for more than seven days.Β 

If the patient is off sick frequently or for a prolonged period, the employer may require more information from the patient’s doctor. This is why writing as much clinical detail as possible on the fit note is important.


Reviewer

Dr Seb Pillon

GP and Primary Care Medical Educator


Editor

Dr Chris Jefferies


References

  • Department for Work and Pensions. Getting the most out of the fit note: guidance for healthcare professionals. Published in 2022. Available from: [LINK]
  • NHS e-Learning for Health. Fit Note Training. Available from: [LINK]
  • British Medical Association. Issuing Fit Notes. Published in 2020. Available from: [LINK]
  • Gov.uk. Statutory Sick Pay (SSP): employer guide. Available from: [LINK]

 

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