Request a Fitness for Work Form

Fit notes after hospital care

If you are likely to need a fit note (otherwise known as a sick note or MED 3) when you come out of hospital or following outpatient attendance, please ask the doctor treating you in hospital to provide you with one before you leave.

Mythbusters

“Consultants and junior doctors don’t write fit notes. Fit notes are a GP’s job” – FALSE
“The hospital just don’t have any fit note pads” – FALSE
“The hospital can only issue notes for one or two weeks at the very most” – FALSE
“The hospital can’t issue you with a fit note if you’ve only been to outpatients” – FALSE
“The hospital won’t be able to message me with my fit note or send it to me in the post” – FALSE
“The doctor who is treating you at the time has a statutory obligation to provide you with a fit note if you need one. This includes all hospital doctors” – TRUE
“The doctor who is treating you should sign you off for the appropriate time period according to the condition you have been treated for” – TRUE
“Both private and NHS doctors can issue fit notes” – TRUE
“It is part of the hospital’s contractual duty to issue a fit note when one is required. Failure to do so is breach of the hospital’s contract with the NHS” – TRUE

This is an extract from the guidance from the Department of Work and Pensions about fit notes (also known as doctors’ statements or Med 3s in this text):

“The role of hospital doctors in issuing the Statement of Fitness for Work: The duty to provide a Med 3 rests with the doctor who at the time has clinical responsibility for the patient…. For an out-patient this will generally be the hospital doctor… Hospital in-patients Form Med 10 should continue to be issued to cover any period that a patient is in hospital. On discharge from hospital the doctor who has clinical responsibility for the patient should provide them, if appropriate, with a Med 3 to cover a forward period. This is to avoid unnecessary referrals to GPs solely for the purpose of sickness certification."

Thousands of appointments and telephone calls with GPs are taken up each year by patients requesting fit notes when they could have actually been issued by hospital doctors providing treatment at the time. Please help us to keep our appointments free for patients who have genuine clinical need, rather than for administrative paperwork that could have easily been dealt with by others at the end of your hospital visit. If you have trouble getting a fit note from the hospital, please contact the PALS (Patient Advice Liaison Service) team at the hospital.

Requests for certification of absence from the workplace relating to Covid-19:

As per normal regulations Healthcare Professionals cannot issue fit notes during the first 7 calendar days of sickness absence. Employees can self-certify for this time, visit Employee’s statement of sickness to claim Statutory Sick Pay for a template form. If your employer requires medical evidence for the first 7 days of sickness absence, it is your responsibility of your employer to arrange and pay for this. Getting the most out of the fit note: guidance for employers and line managers - GOV.UK (www.gov.uk).

For further information on self isolation please refer to Get an isolation note - NHS (111.nhs.uk) and What to do if you have coronavirus (COVID-19) or symptoms of COVID-19 - NHS (www.nhs.uk).

For Non COVID-19 Illnesses lasting less upto 7 days

If you require a sick certificate during this self-certification period we may able to provide a private sick certificate but there is a fee payable for this service. The issuing of a private sick certificate is at the discretion of the doctor at the time of assessment for a fixed period (please enquire at reception for the current fee payable). Please kindly refer to the section below 'Optional Occupational Pay Schemes' for more details.

For Non COVID-19 Illnesses lasting more than 7 days

If you are off work for more than seven days due to illness, your employer can ask you to give them some form of medical evidence to support payment of SSP (statutory sick pay) or other sickness benefit.

A ‘fit note’ is a legal medical that statement made by the Healthcare Professionals at time if they feel you are not able to undertake any work. You should the fit note from the Healthcare Professional who is treating you. This can be either a doctor, nurse, occupational therapist, pharmacist or physiotherapist delivering NHS services (From the 1rst of July 2022). Your healthcare professional can also issue a fit note based on a written report from another healthcare professional, but this is up to their discretion and it is much better to obtain it from the team treating you directly who are better able to assess and issue the fit note with the details required and advise you on your recovery/condition. The fit note: guidance for patients and employees - GOV.UK (www.gov.uk)

Fit notes can be computer-generated and printed out or computer-generated and sent digitally to you and no longer require any signature.

To request a sick certificate or ‘fit note’ please speak to reception. Please note - it may take 48 hours to process the request and it may be necessary to have an appointment if we have not seen you recently regarding the illness. When you receive the ‘fit note’ please make a note of the expiry date and if you require a further certificate request it in good time- the DWP only write once the existing certificate has expired and we are unable to provide "same day" sick certificates apart from in exceptional circumstances.

For Non COVID-19 illnesses where you are deemed able to do some work

Alternatively, under certain circumstances a doctor may issue a ‘may be fit note’. This has four iterations:

A phased return to work: a gradual increase in work duties or hours
Altered hours: changing their work times or total hours
Amended duties: changing their work duties
Workplace adaptations: changing aspects of the workplace

A Healthcare Professional may also use the comments box to give you more detailed advice about what your type work you can do. This advice will be about their general fitness for work, not just related to your current role. If there are certain parts of your role that may be affecting their health, these will be mentioned in the comments box.

In most cases, people do not need to be 100% fit to return to work. This may not mean doing their normal job. People with health conditions may have limits on what they can do at work, but these will not always mean they cannot do any work. Additionally, an ‘Amended fit note’ becomes a ‘fit note’ if the employer is unable accommodate/fulfil the conditions set out by the Healthcare Professional. The fit note: guidance for patients and employees - GOV.UK (www.gov.uk)

Please note once a ‘fit note’ or ‘amended sick note’ expires, if the employer feels that the employee requires further assessment to consider them fit to go back to work, this is up to the employer to make the necessary assessments i.e. by instructing an occupational health assessment or human resources return to work interview.

Optional Occupational Sick Pay Schemes

A number of employers operate occupational sick pay schemes which, while offering employees more benefits than that prescribed under SSP (Statutory Sick Pay) legislation, require more in the way of certification in that they require a Doctor’s certificate for illnesses of less than 7 days’ duration. Since the advent of self-certification for statutory sick pay purposes in 1983, as has been mentioned GPs are not required to issue certificates for periods of sickness of less than 7 days duration. It is clearly not a GP’s role to supervise an employers’ enhanced occupational sick pay scheme. If employers require additional certification it is up to them to make their own arrangements, on a private basis, with a Doctor, be it the patient’s own GP or an occupational health Doctor to examine and verify the genuineness of the patient’s illness. For this reason when GPs are asked to carry out this work and provide a sickness certificate within the first 7 days of illness it is classed as un-commissioned private work and attracts a fee (charged in accordance with national BMA guidance).

Please note that our members of staff including reception and clinicians have a right to work in a safe environment, without fear of bullying, aggression, intimidation or harassment. The NHS Zero Tolerance Policy applies at all times as such any behaviour deemed in breach of this will not be tolerated. Please refer to Zero Tolerance page for further information.

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