Who can sign fit notes?

From 1 July 2022, new regulations are in force that expand the category of people who can sign fit notes. In addition to doctors, fit notes can now be signed by:

registered nurses,
occupational therapists,
pharmacists; and
physiotherapists.

The Government announcement in June 2022 stated that this would “support and empower better conversations about work and health between employers and staff by making it easier to get this advice certified by the most relevant healthcare professional”. The announcement also stated that the change would help reduce pressure on doctors and cut bureaucracy for employers and the NHS.

Who can sign fit notes? Updated guidance

Updated guidance has also been published. “Getting the most out of the fit note: guidance for employers and line managers” explains that:

Employers may be issued a fit note by someone other than a doctor. The healthcare professionals should be treating the employee under NHS services.
The requirement for the healthcare professional to sign the form in ink has been removed and replaced by the issuer’s name and profession.
There will be a transition period during which both the new and previous version of the fit notes are legally valid.

Pharmacists working in multidisciplinary teams within general practices or hospital settings who are able to assess an employee’s fitness for work will have access to fit notes. Employees will not be able to obtain a fit note from a community pharmacy.

There is a reminder for employers that an employee can return to work before their fit note expires. They do not need to go back to their healthcare professional first. The guidance also includes details of further support that may be available, including Access to Work, Occupational Health services and links to guidance from other organisations including the Health and Safety Executive, the Royal College of Surgeons, the Royal College of Psychiatrists and Macmillan.

There is also updated guidance for healthcare professionals. The guidance reiterates that an assessment about whether a patient is fit for work is about their fitness for work in general and is not job-specific.

It also sets out factors that should be taken into account when assessing fitness to work. These include:

Any functional limitations of the patient’s health condition.
The duration of their health condition and any likely fluctuation and whether doing any work – not necessarily their current job – will make their health condition worse.
The impact of any ongoing clinical management.

The guidance also states that fit notes should only be certified following a full assessment of a patient’s fitness for work, and therefore should be provided by a clinician with a holistic oversight of the individual’s condition.

There are case studies and FAQs at the end of the guidance. This includes a reminder that the medical health professionals’ advice is not binding on an employer, and it is for an employer to determine whether to accept the advice.

13 July 2022

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