1. Preparing for the Fit Note
A briefing for union representatives

2. What is changing? From 6th April the sick note changes
Old sick note said whether a person should be off sick or was able to return to work.
New sick note will say:
Whether the person should be off work Or
If they may be fit to do some work if certain changes made.
There will no longer be an option to say the person is fit.
It will also be completed and stored electronically.

3. What is NOT changing? Sick note still needed after 7 days for SSP.
It will still give a brief indication of the condition.
In most cases it will still simply say the person is not fit for work.
Sick note still given to the patient – not directly to the employer.
It will still be given to the patient in paper form and not ed.
In the vast majority of cases the patient will notice no difference.

4. The new form
The form will now have two options. That the patient is 'not fit for work' or that the patient 'may be fit for work taking account of the following advice.'
There will be four types of alterations listed which the GP can tick. These are:
A phased return to work
Altered hours
Amended duties
Workplace adaptations
There will be space for the doctor to provide more information on the condition and how it may affect what they do.

5. The new “Fit” note

6. Why the change?
The government believes that, in some cases, a patient could return to work early if certain conditions are met.
They believe that being at work is often beneficial to a patient rather than staying at home.

7. TUC view
We agree that many people would prefer to be at work if they could do light duties, reduced hours, or different work.
Good employers already allow that.
However the worker should feel they want, and are ready to return.
The new note is a missed opportunity:
There is no reference to prevention.
The fit note could have been used to keep information on employers so that trends of illness could be identified early.

8. Concerns
GPs do not always understand the workplace and may not be able to give appropriate advice.
Most employers do not have access to occupational health advice and will not know what to do with any recommendations.
Workers may feel forced back to work before they are ready.
Going back to work early may make a condition worse – esp. stress and MSDs.

9. What should employers if a GP makes recommendations?
They should involve the worker in discussions on how change will be introduced.
If in doubt they should get professional help from OH provider, ergonomist etc.
If they cannot make changes they must treat worker as if still “not fit for work”.
If they make changes – new risk assessment.
If employee disabled they must make adjustments regardless.
Separate regulations for some groups.
If employer in doubt they must put safety of worker/workforce first.

10. Issues
Some of the issues that union representatives may find they have to deal with, and what they should do to prepare!

11. What if employee disagrees with the GP?
If the employee disagrees with what the GP suggests they should raise this with GP.
In some circumstances – ask for a second opinion.
Raise concerns with the employer.
They should be encouraged to seek support form their union.

12. What if the employer does not act on the GPs advice?
If the employer does not make the changes the employee should not go back to work.
The employee should stay off until fully fit.
The sick note continues to cover the employee.
If employer insists the worker returns without the changes there is a good chance their condition will get worse – the employer will be responsible.
Unions will have a key role in preventing this.

13. What if the employee returns but the condition gets worse?
The employer should go back to the GP at once.
The GP can either issue a new statement to say the person should stay off work, or
The GP can change the recommendations.

14. What if the employer says come back on reduced pay?
If the person returns on reduced duties or reduced hours the employer may try to reduce the pay.
Employers cannot just change someone’s contract.
However if a person is only on SSP, benefits or half pay they may want to agree to it.
Unions must ensure they are no worse off – including in the long term.

15. How does it affect occupational sick pay schemes?
In most cases there will be no change.
Some schemes may not have arrangements for reduced working.
Must make it clear that anyone on reduced duties or hours is not counted as still being sick.
Unions should negotiate “no-detriment” agreements.

16. How will it effect Statutory Sick Pay?
Regulations are not changing.
Any person who cannot return because adaptations not made should still get SSP.
However some people returning on reduced hours and pay may loose SSP or other benefits and may be worse off.
Unions should negotiate no-detriment clauses.

17. Checklist
Inform your members about the changes and ensure that your employer also knows about them.
Seek agreement that any disputes over changes to work or working time proposed as a result of a medical certificate can be dealt with by the grievance procedures.
Make sure that, where necessary, your employer's sickness absence arrangements are updated to take account of the proposed changes.
If you have an occupational sick pay scheme, seek to negotiate a 'no detriment' agreement. Otherwise seek an agreement that no-one will lose out financially through losing SSP or other benefits.

18. Conclusion
New arrangements are no substitute for a good sickness absence policy.
Where employers use the information positively to help those that want to return the fit note could help.
If employers see the fit note as a green light to force workers back to work early it will lead to increased sickness absence.
Unions must be involved in supporting members with problems.

19. TUC advice