Fitness regime: a question of balance

As of April 2010, people going to their doctor to be signed off as too ill to work will no longer receive the traditional sick note. The Government has introduced changes which replace sick notes with fit notes. Under the new regime, a doctor can either determine that a patient is entirely fit to work and thus refuse to sign the fit note, or sign them off as “not fit to work”. So far, so familiar, but now, GPs have a third option: they can assess a patient as someone who “may be fit for work” if their employer takes account of advice which is incorporated within the fit note. Thus, a GP might recommend a phased return to work, altered working hours, amended duties or the provision of workplace adaptations.

The focus on capability rather than deficit is to be welcomed, as is the introduction of a more personalised regime which includes greater subtlety than the old can/can’t work choice previously available to doctors.

But the idea that an effective assessment of a patient’s individual needs can be made by a GP, particularly given the limitations of a ten minute consultation, is dubious. It is the patient who is the expert on their own condition and related requirements and not their doctor. By placing the power with the GP, this reform disempowers the individual patient and prevents them from taking a more active role in their own recovery and return to work.

Ironically, doctors’ recommendations are not binding and the employer has no legal duty to implement their suggested changes to enable someone who “may be fit for work” to re-enter the workplace. This weakens the potential in the reforms and also creates murky water as to the “fitness” status of an employee declared possibly fit to work, when the employer refuses to follow the doctor’s advice.

What is more, fit notes are part of the Government’s wider work-first approach, which conceptualises paid work as the central route to well-being, contentment and citizenship.

This approach risks alienating and excluding all those who cannot work or who choose instead to engage in other equally valuable activities such as unpaid work, caring and parenting. The Government rhetoric behind the fit note reform is suggestive of further steps to put an end to a so-called sick-note culture, and the tabloid press has welcomed their introduction as an important effort in the fight to separate the genuinely sick from the benefit-addicted work-shy. Such spin, which trades on plenty of supposition and very few facts, does disabled people absolutely no favours.

The conclusion is clear. Despite some positive aspects, the new fit notes are simply not fit for purpose.