How to get the most out of the fit note.

Almost 95% of over 6 million fit notes issued by GPs last year advised that the patient was ‘not fit for work’ without suggesting adjustments or advice.1 Over one-third of patients were signed off for 5 weeks or longer, by which point one-fifth are unlikely to ever work again.2 Mental illness accounted for around one-third of all fit notes issued. Psychosocial barriers to returning to work become more established with time, from fear that work will trigger a relapse to practical issues such as taking on childcare while signed off. The premise behind replacing the sick note with the fit note over a decade ago centred on what patients can do, rather than what they cannot do,3 to catalyse conversations between patients and employers about returning to work, with health benefits at an individual and population level. Pre-COVID, the number of fit notes issued by GPs was closer to 10 million each year, but the ‘may be fit for work with the following advice’ section was just as under-used. This likely reflects several issues, from time constraints in primary care to limitations of the fit note itself, recently highlighted in a public consultation.4 However, with little mention of assessing fitness to work on the GP curriculum and barriers to accessing high-quality continuing professional development resources on the topic, navigating difficult grey …