HR talking point: Expansion of healthcare professionals who can certify fit notes

Author: Stephen Simpson

The expansion of the group of healthcare professionals who can now issue fit notes can have a positive impact on employers' sickness absence management procedures, writes XpertHR principal employment law editor Stephen Simpson.

The change, which applies across the UK from 1 July 2022, means that doctors are no longer the only medical professionals who can certify fit notes. Nurses, occupational therapists, pharmacists and physiotherapists can also now provide them.

The Government's press release highlights the need to "reduce pressure on doctors, as people will no longer have to be sent to a doctor to have the fit note signed when seeing and receiving treatment from an alternative professional for their health condition".

While this is clearly good news for many patients, what does it mean for HR professionals at the sharp end of managing their employers' sickness absence reporting procedures?

Initial concerns for HR

Initial concerns for HR may revolve around employees potentially "shopping around" different healthcare professionals for a fit note or even being able to wander into a pharmacy to be handed a fit note over the counter.

Both of these concerns are likely to be unfounded.

The Government's non-statutory guidance for healthcare professionals and their employers states that individuals "should consider their scope of practice and ensure they have the relevant skills, knowledge and experience before undertaking health and work conversations and making decisions around certifying fit notes".

Healthcare services will be giving careful consideration to who will be able to issue fit notes and in what circumstances.

It is also worth pointing out that healthcare professionals are required to complete a fit notes training module before they are allowed to issue fit notes. This means that the impact on employers will be gradual - they are unlikely to be flooded with fit notes from these additional healthcare professionals from the very start of July.

In addition, HR should be aware that healthcare professionals are required to conduct an assessment of an individual's fitness for work before issuing a fit note. This precludes the possibility of staff getting a fit note via over-the-counter services without an assessment.

Potential positive for employers

The way in which fit notes are issued has been evolving for some time and employers need to embrace this change.

The pandemic has made it more difficult than ever to see a GP quickly and employers should be getting used to being more flexible with their evidential requirements for sick leave.

The change may also lead to employers receiving more accurate and up-to-date pointers within the fit note as to whether the employee is fit to do any work and, if so, what they can do.

After all, a physiotherapist who sees a patient weekly knows much more about their potential fitness for work than a GP the patient might see once or twice a year. Similarly, a mental-health nurse with expertise on the prognosis of an employee with depression and anxiety is often going to be in a much better position to comment on their fitness for work than a GP.

Contractual sick pay

There have been suggestions that some employees will misuse the increased availability of fit notes to stay on long-term sick leave, especially where their employer offers generous contractual sick pay.

This concern seems to stem from the view that a doctor's assessment is automatically more authoritative than anyone else's and the wider the pool of medical professionals certifying fit notes, the less stringent fitness-for-work assessments will become.

However, savvy employers will recognise that healthcare services are becoming more multi-disciplinary than ever before and a GP is not always a patient's best port of call.

Some employers may see the solution as making the receipt of contractual sick pay conditional on an employee seeing a doctor. However, this approach is fraught with danger.

At the very least, such a policy risks creating a two-tier system where it is easier for employees who can afford to go private to see a doctor to access contractual sick pay. Employees who have to rely on GP services may be placed at a substantial disadvantage by this approach.

Employers should remember that they retain the option of commissioning a medical report on an employee on long-term sick leave from a doctor or the employer's own occupational health department.