There has been limited take up of healthcare professionals other than GPs writing fit notes since the new legislation was introduced in 2022, Government-commissioned research has found.
An evaluation of changes to allow registered nurses, occupational therapists, physiotherapists, and pharmacists to sign fit notes found that while most GPs, patients and employers supported the move, the use of extended certification was ‘limited at present’.
The latest figures from NHS Digital show around 90% of fit notes are issued by GPs – a figure that has not changed since April 2023 when data was first released. Nurses issue just over 7% of fit notes with practice based pharmacists doing around 1.5%.
In all 2.7 million fit notes were issued in the second quarter of 2024/25, NHS Digital said, a rise of 2.3% on the previous three months.
Awareness that healthcare professionals other than GPs could sign a fit note was low among the general public, an accompanying YouGov survey had shown.
But the reforms had been broadly welcomed, and it was likely that more healthcare professionals would take on fit notes over time, the report commissioned by the Department of Work and Pensions and the Department of Health and Social Care concluded.
Interviews with a range of GP staff, employers and patients also found that the move to a digital fit note was popular.
But healthcare professionals questioned for the report did express some frustration with patients who felt they were entitled to a fit note with no medical justification.
The report found patients and employers commonly felt that signing people off is ‘not always in their best long-term interest, particularly for their mental health’.
The research also identified considerable variation in how GP practices deal with fit notes, despite guidance and training being in place.
Some patients and employers said that it could be difficult for patients to get a GP appointment to obtain a fit note but there was also frustration with hospitals not issuing them which placed additional burdens on GP practices.
Many GPs ‘seem to accept’ that the fit note system is open to misuse by some patients, but some said it was not their job to check people are not abusing the system, the report noted.
Nearly all GPs and other healthcare professionals agreed that GPs’ time was better spent dealing with other issues instead of issuing fit notes.
But the research also found that most GPs did not think allowing other healthcare professionals to sign fit note would make much difference to their own workload.
Instead, the main benefits reported by GPs on the extended fit note regulations was improved patient experience and ‘more substantial discussions between healthcare professionals and patients on the potential for them to return to work’.
A number of doctors – mainly GP partners – who took part in the research were unconvinced that management and training costs of extended fit note certification to other members of the healthcare team would be justified by the long-term gains.
The time spent having to supervise staff doing fit notes was another issue which may partly explain why rate of uptake of extended certification had been relatively slow despite healthcare professionals being largely in favour of the changes.
It follows a report last month which found the ability of GPs to issue fit notes and deal with work and health issues is ‘questionable’.
In an independent review of what more the Government and employers need to do to tackle ‘economic inactivity due to ill-health and disability’, Sir Charlie Mayfield found a disparity between the level of detail that employers might expect and what healthcare professionals offer.
The report pointed out issues with general practice staff not being qualified in occupational health, their lack of knowledge about a patient’s ‘workplace dynamics’, and the lack of time to ‘get to the bottom’ of any workplace barriers.
The Government has announced plans for major welfare reform, aimed at getting people back to work, but has pledged this should not increase GP workload.
