“Trust me, I’m a doctor” – what do your line managers do when they receive a fit note?

By Christopher Watkins


File it away and hope it sorts itself out? Panic and phone HR? Or, exactly what it tells them to do?

Fit notes, or ‘Statements of Fitness for Work’ (for those with too much time on their hands) are a potentially invaluable tool in supporting people with disabilities or long-term physical or mental health conditions, but only if they are used appropriately by the managers that receive them. None of the reactions mentioned above are particularly useful to the employer but are all too common in some organisations, particularly in environments where line managers often have responsibility for large teams with high turnover.

Sometimes they’re just ignored – or, if a colleague’s absence is related to a disability or long-term condition, managers can be nervous to get involved and sickness absence can be left unmanaged to continue indefinitely, often on full pay. This is costly for the employer and of no benefit to the employee, whose employment prospects can be damaged as they lose the opportunity to pursue their career with some simple workplace adjustments.

Two people having a conversation at a desk

Sometimes managers just panic and phone HR. This is probably the least legally risky approach, but can put unnecessary pressure on often overworked HR service centres handling relatively straightforward queries.

However, it is perhaps most unhelpful for line managers to simply take everything written on the fit note as ‘gospel’, following the advice without further consideration, sometimes to the detriment of both the employee and employer.

In the most concerning cases, if an employee is being repeatedly signed off sick by their GP for stress, the line manager’s reaction can be to refuse to let them work. If the employee’s stress is related to factors outside of work, however, being prevented from working can exasperate the situation, leading to unnecessary sickness absence despite the employee feeling they were able (and continually asking to) work. This can be a highly stressful – and expensive – situation for all involved, and highlights the potential damage that can be caused by a last-minute tick-box and barely legible scrawl from an over-worked GP on her last appointment before lunch (and yes, believe it or not, over 80% of fit notes are still handwritten in 2015, five years after they were introduced as the efficient digital alternative to their predecessor[1]).

In such situations, the problem is not that the GP is wrong; indeed, there may be sensible health and wellbeing reasons behind the employee being unable to work. The danger lies where line managers take the advice on the fit note – advice written to the employee – as binding rules that they needed to follow, rather than useful medical guidance to discuss with the employee. A conversation with the employee, the GP and possibly a second opinion from an Occupational Health advisor can improve understanding of the reasons behind the absence, helping the employee back to work as quickly and supportively as possible, and saving the business considerable expense and legal risk in the process.

Deeper still, perhaps the issue is that we can’t know how often this is happening as the problem itself is that these issues aren’t escalated or recorded until things start to go seriously wrong. One can imagine many more cases where an employee with a long-term health condition or disability isn’t able to receive the support they need because (at least for the 20% of fit notes produced digitally), ‘computer says no’.

There’s been some fascinating research in recent months by the Institute of Occupational Safety and Health (IOSH) and the University of Nottingham into this area with some helpful recommendations; the key message to me being that GPs complain that employers don’t act on their advice while employers complain the GPs don’t give them any useful information[2].

It may not be a solution, but surely a starting point here is to get GPs and employers talking to each other. Particularly with the advent of the government’s Fit for Work service, this is likely to only grow as an issue for employers as the quantity – and hopefully quality – of medical advice landing on managers’ desks increases. Like the introduction of fit notes in 2010, this is a potentially very useful and cost-effective tool if managers are properly briefed on how to use this information. If not, conflicting policies and advice from different sources may quickly prove counter-productive.

What measures have you taken to prepare your policies and inform your line managers?

For more information on managing sickness absence and disability visit: http://businessdisabilityforum.org.uk/advice-and-publications/publications/line-manager-guide-attendance-management/

You can talk to Christopher at christopherw@businessdisabilityforum.org.uk or Tweet him at @chrispydubbs


[1] Nottingham University research ‘Getting the best from the fitnote’ (2015), pp. 19 (http://www.iosh.co.uk/~/media/Documents/Books%20and%20resources/Published%20research/Getting%20the%20best%20from%20the%20fit%20note.pdf?la=en) accessed 18 August 2015

[2] http://www.iosh.co.uk/fitnote

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