“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

A taboo too far? Supporting colleagues expressing suicidal feelings in the workplace

By Christopher Watkins


The words ‘stigma’ and ‘taboo’ are fast becoming something of a cliché in the world of mental health and employment, yet few could argue that there are some issues that managers and HR professionals feel uncomfortable dealing with. It is hard to think of a more difficult situation than a colleague expressing suicidal feelings in the workplace.

Last month saw the Office for National Statistics release data on the number of deaths recorded as suicide in 2013[1], showing suicide rates continuing to track upward since the recession in 2007. The groups at most risk (and seeing the greatest increase) are men between the age of 30 and 59; the group most likely to be in full-time employment. Suicide remains the most common cause of death for men under 35.

These figures are only the tip of the iceberg. It is estimated that only 1 in 10 attempts are fatal, and the majority of people experiencing suicidal feelings do not go on to attempt to take their own life. Collecting accurate statistics on this is next to impossible, but it is realistic to assume that in an organisation of 500 employees at least one will be experiencing suicidal feelings at any one time.

Colleagues having serious discussion

With recent ‘stigma busting’ campaigns working to encourage employees to be open about their mental health, it is reasonable to expect the number of employees expressing suicidal feelings to their manager or HR to increase. Our Business Disability Forum Advice Service has noticed this increase. While no manager or HR professional wants to find themselves having this conversation, the increasing openness of employees about these feelings presents an opportunity for intervention, support and ultimately prevention.

If you work in HR, this is an issue you are likely to come across at some point in your career – and it pays to be prepared. Navigating the initial conversation may be an intimidating experience. You are likely to feel out of your depth, but try to understand that the other person is probably feeling exactly the same way, particularly if this is something they are not used to speaking about. Don’t panic, judge or make assumptions; take the person seriously and accept that while you may not be able to help in the immediate term, you are very unlikely to make things worse.

Establishing boundaries and responsibilities at this early stage is absolutely essential. This is not something you can keep to yourself and it is not your place to become the person’s counsellor. When an employee tells you personal information about their mental health and has asked you to respect their confidentiality, it is safest to do so; but, you should still speak to HR (or BDF’s Advice Service) about the situation without identifying the individual. It may be appropriate to breach the employee’s confidentiality if they are at risk or their health is affecting their employment, and whoever you speak to should be able to advise you on this.

If they are not already receiving support from elsewhere, refer the employee to appropriate help. Depending on the circumstances, this could be to their GP, local mental health services, your EAP or Samaritans. If you feel that someone is at immediate risk of harming themselves, you should always contact the emergency services by dialling 999.

Finally, remember that suicidal feelings are rarely a ‘one-off’; this is an on-going situation that you may be supporting the colleague through for some time. These feelings may also be indicative of mental ill-health, so after the initial meeting and any urgent action required, you should sit down with the employee to explore the ways in which you are able to offer support. They may also need reasonable adjustments to their role, such as flexible working, more regular 1:1 meetings with their line manager, or a Tailored Adjustment Agreement

Christopher leads our Mental health: Handling serious situations masterclass, which equips HR and diversity professionals with the skills and knowledge they need to handle unusual and complex situations, including colleagues who are exhibiting suicidal feelings or unusual behaviour.

BDF members can also contact Christopher for advice on cases they are dealing with on christopherw@businessdisabilityforum.org.uk or 020-7089-2482


[1] http://ons.gov.uk/ons/rel/subnational-health4/suicides-in-the-united-kingdom/2013-registrations/suicides-in-the-united-kingdom–2013-registrations.html

[2] https://www.disabilitystandard.com/resource-category/resource/tailored-adjustment-agreement/