Has the fit note reduced general practice sickness certification rates?
BACKGROUND
In 2010, the fit note replaced the sick note to help focus on what people are capable of doing, rather than signing patients 'off sick'.


OBJECTIVE
To compare proportions of work-related ill-health issued with sickness certification pre- and post-fit note introduction and assess sickness absence trends.


METHODS
General practitioners (GPs) report data on work-related ill-health and sickness absence via The Health and Occupation Research network in General Practice. The proportion of cases issued with sickness certification 4 years before and 3 years after the fit note introduction were compared. Changes in certification incidence rate ratios were measured over time.


RESULTS
Participating GPs reported 5517 cases of work-related ill-health. Pre-fit note introduction 50% of cases were certified sick. There was no change in the proportion of cases certified sick in the first year post-fit note, despite 13% of cases classified as 'maybe fit'. However, in the second year, the proportion of cases certified sick had reduced significantly (41%) and a larger proportion (19%) was advised on workplace adjustments. In the third year post-introduction, there was a slight rise in the proportion of cases certified sick; therefore, although there was a fall of 2% per annum in certification rates, this was not significant.


CONCLUSIONS
In the first year post-fit note introduction, modifications to work were recommended for people who would previously have been declared fit. Trends analyses showed a slight decrease in the certification rate, possibly indicating GPs will become more practised in advising on workplace adjustments.
Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, The University of Manchester, Manchester M13 9PL, UK, louise.hussey@manchester.ac.uk.
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L
Hussey
Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, The University of Manchester, Manchester M13 9PL, UK.
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A
Money
Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester M13 9PL, UK.
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M
Gittins
Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, The University of Manchester, Manchester M13 9PL, UK.
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Agius
D001291:Attitude of Health Personnel; D002568:Certification / Q000706:statistics & numerical data*; D058006:General Practice / Q000379:methods; D058015:Health Communication / Q000379:methods*; D006801:Humans; D010817:Physician-Patient Relations; D036301:Qualitative Research; D062707:Return to Work; D018582:Sick Leave / Q000639:trends*; D006113:United Kingdom; D017132:Workplace / Q000592:standards
Fit note; general practice; occupational health; rehabilitation; return to work; workplace adjustments.