title: Completion of fit notes by GPs: a mixed methods study.
abstract: OBJECTIVE
  The aim of this study was to investigate the completion of fit notes by UK general practitioners (GPs). A series of actual fit notes issued to employed patients were examined, and their GPs' reflections and experiences of fit note completion explored.
  
  
  METHODS
  A mixed-methods design was used. Data were collected from copies of 94 fit notes issued to employed patients by 11 GPs, and from 86 questionnaires completed by these GPs reflecting on the fit notes they had issued. Face-to-face interviews were then conducted with each GP.
  
  
  RESULTS
  Fit note completion is not meeting expectations for a number of reasons. These include the following: limited knowledge and awareness of the guidance in fit note completion; problems with the fit note format; lack of mandatory training in completing fit notes; lack of incentive to change practice; incomplete implementation of the electronic fit note; GPs' lack of confidence in, and doubts about the appropriateness of performing this role.
  
  
  CONCLUSIONS
  If UK GPs are to continue their contractual responsibility for completing fit notes, further consideration of their education and training needs is urgently required. Weaknesses in the design and format of the fit note and the availability of the electronic version also need to be addressed.
authors.affiliation: School of Health Sciences, University of Nottingham, A Floor, Medical School, Queens Medical Centre, UK Carolyn.coole@nottingham.ac.uk.
authors.forename: Carol
authors.initials: C
authors.lastname: Coole
authors.affiliation: School of Health Sciences, University of Nottingham, Nottingham, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Nouri
authors.affiliation: School of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: Iskra
authors.initials: I
authors.lastname: Potgieter
authors.affiliation: School of Health Sciences, University of Nottingham, Nottingham, UK.
authors.forename: Avril
authors.initials: A
authors.lastname: Drummond
mesh_terms: D058005:General Practitioners / Q000706:statistics & numerical data; D006801:Humans; D008499:Medical Records / Q000592:standards*; D036301:Qualitative Research; D018582:Sick Leave; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014938:Work Capacity Evaluation
keywords: employees; fit note; general practitioner; sickness certification