BMJ 2015;350:h1024 doi: 10.1136/bmj.h1024 (Published 25 February 2015)

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RESEARCH NEWS “Fit note” is linked to fewer people taking long term sick leave, study finds Julia Pakpoor The BMJ

The introduction of the UK “fit note” is associated with fewer people taking long term sick leave from work, but the proportion of people off sick with mental health issues is rising, a study published in Occupational and Environmental Medicine has found.1

The fit note, which replaced its “sick note” predecessor in 2010, enables GPs to include advice on how a person “may be fit” to work with reasonable workplace adjustments.2 Researchers examined sickness absence data from before and after the introduction of the fit note—obtained from 68 general practices in England, Scotland, and Wales during 2011-13 and from seven of the practices during 2001-02. Comparison of the seven practices studied at both time points showed a rise in the total number of certificated sickness absences but a marked reduction of sickness absences lasting more than 12 weeks (odds ratio 0.65 (95% confidence interval 0.58 to 0.72)). About 14 000 periods of certified sickness absence were issued across the 68 practices during 2011-13. Of these, more than half (53%) did not exceed three weeks, more than a third (35%) lasted less than 12 weeks, and 12% exceeded 12 weeks.

Being male, older, and living in a deprived area increased the likelihood of taking more than 3, 6, and 12 weeks off work in a period of absence. Furthermore, GP partners were more likely than salaried or locum GPs to certify sickness absence of more than 12 weeks (1.25 (1.02 to 1.54)). The largest proportion of time off work was attributable to mild or moderate mental health issues (such as depression, anxiety, or stress), which rose from 26% to 38% over the two time periods studied and accounted for almost one in three fit notes issued to patients studied in 2011-12. In 2011, 131 million working days were thought to be lost to sickness absence in the United Kingdom3 at a cost to the economy of £13bn (€17.7bn; $20bn) in state benefits, as well as a £9bn cost to employers in sickness benefits.4 The government recently began piloting a Fit for Work service to enable the referral of patients off work for more than four weeks

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to a work focused occupational health assessment.5 Given that nearly half of certified absences lasted more than three weeks the study highlighted the considerable resources that would be required in a national roll-out of the scheme.

In an accompanying editorial Raymond Agius and Louise Hussey, of the Centre for Occupational and Environmental Health at the University of Manchester, warned of the difficulty in definitively attributing the study findings to the introduction of the fit note rather than to potential changes in patient population sizes and characteristics.6

They concluded that “the ‘jury is still out’ as regards a corroborated, valid, and comprehensive assessment of the effect of the fit note.” They added, “Moreover, a thorough and systematic evaluation of the effects of the Fit for Work service is much needed, especially considering its potentially very large economic implications as well as effects on wellbeing.”

1 2 3 4 5 6

Gabbay M, Shiels C, Hillage J. Factors associated with the length of fit note certified sickness episodes in the UK. Occup Environ Med 2015; doi:10.1136/oemed-2014-102307. Black C. Working for a healthier tomorrow: Dame Carol Black’s review of the health of Britain’s working age population. 17 March 2008. www.gov.uk/government/uploads/system/ uploads/attachment_data/file/209782/hwwb-working-for-a-healthier-tomorrow.pdf. Office for National Statistics. Sickness absence in the labour market, April 2012. 15 May 2012. www.ons.gov.uk/ons/dcp171776_265016.pdf. Black C, Frost D. Health at work—an independent review of sickness absence. November 2011. www.gov.uk/government/uploads/system/uploads/attachment_data/file/181060/ health-at-work.pdf. Health and Work Service. Fit for Work. October 2014. www.gov.uk/government/uploads/ system/uploads/attachment_data/file/362480/fit-for-work.pdf. Agius RM, Hussey LJ. Certified sickness absence: does the “fit note” work? Occup Environ Med doi:10.1136/oemed-2014-102685.

Cite this as: BMJ 2015;350:h1024 © BMJ Publishing Group Ltd 2015

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"Fit note" is linked to fewer people taking long term sick leave, study finds.

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