Fit Notes (MED3) and Sick Leave

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Succinct notes to superpower your revision
Fit note\: Issued by healthcare professionals (nurses, occupational therapists, pharmacists, physiotherapists, doctors) to
inform employers of a patient's illness a
Types\: Can be handwritten or electronic, used for phased returns, altered hours, amended duties, workplace adaptations,
and to claim sickness-related bene
Self-certi≤7 days can self-certify using verbal/written methods or the SC2 form.
Primary and secondary care\: Fit notes can be issued in general practice, hospital inpatients, emergency departments, and
outpatient clinics.
Content\: Includes patient name, assessment date, clinical reason, work
healthcare professional's name/place of work, and signature (handwritten) or QR code (electronic).
Considerations\: Perform clinical assessment, consider the patient's job role, include detailed advice, backdate if needed,
and ensure employers can meet “may be
Example\: For a delivery driver with a fractured femur, if part-time sedentary work is possible, advise 'may be
with amended duties. If not, advise 'not
Sick pay\: Patients receive statutory sick pay (£109.40/week for up to 28 weeks) if o≥4 days in a row. Employers
can request a
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Introduction

A
occupational therapists, pharmacists, physiotherapists and doctors) to inform employers of a patient's illness, which may
prevent them from working entirely or working to their previous extent.
A
Fit notes can be used for phased returns to work, altered hours, amended duties and workplace adaptations. They can also
be used for patients to claim sickness-related bene
Patients o
can be done verbally or in writing, depending on the employer’s policy. The SC2 form can also be used.

Writing a

A
General practice\: for patients with acute or chronic diseases unable to work
Hospital inpatients\: when preparing for discharge, the patient may need a post-admission or post-operative recovery
period, which a
(MED10), signed by a hospital sta
health condition or disability it covers.
Emergency department\: when an illness or injury will prevent work for a recovery period (e.g. infective illness, fracture)Outpatient clinics\: when an illness or injury will prevent work for a recovery period (e.g.
The
the patient via email/SMS text message.
What should a
A
Patient name
The date that the patient was assessed, which is the same day as the
Clinical reason for the
Advising if 'Not
, which should include speci
achieved, using free text and/or the checkboxes marked\:
‘a phased return to work,
'altered hours'
,
'amended duties' and
'workplace adaptations'
Dates this
Healthcare professional's name and place of work
A signature on handwritten notes; electronic
Figure 1. An example of a
What do I need to consider?
The healthcare professional must perform a clinical assessment and gather patient information before writing a
Consider the job role of the patient\: what does their current illness/injury prevent them from doing?
In the free text box, include as much information as possible to help the patient's employer.
If an employer cannot meet the terms of a “may be
, it automatically becomes a “not
doesn’t need re-doing.
Check speci
overlap dates if a new
Example case
Scenario
A delivery driver has sustained a sporting injury and fractured her left femur. Following hospital admission, she
underwent orthopaedic surgery. Since the operation, she has remained on the hospital ward for observation, pain
management and initial physiotherapy support.
She has recovered well and is now mobilising with crutches. Your consultant has advised it will likely take several
months for her femur to heal completely. She is being discharged from the ward today with a planned outpatient
clinic follow-up in 6 weeks. You have been asked to write a
Fit note
If there is an option for her to work in a part-time sedentary back o
may be
. If this back o
option, she cannot drive her van and lift heavy parcels, so you would advise 'you are not
. In the the
comments box, include details of her injury and the operation undertaken.
The
the outpatient clinic appointment- she can then be clinically re-assessed by the orthopaedic team, and a new up-to-
date Sick pay
A patient will get statutory sick pay (SSP) when they cannot work due to illness for at least four days in a row (including
non-working days). This is £109.40 per week for up to 28 weeks.
If an employer pays 'contractual sick pay' (CSP), patients may be able to get this alongside the SSP.
An employer can request a
If the patient is o
doctor. This is why writing as much clinical detail as possible on the

References

Department for Work and Pensions. G e t t i n g t h e m o s t o u t o f t h e
2022. Available from\: [LINK]
NHS e-Learning for Health. F i t N o t e T r a i n i n g . Available from\: [LINK]
British Medical Association. I s s u i n g F i t N o t e s . Published in 2020. Available from\: [LINK]
Gov.uk. S t a t u t o r y S i c k P a y ( S S P ) \: e m p l o y e r g u i d e . Available from\: [LINK]

Reviewer

Dr Seb Pillon
GP and Primary Care Medical Educator

Test yourself

Source\: geekymedics.com