Smart Clinic
Fit notes

Fitness for work: GPs or occupational health

When assessing an individual’s fitness for work, a GP may issue a fit note. Although they are only providing advice to their patient, a fit note helps to document this advice, often so that the individual may present this to their employer.

Making a referral to an occupational health company or practitioner can achieve much the same, albeit often in a lot more detail.

This begs the question of which one an employer should use, and what an employer should do if advice is conflicting. Lets address these two points separately.

Fit note or occupational health report?

When an employee presents at their GP surgery either in person or remotely, they will have an allocated amount of time with their GP, typically around 10 minutes. To stick to this timeframe the appointment needs to be focussed on the presenting issue, as there won’t be time to discuss the context surrounding the issue, or how this is affected by the working environment.

The GP also acts an advocate for the individual’s health, and may have an existing relationship with the individual and their family. The GP hasn’t been sent any contextual information prior to the appointment, such as a referral from a line manager or HR manager, job description setting out employee expectations, or a description of the working environment. So any information presented by an employee will be brief, and could be selectively presented and only briefly interpreted.

Following on from the appointment, the GP may issue a fit note or a report. Typically these are light on useful information and include clinical phrasing that needs interpreting for a non-medical professional.

This fit note is documented evidence of the advice the employee has received, and is not a final determination for an employer, so should be treated as nothing more than advice. For a more comprehensive assessment of fitness for work, and advice for management, an employer may be inclined to seek further advice from a specialist occupational health organisation.

If an employer chooses to seek advice from an occupational health practitioner, they will be asked to complete a full management referral. Hopefully you will already have a package or an arrangement with an occupational health practitioner who understands your sector and how your organisation works, but you will also be asked to provide background as part of the management referral. The referrer can include relevant health history, context or specific work demands that an employee may not be aware of, or may not readily disclose to the practitioner. It’s important that any decision on fitness for work takes into account information from both employer and employee.

An occupational health assessment, and subsequent report, will focus on the barriers to returning to the workplace. This helps an employer to plan accordingly and implement the necessary adaptations and recommendations as appropriate. Where there are practical issues that can be overcome in order to expedite the member of staff returning to the workplace, these will be included in the report, as will the answers to any specific questions you have raised as part of your referral.

Occupational health practitioners are also trained in the Equality Act 2010, and will help to advise employers on this to ensure they remain on the right side of any employment law issues they may need to consider.

What should an employer do if occupational health advice contradicts GP advice?

There is no right or wrong answer to this question, it’s a decision for the employer to make alongside the employee.

However it will be important to consider as many factors as possible, and be able to evidence and justify a decision. For all of the reasons cited in the previous section, an occupational health assessment is more detailed, balanced and specialist, so it may be that an employer chooses to heed the advice of occupational health over a GP. If this is the case, document the decision-making process and take the time to explain this to the employee so that they understand the efforts you’ve gone to in order to make a supportive and fair decision.

Where a more serious employment decision needs to be made, such as formal capability proceedings, you may also need to consider the qualification and seniority of the occupational health practitioner who has assessed an employee.

There are specialist qualifications and tiers of occupational health practitioner, ranging all the way up to a consultant doctor. A good occupational health company will triage your referral and ensure that your employee is paired with a suitably qualified practitioner. If the referral is likely to lead to formal proceedings, it may be recommended that your referral is handled by a consultant occupational health physician (OHP). Typically this is a doctor with an MFOM or FFOM qualification, and this is someone trained to give the most definitive and highly qualified view on employment related health issues, comforting for an employer to know should the formal proceedings eventually lead to a tribunal situation.