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The Royal College of Psychiatrists Improving the lives of people with mental illness
Work and mental health

From sick note to fit note

GPs now give a 'may be fit for work' statement if they think that someone’s health condition may allow them to work - as long as they are provided with the right support.

As of April 2010, the sick note was replaced by the fit note (a statement which identifies the type of work than can be carried out with appropriate support).  This signalled a shift in emphasis from how long an employee cannot be or must not be at work to providing more useful information on how a person’s condition affects what they do and how they might be able to return to work.  GPs now give a 'may be fit for work' statement if they think that someone’s health condition may allow them to work - as long as they are provided with the right support.  This support could be a phased or graduated return to work as well as the ‘reasonable adjustments’. 

The 6th National General Practitioner Worklife Survey found that almost 90% of respondents felt they had a proactive role to play in helping patients to stay in or return to work and two thirds agreed they had a responsibility to society to facilitate a return to work.   The survey found that the fit note helped GPs to improve the quality of discussion with their patients about returning to work and had helped patients make a phased return to work. 

GPs can help their patient’s to play an active role in this process by ensuring that they discuss the occupational health provision (if any) in the workplace and the level and quality of support that is actually in place at work and outside.  It might be worth asking your patient and the employer about the policies and practices of the organisation as well as the level of expertise and training of the line managers as appropriate. 


A key shift in the mindset that the fit note brings is that sickness absence is in effect an intervention; it needs to be applied carefully, reviewed regularly and be a part of a broader treatment plan.  Like any intervention, it is not a ‘cost free’ option; it may have side effects which are detrimental to the employee. 

Links to resources:

Department for Work and Pensions – Sick note to Fit Note

From the 6 April 2010 the sick note was replaced by the fit note.  This section of the DWP website includes a guide for employers, employees and health professionals on the new system. 

Information specifically for doctors and other health professionals.

Statement of Fitness for Work

The Med 3 and Med 5 medical statements were replaced with the Statement of Fitness for Work. This page sets out the scope of the changes and what has stayed the same as well as how the new system is of benefit to doctors This page contains links to practical tools such as desk aids, the guides on the statement of fitness for work for GPs, hospital doctors and occupational health professionals as well as guides to completing medical (factual) report for the DWP and the Health and Work Handbook.

Statement of Fitness for Work: A Guide for General Practitioners

Statement of Fitness for Work: A guide for hospital doctors

Statement of Fitness for Work: A guide for Occupational Health professionals

Healthy working UK

This website provides GPs, other primary healthcare professionals and health professionals in secondary care settings with timely access to information, training and decision aids to support the management of health and work. 


This Fit for Work decision aid can be used during the consultation with a patient.  It has been designed to give access to downloadable leaflets and useful links in formats that you can share with your patient. 

The website includes training modules for GPs on health and work topics these are accredited by the Royal College of General Practitioners

There are also training modules for practitioners working in secondary care aimed at improving knowledge and competence in the implications of work on a patient’s health and wellbeing. 

These tools have been developed in collaboration with the Royal College of General Practitioners, the Faculty of Occupational Medicine and Society of Occupational Medicine and are based on the Healthy Working Wales pilot developed by Cardiff University and the Welsh Assembly Government. The website includes information which is specific for England, Scotland and Wales. 

General Practitioners’ attitudes towards patients’ health and work

This is a summary of the research findings from the 6th National General Practitioner Worklife Survey which asked a sample of GPs in England, Scotland and Wales about the role of GPs in patients’ health, work and well-being.  The summary also draws out similarities and differences in the views of GPs in England and Wales compared with Scotland. 


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