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Table 1 Delphi statements where consensus was achieved

From: Recommendations to facilitate the ideal fit note: are they achievable in practice?

  Statement % of respondents who agreed Number of respondents
  General format and application
1 Electronic/computer-generated fit notes should be standardised. 88.2 % 17
2 Electronic/computer-generated fit notes must exactly match the hard copy fit notes. 94.1 % 17
3 Fit notes should include a section stating whether or not the patient is employed. 82.3 % 17
4 The electronic/computer-generated fit note should have drop-down prompts for the GP, giving examples of the information they are expected to provide. 100 % 17
5 The comments section should be separate from the work modification tick boxes to encourage GPs to comment on 'not fit' notes as well as 'may be fit' notes. 76.4 % 17
6 GPs should be able to access a second (independent) opinion of a patient’s fitness to work. 100 % 17
7 The DWP should actively promote the use of electronic/computer-generated fit notes. 100 % 17
8 The DWP should actively monitor the use of fit notes. 88.2 % 15
9 Completion of all fields of the electronic/computer-generated fit note should be mandatory. 82.3 % 17
10 Electronic/ computer-generated notes must require the GP to select either the 'may be fit' or ‘not fit’ option. 82.3 % 17
11 GPs should have the option of selecting both fitness to work options ('not fit' and 'may be fit') if they qualify these choices with clear dates, duration and advice. 76.4 % 17
12 It is for the employer in conjunction with the employee, to consider and act on - or reject - the advice that they receive. 76.4 % 17
13 Other healthcare professionals with relevant training and competency should be able to complete fit notes. 88.2 % 17
14 If a patient has another job with different demands, the GP should complete the fit note to cover each job. 76.4 % 17
15 GPs need to understand the details of their patient’s work tasks in order to comment on the ‘functional effects’ of the patient’s condition. 82.3 % 17
16 Fit notes should include a section stating whether or not the patient is employed/ self-employed/ unemployed 75 % 16
17 The review section should be amended to a default statement ‘I will not need to assess your fitness for work again at the end of this period’ with the option to amend this if required. 75 % 16
18 There should be local audits of fit notes to ensure that fit notes are completed according to most up-to-date DWP guidelines. 82.5 % 16
19 Other healthcare professionals with relevant training and competency, who complete fit notes, should be Any Qualified Providers who have clinical data sharing set-up locally with GP systems. 75 % 16
20 GPs should provide as much information about the health condition on the fit note, relevant to their return to work, as the patient will consent to. 93.8 % 16
  Completion of the fit note
21 Fit notes should be completed electronically. 82.3 % 17
22 Each section of the fit note must be completed. 82.3 % 17
23 The content of each section of the fit note must be discussed and completed with the patient’s knowledge and agreement. 88.2 % 17
24 If a patient has more than one condition affecting their ability to work, information and advice on the fit note should clearly distinguish to which condition this refers. 82.3 % 17
25 If medical terminology is used on a fit note, then a lay person’s version should also be provided e.g., CVA (stroke). 94.1 % 17
26 If a patient’s health condition is work-related (partially or fully) the GP should specify this on the fit note, with the patient’s consent. 76.5 % 17
27 If a patient has had, or is undergoing surgery, and with the patient’s consent, the GP should use the fit note to advise on expected post-operative complications and restrictions. 88.2 % 17
28 GPs should clarify the duration of recommended modifications on a fit note where possible. 94.1 % 17
29 GPs must complete the comments section of the fit note on both ‘not fit’ and ‘may be fit’ notes. 76.5 % 17
30 GPs must ensure there is no ambiguity as to the return to work date on the fit note. 76.5 % 17
31 If a patient’s symptoms are aggravated by work, then the GP should specify this on the fit note, with the patient’s consent. 88.2 % 17
32 With the patent’s consent, information on planned tests and treatment interventions impacting on the patient’s ability to work should be included on the fit note, with timescales where known. 82.3 % 17
33 Where possible, and with the patient consent, GPs should include information on the fit note as to the likely duration of reduced work capacity. 88.2 % 17
34 GPs should avoid using non-specific advice on work adjustments on a fit note e.g., light duties. 88.2 % 17
35 GPs should have the most up-to-date DWP fit note guidance available on their website and/or at their surgery. 88.2 % 17
36 When completing a fit note, the option of ‘may be fit’ should always be considered initially. 75 % 16
  Management of the fit note
37 GPs must ask all employed patients whether there is anything about their health condition that makes it difficult to work, and if so, what this is. 82.4 % 17
38 GPs should state how the patient’s condition affects their ability to work (i.e., the functional effects of the condition) on both ‘not fit’ and ‘may be fit’ notes. 82.4 % 17
39 GPs must conform to the most recent fit note guidance published by the DWP. 82.4 % 17
40 It should be possible for patients to access the same GP for ongoing fit note consultations 76.5 % 17
41 GPs should ask the patient the extent of their employer’s occupational health provision and involvement when completing the fit note. 88.2 % 17
42 The option should be available, with patient consent, for fit notes to be emailed to the employer. 94.1 % 17
43 Employers must conform to the most recent DWP fit note guidance. 88.2 % 17
44 Organisations must have a timely mechanism for dealing with ‘may be fit’ notes. 94.1 % 17
45 Employers should ensure that sickness absence monitoring schemes do not discourage employees from returning to work before the expiry of their fit note, if they feel able. 94.1 % 17
46 There should be a defined period within which GPs complete reports requested by an employer or the employer’s occupational health provider. 88.2 % 17
47 Patients should not be discouraged from consulting their GP about a health problem that impacts on their ability to work during self-certificated sickness absence. 94.1 % 17
48 GPs should be able to write a fit note during the self-certification period, free of charge. 82.3 % 17
49 The use of email to send fit notes to patients’ employers should be piloted before a final decision is made. 88.2 % 17
50 The DWP should provide more detailed guidance to employers on best practice in the management of the fit note through their organisation. 94.1 % 17
51 Employers should have the most up-to-date DWP guidance available for employees on their website and/or at the workplace. 76.4 % 17
52 Reports requested from the GP by an employer or the employer’s occupational health provider should be completed within two weeks of the request being made. 88.2 % 17
53 Where reports are requested from the GP by an employer or the employer’s occupational health provider, there should be a standard fee. 82.3 % 17
54 Patients who seek consultation with their GP about a health problem affecting their ability to work should be able to request a face-to-face consultation. 87.5 % 16
55 Employees should contact their employer to discuss a 'may be fit' note within two working days of being issued with one. 87.5 % 16
  Communication about the fit note
56 Fit notes should include GP contact details (phone, email) to facilitate discussion of the patient’s return to work should the employer wish to do so, and with the employee’s consent. 94.1 % 17
57 Employers should contact the GP by phone or email, with employee consent, if they have questions about the employee’s fit note. 88.2 % 17
58 Employers must ensure strict confidentiality in their management of fit note information. 100 % 17
59 Where necessary, and with patient consent, GPs should communicate with their patient’s employer to seek more information on the employee’s job and possible modifications. 82.4 % 17
60 Patients should be the primary channel of information between their GP and employer concerning the fit note. 88.2 % 17
61 Records of any contacts made between the employer and the employee’s GP should be sent to the employee (with the employee’s consent). 88.2 % 17
62 Employees should be consulted as to which members of staff within their organization will see the content of their fit note. 82.3 % 17
63 GP fit note training should be incorporated into official GP training events (e.g., Practice Learning Time). 100 % 17
64 GP fit note training should be mandatory. 88.2 % 17
65 Employers must inform their workforce about how their organisation manages the fit note. 88.2 % 17
66 Employers must inform individuals as to any impact that work modifications advised on a fit note might have on their pay. 94.1 % 17
67 Training in the use of the fit note should include GPs, employers and patient/employee representatives so that each can hear the others’ viewpoint. 100 % 17