Exploration of GPs' views and use of the fit note: A qualitative study in primary care

Abstract

Background: Sickness certification constitutes daily clinical practice for GPs. In April 2010, the UK sickness certification system changed to reflect the evidence that work is generally good for health and a new Statement of Fitness for Work - the 'fit note' - was introduced. Sickness certification is a contentious topic among GPs and the proposed fit note generatedmixed reviews. Aim: To explore GPs' views and use of the fit note during its first year of operation. Design and setting: Qualitative interview study of GPs based in different geographical locations across the UK. Method: GPs ( n= 15), who were recruited froma national sample, participated in semi-structured telephone interviews which were subject to constant comparative analysis. Results: Overall, the fit note was well received. GPs recognised that work is generally good for health and felt the fit note facilitated using an earlier return to work as a negotiation tool. GPs perceive employers as themajor obstacle to early return to work. There were reports of scepticism towards the systemthat negatively impacted on some GPs' operation of sickness certification. Feedback over the fit note's impact on employer behaviour and the return of a mechanism that enables GPs to request early independent assessments would be welcomed. Conclusion: A revised approach is needed to address the scepticism towards the sickness certification systemthat persists among some GPs. New strategies need to be designed to engage employers in facilitating an early return to work and to enable the objectives of the medical statement reforms to be achieved. ©British Journal of General Practice.