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Occupational therapists now able to certify ‘fit notes’

RCOT
09 June 2022

The UK government has announced that anyone needing fit notes after Friday 1 July 2022 will be able to get them legally certified by an occupational therapist. This will apply in Scotland, Wales, England, and Northern Ireland.

Previously, only doctors, through a fit note could legally certify whether someone needed help returning or was unable to return to work. Under the new legislation, occupational therapists – along with physiotherapists, nurses and pharmacists - will also be able to legally certify fit notes.

This is something we have long been lobbying the government for.

The new legislation recognises the valuable role occupational therapists and other allied health professionals have to play in providing health and work advice, and supporting people to remain in work where possible.

The changes will have a really positive impact on health services across the UK. People who have health and work problems will now be able to get more detailed, tailored advice. Furthermore, waiting times and demand for doctors will be reduced, allowing them to focus on other medical matters.

Commenting on the upcoming changes, RCOT Director of Practice and Innovation Karin Orman. said:

“By joining forces and being bold and progressive, RCOT has opened this new opportunity for occupational therapists. Workers and employers are crying out for more help to support people with health problems to stay in work. Join us to see how you can lead the way.”

FAQs about fit note changes

What do you mean by the fit note?
We mean the GP fit note or Med 3 which could previously only be issued by doctors. More than ten million are signed every year across the UK, mostly for sickness absence from work or welfare benefits.

Does the change include all occupational therapists across the whole UK?
It covers all qualified occupational therapists at point of registration with the HCPC (Health and Care Professions Council) in Wales, Scotland, and England. Northern Ireland will be able to adopt the changes if wished.  
 
What are the benefits of occupational therapists issuing fit notes?

  • You can relieve pressure on GPs/doctors so they can focus on medical needs.
  • You are experts at giving work and health advice.
  • You can ensure people get more tailored advice faster.  
  • You can use this to build innovative pathways to vocational support.
  • Your occupational therapy rehabilitation offers all round solutions by targeting the worker and their health/disability, their job tasks, and the work environment.

Where do I find the training module?
The training module released on 1 July. It aims to empower and support you to issue fit notes. The course is hosted on  Home - elearning for healthcare (e-lfh.org.uk)  and should take two to four hours to complete. It uses a case study approach and includes:

  • Session 1 - An enabling approach to health and work conversations
  • Session 2 - Key legislation and guidance relevant to the fit note
  • Session 3 – Making recommendations on the fit note
  • Session 4 – Practical application of the fit note.

What does this mean for the AHP Health and Work Report?
It does not change anything about this tool which can still be used as before, for example, for statutory sick pay. The AHP Health and Work Report and the fit note are similar in content. If you are familiar with it, the transition to the fit note will be easier. Supporting People To Work (Members Only) - RCOT
 
Who else will be able to issue fit notes?
Four new groups are involved: Occupational therapists, nurses, physiotherapists, and pharmacists. Doctors will continue to be able to sign fit notes.
 
How do I work with my employer to start using the fit note?
New guidance, released on 1 July, is for you and your employer to work out how to make this change in practice. It covers job roles, scope of practice and how employers can provide in house development opportunities for you.  

As four new professions are involved, it may be easier to make the changes together. In primary care, it will be important to involve Practice Managers, GP and Nursing Leads and receptionists in the change. You can also share your skills with the primary care team to expand capacity for fit notes.
 
I’m an occupational therapy student in a GP surgery – can I use the fit note?
No - You can use the AHP Health and Work Report but issuing fit notes can only be carried out once you have qualified as an occupational therapist and are on the HCPC register.
 
Will I be using a paper or electronic fit note?
The fit note used to be directly signed by the GP/doctor. This meant using paper pads of fit notes or printing them from the electronic care records. However, the need for handwritten signatures was removed in April 2022. A new fit note template using digital certification is being embedded in all GP IT systems. This means completing, certifying, and issuing fit notes can shortly all be done digitally.
 

I work in a hospital –can I use the fit note?
Yes – currently very few fit notes are issued from acute care, but we hope that will change to offer people earlier health and work advice. Progress to embed the fit note in hospital IT systems has started but changes to primary care IT systems will happen first.
 
Is there suggested text that can be added to my job description to cover this?
The occupational therapist will contribute to the fit note process and help people remain in work by using vocational-focused interventions that address work ability, job demands and working environment. They will advise on, and develop, return to work plans using the fit note.
 
Where else can I learn more in this area?