Health Work Wellbeing

Dr James Bolton, Deputy Chief Medical Adviser for the Department for Work and Pensions

The Government intends to launch a new ‘fit note’ next April. Replacing the current ‘sick note’ the new form will support employers to respond more flexibly to sickness absence and take a more positive role in the health of their workforce.

How the new fit note can help employers tackle sickness absence better and improve productivity



The data surrounding sickness absence paints a clear picture. Sickness absence and worklessness due to ill-health costs the British economy an estimated £100 billion each year. A large proportion of this cost – the CBI estimates £13 billion – is borne directly by business themselves.

In addition to this economic cost there are wider consequences for individuals and for society from sickness absence and long-term sickness absence, in particular. Surveys carried out by the Department for Work and Pensions suggest that annually around half of all individuals claiming health-related benefits will have been in work before making a claim. Once on benefit individuals are at more risk of falling into poverty or experiencing social exclusion, which impacts not only the individual affected but also their families and the communities where they live.

It is therefore in everyone’s interest – government, employers and individuals – to reduce sickness absence. Indeed, evidence shows that, in general, work is good for health and can aid the recovery process. Importantly, action to tackle sickness absence need not be expensive; it is estimated that with only basic workplace and healthcare support more than 90% of people with common health conditions can be supported to work.

The medical statement or ‘sicknote’ provides the foundations to the sickness absence system and is crucial in providing information about whether or when an individual with a health condition should work. However, the government believes that the current certification system promotes an overly simplistic approach to sickness absence.

The present medical statement makes fitness for work an absolute issue – either an individual is absolutely fit to work, or they absolutely are not. In doing so, the sick note masks the reality that many people with health conditions could, with the help of their employer, be supported to undertake productive work. As a result, many employers feel confused and frustrated by the current system and would like to do more to help their employees.

In a bid to change this, the Government is revising the system and creating a new fit note which will provide much better information to help individuals and their employers to understand better what work they could do with some basic support.

The new form, which was developed after a pilot study involving nearly 600 GPs and a wide-ranging public consultation, will allow doctors to offer simple, practical advice about basic workplace adjustments that could help an individual make an earlier return to work (for example through temporarily reducing their hours or modifying the work that they undertake). Employers will then be able to use this information as a starting point for a discussion with an employee about how or whether an early return to modified work is possible. In doing so it is hoped that more individuals can be supported to return to appropriate work more quickly, reducing the risk of long-term absence and job loss for them and costs of sickness absence for the employer.


Whilst the doctor’s recommendations are not binding, getting employees back to work early makes good business sense and can result in savings from a reduction in sick pay and other costs of sickness absence such as turnover costs, re-training costs and poor staff morale. Alternatively where work is not appropriate for an individual, doctors will, as now, be able to clearly state that this is the case.

To ensure employers are in a position to make the most of the fit note the Government is working with stakeholders such as the Confederation of British Industry, the Federation of Small Businesses and the Chartered Institute of Personnel Development to provide clear and comprehensive guidance for employers, line managers and HR professionals.

Work is also underway to support GPs through the change to ensure that the advice that they provide to their patients is useful for them and their employers. Guidance will be available in the new year to ensure that organisations have the opportunity to prepare for the changes.

In challenging economic times the new fit note represents an opportunity for employers to tackle sickness absence better and improve productivity. Good managers already understand the importance of good sickness absence management and practice. The fit note will make it easier for them to do this as well as encouraging others to improve their practice. And whilst there is no obligation for employers to act on the GP’s recommendations, taking a more proactive role in their employees’ sickness absences will not only benefit staff morale and the health of their workforce, it will ultimately help the long-term health of their business as well.

Dr James Bolton, Deputy Chief Medical Adviser for the Department for Work and Pensions is speaking at the Absence Management Forum 2009 on Thursday 28th January 2010 in London.

To register for the bsence Management Forum 2009 please visit