Fitness Certificates

Statement of Fitness for Work

From 6 April 2010, doctors across Great Britain have been issuing their patients with a revised Form Med 3 (Statement of Fitness for work or “fit note”), which enables them to give their patients better advice about their fitness for work.

The fit note was launched in April 2010 to replace the old sick note. It allows doctors to give more information to patients about the functional effects of their health condition on their fitness for work, to help people return to work where appropriate .

The Department for Work and Pensions (DWP) issues guidance about not providing back-dated statements. GPs should be familiar with this.

Find out more in the DWP benefit guide for GPs

• GPs are not allowed to issue duplicate certificates relating to social security claims. An exception is where replacements are required for forms which have been lost. These should be marked duplicate.
• GPs are not obliged to issue Med 3 forms for periods of sickness lasting 7 days or less.

Information you should provide

• Medical statements should record the advice given to the patient, along with other factual information including an accurate diagnosis, except on the occasions when a doctor feels that it could be prejudicial to their patient’s wellbeing if the true diagnosis were given.
• The remarks sections on medical statements allow for additional comments about the disabling effects of the diagnosed condition, its treatment and prognosis.
• In cases where you consider that a patient would benefit from the help or advice of a Disability Employment Adviser (DEA) this opinion should also be included in the remarks section.
• Medical reports should indicate clearly the information required. Generally GPs should not speculate but should provide only factual information and should not certify something they are unable to verify.
• GPs are reminded that they might be asked to provide further information to substantiate certification in such circumstances. In cases where you consider that a patient would benefit from the help or advice of a Disability Employment Adviser (DEA) this opinion should also be included in the remarks section.

Medical Certificates for Patients who have been in Hospital

While in-patients are often issued with Med 10s, many hospital doctors are unaware that they should, when required, also issue Med 3s.

Med 3s may be appropriate for social security and Statutory Sick Pay purposes for patients who are either incapable of work or who may be fit for work with support from their employer.

Not issuing Med 3s denies patients the best care and leads to unnecessary duplication and stress for those, who have to make an extra appointment with their GP to get one. GPs, may not be the most appropriate clinician to provide advice regarding fitness for work related to certain conditions.

Hospital in-patients

Form Med 10 should continue to be issued to cover any period that a patient is in hospital. On discharge from hospital, the doctor who has clinical responsibility for the patient should provide them, if appropriate, with a Med 3 to cover a forward period. This is to avoid unnecessary referrals to GPs solely for the purpose of sickness certification.

Hospital out-patients

Where the out-patient care follows an episode of in-patient/day patient care, the hospital doctor should issue the Med 3 on discharge and a subsequent Med 3 if required when a patient attends for out-patient review.

Where a patient has been referred to a hospital for an opinion or advice on their health condition, responsibility for issuing a Med 3 should remain with the GP.

Patient with Complex Chronic conditions

Patients with complex chronic diseases who are attending hospital as out-patients are, in most cases, also likely to be attending their GP. In these cases, the GP should issue the Med 3.

Additional information relating to has been issued by the Chief Medical Officer and can be found in the LMC Library below.

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