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Fit for Work: guidance for GPs

What is Fit for Work?

Fit for Work has two elements:

  • Advice: Fit for Work can give you, your patients or their employers advice about work-related health matters e.g. when a patient’s health condition is affecting them at work or when they are off sick from work. This might involve providing help with issue identification, information on the type of adjustments which could help patients stay in or return to work, or more general work-related health advice. This advice will be available on-line and via a phone service. The advice service is targeted at employees, employers, and GPs, but others, such as self-employed patients can also contact the service
  • Referral for an occupational health assessment: Fit for Work will provide GPs with a referral route to access a supportive occupational health assessment for patients who you think could be absent from work for four weeks or more. Patients will be contacted within two working days of a referral by a Fit for Work occupational health professional. They will receive a holistic, biopsychosocial assessment. This assessment will usually take place over the telephone. Face-to-face assessments will be available for the limited number of patients who will require them
  • The Fit for Work occupational health professional will seek to identify all of the obstacles preventing the patient from returning to work and agree a plan with the patient that is designed to address each obstacle to enable a safe and sustained return to work

How can Fit for Work help me and my patients?

  • Fit for Work provides:
    • access to independent quality advice and a specialist occupational health assessment
    • a free and rapid early intervention service that is easy to use and provides support for you, your patient and your patient’s employer via the Return to Work Plan
    • removal of the need to issue repeat fit notes where there is a Return to Work Plan in place
    • support to improve health outcomes for patients through a faster return to work
    • assistance in managing your patient’s understanding about the impact of their condition on their fitness for work
    • support in managing difficult return to work consultations
    • help which improves your patient’s chances of keeping their job
    • information to help your patient and their employer to discuss how they could be supported at work and in returning to work

Assessment referral: patient eligibility criteria

  • The criteria for referring patients to Fit for Work are:
    • those patients of any age in paid employment
    • the patient is likely to be absent from work for four weeks or more
    • the patient has a reasonable prospect of returning to work (if unsure please make a referral to Fit for Work or contact the advice line)
    • the patient has not already been referred within the last 12 months and has not received a Return to Work Plan
    • the patient consents to the referral
  • Your patients will not be eligible for referral to the assessment part of Fit for Work if they:
    • live outside England, Wales, and Scotland
    • are not absent from work
    • are unemployed or self-employed
    • have been referred within the last 12 months and a Return to Work Plan has been issued
  • You may want to consider whether your patient is receiving employer occupational health support which is sufficient to enable them to return to work, prior to making a referral
  • The following patients may not be suitable for a referral for a Fit for Work assessment:
    • individuals who, in your judgement, will not be able to return to work (if unsure please make a referral to Fit for Work or contact the advice line)
    • terminally ill patients, unless in your clinical judgement a referral and return to work would be possible and beneficial for the patient

Other circumstances

  • There may be circumstances where you consider it more appropriate to refer a patient for a Fit for Work assessment later in their absence—perhaps because there have been improvements to their health and they have a better prospect of returning to work
  • You may also refer patients to a Fit for Work assessment before four weeks of sickness absence if you think they will be sick for at least four weeks and earlier support from Fit for Work will benefit them
  • In all cases, making a referral should be considered as the default position for patients who are likely to be absent for four weeks or more: if you are in any doubt about the merits of a referral, please make a referral or contact the Fit for Work Advice line

What happens once I make a referral to a Fit for Work assessment?

  • Fit for Work will contact your patient to conduct a telephone assessment at a convenient time for them (within two working days of receipt of referral or five working days for a face-to-face consultation if it is deemed appropriate)
  • During the assessment, the occupational health professional will ask your patient to describe their condition, their job role and any factors—including health, work, home or any other relevant issues—which are affecting their return to work
  • The occupational health professional will develop a Return to Work Plan which will reflect the assessment and include advice and recommendations for interventions which are appropriate for your patient in order to support them back to work. The recommendations are not compulsory and you will retain full clinical responsibility for your patient
  • Your patient will discuss the contents of the Return to Work Plan with the occupational health professional. They will be asked by the health professional whether they consent to the plan being shared with you and/or their employer
  • Where your patient has consented to the plan being shared with their employer, the employer and their employee will consider the recommendations on how best to support the employee back into work
  • The employer can accept the Return to Work Plan as sufficient information for purposes of Statutory Sick Pay in place of a fit note
  • The case manager will contact the patient at an arranged point to check if the plan is on course and in addition will contact the patient shortly after the anticipated return to work date. If necessary the case manager will arrange for a further assessment by Fit for Work, for example if the patient has not returned to work as anticipated. The Return to Work Plan may also be revised to reflect any changes that are necessary
  • As with a fit note, a patient can return to work before any date predicted for their return by Fit for Work
  • Patients will automatically be discharged from Fit for Work:
    • two weeks after they have returned to work (including a phased return)
    • on the date Fit for Work decide that there is no further support they can offer the patient: this will be either when the patient has been with the service for three months or at the point Fit for Work decides the patient will be unable to return to work for three months or more
  • Patients, GPs, and employers will still have access to the advice line for additional support

full guideline available from...
www.gov.uk/government/publications/fit-for-work-guidance-for-gps

Department for Work and Pensions. Fit for Work: guidance for GPs. London: Department for Work and Pensions.
First included: September 2015.