Covid-19 Fit Notes (MED3)
During this time of national emergency there has been a significant increase in requests for GPs to issue Fit Notes. The Government have put in place some measures which should help reduce the workload for GPs, particularly in relation to requests relating to Covid-19.
GPs also continue to receive requests from employers for Fit Notes not related to Covid-19. This document aims to provide guidance for practices on the new steps put in place and to provide information on electronic Fit Notes.
Where absence is related to having symptoms of coronavirus or living with someone who has symptoms, an isolation note can be used and not a GP Fit Note to provide evidence of the advice to self-isolate.
Patients can obtain Self Isolation certificates online via NHS111
After answering a few questions, an isolation note will be emailed to the user. If they don’t have an email address, they can have the note sent to a trusted family member or friend, or directly to their employer. The service can also be used to generate an isolation note on behalf of someone else.
Isolation notes will provide employees with evidence for their employers that they have been advised to self-isolate due to coronavirus, either because they have symptoms or they live with someone who has symptoms, and so cannot work.
Patients who are very high risk and shielding for 12 weeks
For those patients that have received a letter from the government on shielding for 12 weeks, this letter is to be accepted as the fit note. This letter should enable discussions with their employer. There should be no requirement for GPs to provide certificates for those patients shielding as the letter should be recognised by the employer.
If there are patients who have not received the letter and fall into one of the categories identified below, these need to be coded with the appropriate code and sent the shielding letter. These patients may request a Fit Note however, the shielding letter needs to be issued by the practice so they can share this with their employer instead of a Fit Note.
People falling into the very high risk group include:
- Solid organ transplant recipients.
- People with specific cancers:
- people with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer
- people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
- people having immunotherapy or other continuing antibody treatments for cancer
- people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
- people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
- People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD.
- People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell).
- People on immunosuppression therapies sufficient to significantly increase risk of infection.
- Women who are pregnant with significant heart disease, congenital or acquired.
Patients who are at risk and isolating/social distancing for 12 weeks
There are a further cohort of patients that have been identified as at risk (likely to be the patients receiving a flu vaccination) but will not receive the shielding letter. It is these patients that will be looking for a Fit Note.
Their employers will need to consider if they can be furloughed. If this isn’t possible and they are also unable to work from home, you are likely to receive a request for a Fit Note. We would suggest you need to assess this on an individual patient basis and if you feel the action they are taking is appropriate then you can issue a Fit Note.
The GP Guidance for the fit note does state that in the first six months of a patient’s condition, a fit note can cover a maximum of three months. Hence covering the 12 weeks period. However, as the patient may not be unwell but are social distancing due to "risk" factors, we would suggest that in completing such fit notes in relation to Covid-19 that a note is made in the clinical record that the fit note was completed as requested by the patient and/or employer to cover the 12 week period for patients at risk as per national guidance.
Sending Fit notes electronically
The Covid-19 primary care bulletin of 21st April referenced fit notes and included the following:- A fit note with a wet signature (defined as ‘other medical evidence’ required by Medical Evidence Regulations) can be scanned and emailed to a patient. GPs should give due consideration of GDPR with necessary consent in place, guidance to employers will be updated to reflect this.
We are aware of a work around for sending, signed Fit Notes, electronically via email to patients to avoid them having to attend your practice to collect it. Ardens have produced an article and video of a step-by-step guide on how to do this.
TPP SystmOne guide to sending Fit Notes electronically
EMIS Web guide to sending Fit Notes electronically
|Symptomatic so isolating for seven days - used NHS website/111 online/been told by HCP that have symptoms||Patients can use isolation note||Use NHS111 online|
Symptomatic and remaining unwell for over seven days
|If they remain unwell and unfit to work after seven days, the current advice is to visit www.111.nhs.uk where there is an online self-assessment tool||Use NHS111 as above|
|Household contact has symptoms so isolating for fourteen days as per government advice||Patients can use isolation note||Use NHS111 as aboveUse NHS111 as above|
Very high-risk group so following government advice on shielding for 12 weeks
If asymptomatic they would let employer know who may be able to set work to do remotely or give leave of absence.
Most will have letters as proof of need to shield.If they don’t, check whether condition is coded on medical record. If not, then add appropriate code and issue shielding template letter
|They do not need to contact their GP for a fit note. If not received shielding letter but should have, take appropriate action as described under advice column|
|At risk group and isolating/social distancing for 12 weeks||
If asymptomatic they would let employer know who may be able to set work to do remotely
If that is not possible, employer to consider furlough where appropriate or they may require the issue of a fit note.Where assessed as appropriate action taken by patient you could issue Fit Note following guidance in sections 4 & 5
|May need to contact GP|
With special thanks to Nottinghamshire LMC where original document was produced
The GOV.UK website link to Information for Employers may also be a useful resource.