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.
One of our Medical Directors have advised the following to another collegue who had concerns about issuing a fit note to a patient who's employer was asking for one as they were in a vulnerable group.
This scenario is indeed a sad consequence of the current Pandemic and does present us with an uncomfortable dilemma. Your concerns around the appropriateness of issuing a Med3 are all valid.
As the DWP point out in their GP guidance around fit notes ( https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/465918/fit-note-gps-guidance.pdf ), ‘Your assessment about whether your patient is fit for work is about their fitness for work in general and is not job-specific’. We are reminded to ‘Always consider if your patient could do work of some kind before advising that they are not fit for any work’.
With this in mind I would concur that the issuing of a Fit Note stating that the patient is not fit for work would be inappropriate in the situation that you describe.
You could use a fit note to give advice about the functional effects of your patient’s condition on their fitness for work in general but the patient you describe doesn’t have any functional limitations relating to his diabetes, rather a theoretical increased risk of contracting an infection ( in this case Covid).
You are not expected to have specialist knowledge of workplaces or occupational health, and you do not need to suggest possible changes to your patient’s workplace or job.
If you require more specialist occupational health advice and your patient is employed and has been, or is likely to be on sick leave for four weeks or more, you can refer them to ‘Fit for Work’ which will carry out an occupational health assessment and provide them with a Return to Work plan. This is free. This would not seem to apply to the case that you describe, however, because he isn’t sick and hasn’t been off work sick. He has been furloughed.
You can access the Fit for Work advice line or use their website to get general health and work advice. www.fitforwork.org .
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.
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 above|
Very high-risk group so following government advice
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 take extra stringent measuresIf 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||
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 request the issue of a fit note. This is not appropriate, as the patient is not unwell.
|May contact GP, offer the template letter.|
With special thanks to Nottinghamshire LMC where original document was produced
You may also be interested in GP Guidance for the fit note
The GOV.UK website link to Information for Employers may also be a useful resource.