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.
The BMA advises that GPs are reminded that they are still required to issue fit notes (med 3) as normal. There are specific scenarios relating to COVID-19 where patients can use the isolation note service, instead of seeing a GP, as outlined below. Please do not signpost patients to NHS 111 in order to get a fit note as they are not provided by the service. During the pandemic DWP is encouraging employers to use their discretion as to what medical evidence is required to support periods of sickness absence.
Previously advice was issued on issuing fit notes (med 3s) remotely during the pandemic, which remains in place until further notice. A properly signed and scanned fit note sent via email to the patient will be regarded as 'other evidence' and will be accepted by DWP for benefit purposes. Not signing fit notes can mean that they are rejected by employers and DWP, so we have been asked to remind GPs that fit notes must be signed.
The original hard copy does not need to be retained if there is an electronic copy of the fit note in the medical record.
If the patient is unable to receive their fit note electronically, they will be required to collect a hard copy from the practice or it will posted to them, at the practice’s discretion.
One of our Medical Directors has advised the following to another colleague 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.
The isolation service does not provide fit notes (med 3s). It is an automated service that can be used to provide evidence of the need to self-isolate by those who:
- Have symptoms of coronavirus
- live with someone who has symptoms of coronavirus
- are in a support bubble with someone who has symptoms of coronavirus
- have been told to self-isolate by a test and trace service
It can be used to cover continuing periods of isolation if patients still have symptoms or develop new symptoms following their initial isolation period.
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.