NALW Response to Fit Note Reform: call for evidence

Response to Fit Note Reform: call for evidence

What can be done to improve the fit note process to meet individuals’/patients’ work and health needs?

1. Holistic Assessments: Incorporate more comprehensive assessments that consider patients’ social, mental, and physical health needs.
2. Proactive Follow-ups: Implement follow-up assessments with social prescribing link workers where appropriate or in collaboration with wider MDT

What can be done to improve the fit note process to meet healthcare professionals’ needs to provide more health and work support for patients?

1. Training and Education: Training for healthcare professionals on social prescribing, personalised care approaches and occupational health.
2. Integrated Systems: Improve the integration of electronic health records (EHR) by ensuring full implementation of social prescribing information standards
3. Accreditation of social prescribing link workers: This will increase confidence, reduce risk and enable a searchable register of social prescribing link workers. Social Prescribing Link Workers backed accreditation May 2024

What are the enabling factors for healthcare professionals to have an in-depth work and health conversation with individuals requesting a fit note?

1. Time Allocation: Allocating sufficient time during consultations to discuss work and health issues in detail or make use of the MDT such as social prescribing link workers where appropriate.
2. Training: Providing training on conducting effective work and health conversations.
3. Resource Availability: Ensuring access to sufficient number of social prescribing link workers, community resources and referral pathways for additional support and interventions.

What are the challenges for healthcare professionals to have an in-depth work and health conversation with individuals requesting a fit note?

1. Time Constraints: Limited consultation time can hinder comprehensive discussions about work and health.
2. Knowledge Gaps: Healthcare professionals may lack knowledge about work-related health issues and available support services.
3. Systemic Barriers: Bureaucratic and systemic barriers can impede effective communication and follow-up.
4. Patient engagement: The patient needs to be willing and ready to engage

What are the enabling factors for healthcare professionals in providing detailed and applicable advice in ‘may be fit for work’ fit notes to support patients’ work and health needs?

1. Clear Guidelines: Providing clear guidelines, pathways and examples for healthcare professionals to follow when issuing ‘may be fit for work’ fit notes.
2. Interdisciplinary Collaboration: Encouraging collaboration between healthcare professionals, social prescribing link workers, and occupational health

What are the challenges for healthcare professionals in providing detailed and applicable advice in ‘may be fit for work’ fit notes to support patients’ work and health needs?

1. Complex Cases: Managing complex cases where multiple health and social factors are involved can be challenging.
2. Limited Resources: Limited access to resources for implementing recommended workplace adjustments and support measures.
3. Communication Gaps: Ensuring communication between healthcare professionals, employers, and patients can be difficult for various reasons.

What steps might the government take to support healthcare professionals or work advisers to have an in-depth work and health conversation with individuals requesting a fit note?

1. Policy and contract: policies and contract that support holistic care approaches and the integration of social prescribing into the fit note process.
2. Funding: Allocate funding for training, resources, and tools for healthcare professionals working with professional bodies of the professions.
3. Digital Tools: build on the social prescribing information standard and digital social prescribing to ensure entire journey is captured rather than lost.
4. Accreditation of social prescribing link workers: Social Prescribing Link Workers wish to be an accredited profession and the government should back this so we can make progress.

Which patients do you feel would benefit most from more in-depth work and health conversations?

1. Chronic Conditions: Patients with chronic health conditions that impact their work abilities.
2. Mental Health Issues: Individuals experiencing mental health challenges that affect their employment.
3. Complex Social Needs: Patients with complex social needs requiring multidisciplinary support and interventions.
4. Universal access: offer this service to all that may benefit just like social prescribing (embed this into social prescribing). This is because the complex social needs may only be discovered or disclosed after the conversation when the person has been given time.

How can those patients who would benefit most from more in-depth work and health conversations be identified?

1. Proactive Case finding risk stratification can help identify patients who would benefit from in-depth work and health conversations or most at risk
2. Referral Systems: Implement robust referral systems from primary care to secondary care and vice versa
3. Patient Self-referral: Allow patients to self-refer for work and health support services when they recognise the need for such conversations.
4. Making every contact count

What, if any, are the benefits and drawbacks of patients using private companies to issue online ‘work sickness certificates’?

Benefits:

1. Accessibility: Increased accessibility for patients unable to visit a healthcare professional in person.
2. Convenience: Convenient for patients who require quick documentation for work purposes.

Drawbacks:

1. Quality and ethical concerns: Potential concerns about the quality of assessments conducted by private companies.
2. Health Inequalities: Patients with complex needs could be disadvantaged
3. Lack of continuity of care
4. Missed opportunities
5. Exploitation concerns
6. No Social Prescribing

What knowledge, skills and support would healthcare professionals need to accurately assess the impact of a patient’s health condition on their ability to work?

1. Comprehensive Training: Training on assessing work-related health issues and understanding the impact of various health conditions on work capabilities. This needs to be done within the scope of practice for each profession.
2. Access to Resources: Providing resources and tools for effective assessment and advice on workplace adjustments.
3. Collaboration Opportunities: Facilitating opportunities for interdisciplinary collaboration with occupational health experts and social prescribing link workers.

What knowledge, skills and support would work advisers need to accurately assess the impact of a patient’s health condition on their ability to work?

1. Health Literacy: Enhancing knowledge of common health conditions and their impact on work capabilities.
2. Interdisciplinary Collaboration: Training on working collaboratively with healthcare professionals and social prescribing link workers to provide comprehensive support.
3. Resource Access: Ensuring access to up-to-date information on vocational rehabilitation, and other support services.

How could the fit note process more effectively link to different forms of work and health support, such as vocational rehabilitation, occupational health, and employment support?

1. Referral Pathways: Establish clear referral pathways to vocational rehabilitation, occupational health, and employment support services.
2. Integrated Care Models: Develop integrated care models that incorporate social prescribing and ensure seamless transitions between different forms of support.
3. Collaboration: Foster collaboration between various support services to provide comprehensive care for patients.

What, if anything, can be done to incentivise and increase “may be fit for work” fit notes issued by healthcare professionals, where being in work is the best outcome?

1. Resourcing: more staff and primary care leadership
2. Outcome Tracking: Track and report positive outcomes associated with the use of ‘may be fit for work’ fit notes to demonstrate their benefits.

Please can you provide us with any case study examples of where the fit note process is working well to support people with health conditions to return and remain in work?

Thistlemoor Medical Centre

Is there anything else you would like to tell us about the fit note process?

The fit note process should evolve to encompass a more holistic approach, integrating social prescribing and ensuring proactive follow-up assessments. While data gathering is essential, we must understand the sensitivities surrounding disclosure and concerns about social welfare benefits. There must be incentives for patients to willingly engage with the available support (and the support needs to resourced), as well as for employers to support these initiatives. Success relies on the collective buy-in from patients, employers, and healthcare professionals.