Intended for healthcare professionals

Practice Practice Pointer

Assessing fitness for work and writing a “fit note”

BMJ 2010; 341 doi: (Published 26 November 2010) Cite this as: BMJ 2010;341:c6305
  1. David Coggon, professor of occupational and environmental medicine1,
  2. Keith T Palmer, professor of occupational medicine1
  1. 1MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
  1. Correspondence to: D Coggon MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton SO16 6YD UK dnc{at}

This article offers advice on assessing whether patients are ready to return to work after injury or illness and whether job modifications might help them to return

In Great Britain there was a more than sevenfold increase in long term sickness absence for back pain (measured in days of sickness and invalidity benefit payment a year) between the 1950s and the early 1990s1 at a time when the physical demands of work were generally falling. More recently, mental health problems have rapidly overtaken musculoskeletal disorders as the main reason for incapacity.2 Doctors are often asked to advise about fitness for work after illness, injury, or surgery. In particular, general practitioners in the United Kingdom are often required to certify sickness absence so that patients can obtain sick pay or social security benefits. The UK government recently introduced a redesigned Statement of Fitness for Work (“fit note”), which replaced the “sick note” used previously. The new form includes an option not previously available: the doctor can indicate that, although patients are not fit for their normal work, they could work if the job were suitably modified. This article explains why and how doctors might support patients in their return to work, how any helpful modifications to work can be identified within the time constraints of a busy clinic, and how advice on a fit note can usefully be framed.

Why should doctors be concerned with their patients’ work?

Occupational hazards are an important preventable cause of injury and disease, and identifying patients whose illness is caused or aggravated by work can lead to more effective clinical management. For example, newly presenting asthma in an adult of working age might be the result of exposure to a respiratory sensitiser in the workplace, avoidance of which would prevent or reduce symptoms. The patient could also be eligible for compensation, through …

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