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Fewer people taking long-term sick leave

Mild to moderate mental health issues responsible for more sick leave since ‘fit note’

Louise Prime

Tuesday, 24 February 2015

Introduction of the ‘fit note’ has been associated with a reduction in the number of people taking long-term sick leave of at least 12 weeks, UK research has shown. Authors of the study*, published today in Occupational & Environmental Medicine, found that since the fit note replaced the sick note in 2010, there has also been an increase in the proportion of people taking time off work because of depression, anxiety and stress. But commentators warn that changes in list sizes and characteristics in the practices studied over a decade, make it difficult to assume that the fit note system itself altered patients’ chances of being deemed fit for work – and they are concerned at the lack of a reliable evaluation of its effects.

Researchers in Liverpool and Brighton collected fit note data for 2011-13 from 68 practices with different list sizes in England, Scotland and Wales. The data included the note’s date of issue, diagnosis, length of time off work, whether the patient might be fit to do some work, and whether a follow-up assessment was needed. The researchers also considered patients’ gender, birth date, and postcode (to identify those in areas of deprivation).

They identified a total of 13,994 patient sickness ‘episodes’ between 2011 and 2013 across all 68 practices. More than half (53%) of these lasted 3 weeks or less; over a third (35%) lasted less than 12 weeks; and the remaining 12% lasted 12 weeks or more. Patients who were older, male and living in a deprived area were significantly more likely than others to take time off work lasting more than 3, 6, and 12 weeks. Furthermore, GP partners were more likely than either salaried or locum GPs to sign off patients for at least 12 weeks.

For seven of the practices, the researchers compared the recent fit-note data with sick note data for 2001-02. They found that overall, fewer people took at least 12 weeks’ sick leave in 2011-12 than in 2001-02. However, mild to moderate mental health problems including depression, anxiety and stress amounted for a higher proportion of sick leave in 2011-12 (38%) than in 2001-02 (26%). In contrast, the proportion of sick leave attributed to respiratory health problems fell from 10% to 6% over the same period. The study authors wrote: “In the UK, common mental health problems (such as depression, anxiety and stress) continue to account for a high proportion of total certified sickness, both in the form of individual fit notes issued to the patient and certified sickness episodes.”

But the authors of a linked editorial** on the study pointed out that over the decade there could have been changes in the size and character of the patient lists. “Therefore,” they said, “it is difficult to ascertain whether the fit-note has resulted in a change in the likelihood of patients being determined fit for work.”

They also warned that because almost half of patients were off work for at least 3 weeks, there would be huge resource implications if the government rolled out nationally its Fit for Work Service, in which GPs and possibly employers can refer people for a work-focused occupational health assessment to identify those factors that may be preventing them from returning to work.

They concluded: “The ‘jury is still out’ as regards a corroborated, valid and comprehensive assessment of the effect of the fit-note. Moreover, a thorough and systematic evaluation of the effects of the Fit for Work Service is much needed, especially considering its potentially very large economic implications as well as effects on wellbeing.”


* Mark Gabbay, et al. Factors associated with the length of fit note-certified sickness episodes in the UK. Occup Environ Med, 2015 doi:10.1136/oemed-2014-102307

** R M Agius, et al. Certified sickness absence: does the ‘fit-note’ work? Occup Environ Med, 2015 doi:10.1136/oemed-2014-102685

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