Guidance on issuing fit notes
Please see attached documentation for generic patient isolation letter
Requests for certification of absence from the workplace relating to covid-19 may fall into five categories:
1. Symptomatic so isolating for seven days
Patients can and should self-certify for the first seven days as normal if they are unfit to work. They do not need to contact their GP.
2. 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 which should be up and running soon. They do not need to contact their GP for a certificate but you can advise patients to use the template form below.
3. Household contact symptoms so isolating for fourteen days as per government advice
GPs cannot and are not the gatekeeper of the statutory sick pay system and can only provide certificates for the purpose of illness, not in relation to government advice regarding self-isolation. Employers are responsible for putting in place arrangements for home/remote working where this is possible. Where it is not, the employee may self-certify and return to work following the relevant absence which their employer may authorise as per government advice.
4. At risk group so following government advice
Where they do become unwell during or after this time, point 1 and 2 applies. They do not need to contact their GP.
5. Those in full time education who are symptomatic or requiring self-isolation.
There is no NHS requirement to issue certification to schools or colleges to confirm absence. These organisations must work with parents and students to ensure that any absence is appropriately recorded, obviating the need for a ‘doctor’s note’. They do not need to contact their GP.
The current Government Guidance for employers and businesses on coronavirus (COVID-19) states;
“By law, medical evidence is not required for the first 7 days of sickness. After 7 days, employers may use their discretion around the need for medical evidence if an employee is staying at home.
We strongly suggest that employers use their discretion around the need for medical evidence for a period of absence where an employee is advised to stay at home either as they are unwell themselves, or live with someone who is, in accordance with the public health advices issued by the government.”
Until further guidance is available, Londonwide LMCs would suggest that practices upload the attached letter to their website and requests that if needed by patients they use this letter as the practice will not provide a medical certificate for patients requiring self-isolation for coronavirus.
Doctors providing primary medical services under the National Health Services Acts are required, under the Social Security Acts, to issue free of charge a fit note (Statement of Fitness for Work, Form Med 3, or Med 3), to patients for whom they provide clinical care.
The Department for Work and Pensions (DWP) issues guidance about fit notes. GPs should be familiar with this.
What you need to do
- You do not need to issue a fit note for the first seven calendar days of a patient’s sickness absence. Patients can self-certify for this period.
- If you assess that your patient’s health affects their fitness for work, you should give them a fit note indicating whether your patient is not fit for work OR may be fit for work.
- GPs should note that they can back date a fit note; in certain situations, parts of the fit note may need to include dates which are earlier than the date of the statement.
- If you are issuing a fit note based on an assessment conducted at an earlier date, you should enter the date of this earlier assessment in the date of assessment field.
- If your patient’s condition has affected their function for some time without a previous fit note being issued, you must enter an estimated date that their function was affected from in the ‘this will be the case from’ field.
Information you should provide
- Fit notes should record the advice given to the patient, along with other factual information including an accurate diagnosis, except on the occasions when a doctor feels that it could be prejudicial to their patient’s wellbeing if the true diagnosis were given.
- The comments section on medical statements allows for additional comments about the disabling effects of the diagnosed condition, its treatment and prognosis.
- Fit notes should indicate clearly the information required. Generally GPs should not speculate but should provide only factual information and should not certify something they are unable to verify.
- GPs are reminded that they might be asked to provide further information to substantiate certification in such circumstances. In cases where you consider that a patient would benefit from the help or advice of a Disability Employment Adviser (DEA) this opinion should also be included in the remarks section.