While many organisations already invest in occupational health (OH) services, many don’t. The lack of a fit for work scheme, and no OH services, mean many employers struggle to return staff to work. Others are left struggling with heightened unnecessary time off for sick leave.
In 2016, a new scheme called "Fit for Work" was rolled out to help tackle increasing rates of sick leave, but this scheme closed in 2018. New processes are now in place for assessing whether staff are fit for work.
In this article, we’ll take a look at what replaced the Fit for Work scheme, provide advice on managing sick leave, and explore the new rules on fit notes.
What is Fit for Work?
The Fit for Work scheme helped employers cut back on problematic employee sick leave. The aim was to increase the productivity and workload of the entire company. The Fit for Work scheme would refer certain employees for an Occupational Health Assessment. Any staff member who was, or was likely to be, off work for more than four weeks could be referred.
While the Fit for Work scheme is no longer applicable, the process remains almost the same. If someone is off sick for four weeks or more, you may refer them for an occupational health assessment. While you can refer an employee to occupational health at any time, they must consent to the assessment.
Process for Assessing Fitness to Work
Employees can self-certify their sick leave for the first week of their absence. Afterwards, they must obtain a fit note from a medical professional.
Here’s how sick notes should be used:
Fit Note
A fit note provides medical evidence that an employee is incapable of performing work. It should also detail the length of time the individual should be off work.
A fit note can cover a maximum of 3 months. However, a doctor will usually set a period of time shorter than that to either review their condition or specify a date they’ll return to work. The note can include health and work advice on how to support them once they return, but this is usually covered more in the OH assessment.
The rules on who can issue a fit note used to specify that only a doctor or general practitioner can issue a sick note. Now, a fit note can be issued by:
A doctor / GP
Nurses
Occupational therapists
Pharmacists
You can check whether employees’ sick notes are genuine. If you contact their doctor, they’ll be able to tell you whether they provided the note. However, they cannot reveal any medical evidence without employees’ consent.
While a fit note does make a person’s absence legitimate, it does not mean they can remain on leave indefinitely. The change to who issues a fit note applies across England and Wales, as well as Scotland, and is being mirrored in Northern Ireland. This is part of the reason why the Fit for Work scheme was introduced in the first place. However, now the scheme is unavailable, you should instead refer to occupational health.
Occupational Health Assessment
Once you have done this, and the individual has given consent, they’ll undergo a series of tests.
Depending on the situation, the tests they take will be different. Some professionals who provide fit notes can also conduct an occupational health assessment, such as a doctor. However, there are others who can conduct this.
The referred employee will be assigned to one, or more assessors who will assess them and produce a report. The employee must also consent to this being shared with you. The report will provide you with health and work advice, plus information relating to the employee’s wellbeing. From there, you must make a decision about their capability and any plans to return them to work.
If the health assessment deems that they’re capable of working, you can start putting together a return-to-work plan. Take the recommendations by the doctor, or other professional who conducted the occupational health assessment, into account. Plus, some points to consider are:
A timeline for their return
Adjustments to make returning easier
Ways you can support with recovery.
Some larger organisations may have their own in-house occupational health service. If so, they can provide advice on returning to work. Most companies won’t have this option and will need to outsource to an external assessment service.
To get the best results, you should conduct a return-to-work interview. This helps you manage absence effectively, as well as highlighting any concerns the person might have. Keep a record of the interview as well as any documents provided in the meeting, such as a fit note.
Not sure what questions to include in your interview? Download our free template and questionnaire form.
What Types of Assessments are there?
As every workplace is different, and each job role has its own hazards, to ensure each employee is fit for work, every occupational health check will be different too. Some will be no more than a questionnaire, requiring employees to fill in a form. Others will require in-depth medical examinations.
When assessing fitness for work, there are many factors an OH specialist might take into consideration. The list is long, so we won’t name them all—here are some of the most common checks staff could undertake:
Musculoskeletal questionnaire/assessment
Skin health check
Respiratory health check
Audiometry health check
Blood pressure
Vision (Keystone test)
Vibration health check
Colour vision (Ishihara)
Urinalysis
Mental health/workplace stress assessment
General fit for work check.
Communicate with the OH provided which type of assessment you need. For example, an employee having to perform heavy lifting as part of their role may need to undergo a musculoskeletal questionnaire. Once the fit for work assessment is complete, you’ll be provided with a report, including health and work advice to act upon. You should use this in tandem with a report from a doctor, or any other medical advice you’ve received to assess their capability to return to work.
Mental Health Capability
One issue that we receive a lot of questions on is capability in relation to mental wellbeing and sick leave. Unfortunately, there is still some stigma in this area, and some employers believe that it does not constitute legitimate sick leave.
However, stress, depression, and anxiety are some of the leading causes of absence in the UK. Whatever your beliefs on the matter, it is a serious issue that needs handling with care. Failure to do so as an employer can lead to tribunal claims and damage to your company's reputation.
Your first step to solving this issue could be to implement an employee assistance programme (EAP). Some of these services offer OH assessments as part of the package. Find out more about our employee assistance programme here.
Other simple steps include drafting and publishing a mental health page somewhere you staff can easily access. Some employers include mental health pages on their company intranet or website.
Who Can I Refer to the Fit for Work Scheme?
You can refer the following to the Fit for Work scheme:
Employees (not self-employed).
Employees who have been absent from work or are likely to be absent for at least four weeks.
The employee should have a likelihood of being able to return to work within three months and have not used the service in the previous 12 months.
The same criteria apply when referring employees for a fit for work check via an OH assessment.
What are the Benefits to Employers?
It is not compulsory to use an assessment service. However, there are some benefits to doing so, including:
Improved staff relations and morale.
Improved business efficiency.
Improved public image and PR.
Reduces costs associated with accidents and incidents at work.
Lower cost of absences per person.
An OH assessment is often more enlightening than a regular medical report. It focuses on the specific job the employees are performing.
What is the Process if Someone isn’t Fit for Work?
Once a doctor deems a person too sick to work, you need to start considering your next steps.
Don’t jump straight to — consider whether there are any reasonable adjustments you can make to make returning to work easier. If there are none, or the employee rejects the changes, then you could consider a capability dismissal, as they are no longer fit for work. Stay in communication with the employee during the process. Ensure they are aware of the steps you are taking to accommodate them. If a return to work looks to be impossible, then you can invite employees to a formal medical capability hearing. Make this meeting as accessible as possible—using video call, for example—as they may be unable to attend in person.
If they fail to attend this meeting after multiple invitations, you can hold the meeting in their absence. However, having them in attendance is better for both parties. If the employee does attend, and you cannot come to an agreement about them returning to work, you may issue a letter informing them of dismissal due to them not being fit for work. We would not recommend making a decision in the room. Instead, come away from the meeting and consider the points raised.
In cases where the employee’s absence is related to a disability, you need to ensure you don’t discriminate during the dismissal process.
Practical Suggestions on Fitness for Work
We recommend that employers consider whether to update their sickness absence policies and procedures. If your company wants to utilise occupational health, your documentation should reflect this. Also, if you have an effective absence policy in place, you can reduce your reliance on occupational health. If you have your own OH assessment service, this should also be reflected as a page in your staff handbook, contracts, and/or company website.
When employees undertake work that increases their risk of injury or of becoming sick, such as heavy lifting or working with dangerous chemicals, keep OH assessments in mind. You may even use one at the beginning of employment to measure whether they are fit for work or not.
Remember that rules around who can write a fit note have changed. Don’t reject a fit note just because it hasn’t been issued by a doctor.
Finally, when seeking solutions on health and work, remember to communicate with your staff. They should be your first stop when gathering data on the issues that affect their wellbeing and safety. You could put together a form or questionnaire that they fill in anonymously to gauge their major concerns.
Support with Occupational Health
Although the Fit for Work scheme is no longer viable, you still have options when an employee has health concerns. Using occupational health is a good way to assess fitness for work, but you must be sure to get the process right to avoid discrimination.
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