Factors associated with prevalence and types of 'may be fit' advice on fit notes: a cross-sectional primary care analysis.

BACKGROUND

The 'fit note', with the opportunity for the GP to advise that a patient 'may be fit' to do some work, was introduced in April 2010.

AIM

To estimate numbers of fit notes with 'may be fit' advice, the types of advice, and factors associated with any inclusion of such advice in the fit note.

DESIGN AND SETTING

Cross-sectional analysis of fit note data from 68 general practices in eight regions of England, Wales and Scotland.

METHOD

Collection of practice fit note data via GP use of carbonised pads of fit notes for a period of 12 months.

RESULTS

The 'may be fit' box was ticked on 5080 fit notes (6.4% of all fit notes in study). But there was a wide variation in completion rates across the 68 practices (from 1% to 15%). The most prevalent individual item of advice was to 'amend duties' of patient as a prerequisite for return to work (included in 42% of all notes containing any 'may be fit' advice). Advice was often incomplete or irrelevant, with some GPs failing to comply with official guidance. Inclusion of any 'may be fit' advice was independently associated with the patient being female, less socially deprived and having a physical health reason for receiving a fit note.

CONCLUSION

Unlike other studies that have relied upon eliciting opinion, this study investigates how the fit note is being used in practice. Findings provide some evidence that the fit note is not yet being used to the optimum benefit of patients (and their employers).