Should ‘fit notes’ replace ‘sick notes’?

by Stephanie Zillman09 Oct 2013

Absenteeism is an ongoing issue in workplaces across Australia – and in the face of a medical certificate, there’s not much employers can say or do. However, the rise of graded sickness absence certificates, or ‘fit notes’, in the UK and Europe may be about to hit our shores.

In the case of prolonged illness, or a complex mental health issue, employees may be off from work for months at a time. However, according to University of New South Wales (UNSW) workplace mental health lecturer Dr Sam Harvey, fit notes are aimed at addressing what somebody can do, instead of solely focusing on what they can’t do. In the UK, GPs issue this kind of notice, and are required to respond to specific prompts which address whether the employee could be fit to work with modified duties, or modified hours.

Norway has been a frontrunner in the use of graded sickness absence. Professorial Visiting Fellow at UNSW, Arnstein Mykletun, told ABC Radio that despite the widespread agreement that health works on a continuum spanning ‘well’ to ‘ill’, feeling unwell and being absent from work shouldn’t be viewed in black and white terms. “Very rarely would I say I feel 100% - why then should sickness be a case of either [present or absent]?” Mykletun commented.

Mykletun was instrumental in the move untaken by the Norwegian Institute of Public Health to shift the practice away from workers being simply present or absent. In use for nearly 10 years, graded sickness absence certificates must be filled out by GPs, and issued to employers. The initiative to increase the use of graded sickness absence has seen a dramatic drop in sickness absence, Mykltun said.

Making the switch – UK case study

The fit note can still be used as evidence for why an employee cannot work due to illness or an injury. In the UK, many employers do not require a fit note as evidence until after the seventh calendar day of sickness. If the doctor has recommended that an employee 'may be fit for work', employees can still apply to remain absent.

The requirements for the payment of sick pay did not change – and if a doctor recommends that an employee 'may be fit for work', and the employer and employee agree that the worker should remain off work, statutory sick pay will be still be paid.

When the doctor provides a fit note they will advise the employee on one of two options. Either the worker will be 'not fit for work' or 'may be fit for work'.

Not fit for work
The doctor will choose this option when they believe that the employee’s health condition will prevent them from working for a stated period of time.

May be fit for work
The doctor will choose this option when they believe that the employee may be able to return to work while they recover with assistance from the employer – for example, changed hours or alternate duties/tasks.

The doctor may include some comments which will help employers understand how they are affected by the employee’s health condition. If appropriate, they may also suggest one or more common ways for employers to aid the return to work.

This could include:

  • Phased return to work – where employee’s may benefit from a gradual increase in work duties or working hours, for example after an operation or after injury
  • Altered hours – allowing the flexibility to start or leave later, for example to avoid the struggle of travelling in rush hour
  • Amended duties to take into account the employee’s condition. Eg, removing heavy lifting
  • Changes to the workplace to take into account the employee’s condition. Eg, allowing the employee to work on the ground floor if they have problems going up and down stairs


  • by Bernhard Racz 7/05/2012 4:01:00 PM

    Fully agree with this, but should also be used in work-place injuries. Many years ago I was the 'night matron' of a large Sydney hospital, and the ADN of Intensive care units. I was injured when a stairway at work collapsed, and despite the back pain, I kept saying I could work, and wanted to return to work, but the employer and the insurer blocked every door, including blocking employment throughout NSW Health. To survive, I started emplyment agencies and a few other businesses, and sued them on a Civil claim to 'give me my job back or pay the difference' in wages not earned. After 12 years of court cases, where even the court ruled the insurer ' had to pay (&awarded $1.8 million), the insurers persisted, pushed for more court time, and when we were told we'd be in court another 10 years we called it quits and walked away.
    Despite bouts of pain etc, I worked ALL that time, yet still the employer and insurers insisted that I 'couldn't work'. My own solicitors insisted that to be paid I needed to stop all work, use a cane to walk, 'try to hire' a wheelchair', and never lift my kids, do shopping, mowing etc. The legal system is criminal.

  • by John Linnett 11/10/2013 3:34:30 PM

    Bernhard you should name and shame the insurer. Your case is a disgrace and the insurers should be made to pay the $1.8M, if the court ordered it. The legal system does not want real honest workers to work.

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