Fitnote Hospital Guide

Statement of
Fitness for Work

A guide for hospital doctors
2 | Statement of Fitness for Work
Hospital doctors and sickness

certification
From 6 April 2010 doctors across Great Britain will be issuing
their patients with a revised Form Med 3 (Statement of Fitness
for Work or fit note) which will enable them to give their
patients better advice about their fitness for work.
However, while patients are often issued with Med 10s, many
hospital doctors are still unaware that they should also, if
appropriate, issue Med 3s. Not issuing Med 3s denies patients
the best care and leads to unnecessary duplication and extra
work for GPs. In many cases it is the hospital doctor who is best
placed to give advice on a patient’s fitness for work.
This brief guidance sets out when hospital doctors should use
the new Statement of Fitness for Work and explains the key
changes to the Statement itself.
The role of hospital doctors in

issuing the Statement of Fitness
for Work
Hospital doctors may need to provide all certification for social
security and Statutory Sick Pay purposes for patients who are
either incapable of work or who may be fit for work with
support from their employer. The duty to provide a Med 3 rests
with the doctor who at the time has clinical responsibility for
the patient.
Guide for hospital doctors | March 2010 3
Hospital out-patients
For an out-patient this will generally be the hospital doctor,
except where the GP retains responsibility, for example where
the patient has been referred to a hospital for an opinion or
advice on their health condition. In cases where the patient’s
GP has not taken over responsibility for the incapacitating
condition the treating clinician should issue any subsequent
Statements for an appropriate forward period.
Hospital in-patients
Form Med 10 should continue to be issued to cover any period
that a patient is in hospital. On discharge from hospital the
doctor who has clinical responsibility for the patient should
provide them, if appropriate, with a Med 3 to cover a forward
period. This is to avoid unnecessary referrals to GPs solely for
the purpose of sickness certification.
Examples where hospital doctors should

consider issuing a Med 3:
• when a patient has received treatment in Accident &
Emergency and the treating doctor believes that the patient
will be unable to work for over 7 calendar days, it would be
appropriate to issue a Med 3 for a period consistent with
the anticipated incapacity;
• when a patient is receiving treatment at a fracture clinic and

so does not need to see their GP for any clinical reason;
• when discharging a patient from hospital, as well as issuing

a Form Med 10 to cover the in-patient period, doctors
should consider if the health condition will affect the
patient’s fitness for work for a forward period; and
• patients who have mental health conditions and are under

regular review could also have their sickness certification
integrated into this review in cases where the hospital
doctor maintains clinical responsibility.
Statement of Fitness for Work:

the basics
What is changing?
On 6 April 2010, the current Forms Med 3 and Med 5 will be
replaced with a single revised Statement of Fitness for Work
(revised Form Med 3). The new form was developed in
partnership with practising doctors and members of professional
bodies including the British Medical Association and the Royal
College of General Practitioners. The key changes are:
• including telephone consultations as an acceptable form of

assessment;
• removing the option to say a patient is fit for work;
• introducing a new option: ‘May be fit for work taking

account of the following advice’;
• increasing space for comments on the functional effects of

your patient’s condition with tick boxes to indicate simple
things such as altered hours or amended duties that could
help their return to work;
• changing the rules for issuing the Statement so that, during

the first 6 months of sickness, the new Statement can be
issued for no longer than 3 months; and
• simplifying the current system by combining the Forms

Med 3 and Med 5 into one form.
What stays the same?

• the Statement can only be completed by a doctor;
• you can still advise your patients that they are not fit for
work;
• the Statement remains advice from you to your patient;
• your patient can still use the Statement as evidence of

fitness for work for sick pay and benefit purposes; and
• the advice on the Statement is not binding on employers.

Not fit for work or may be fit for

work?
The new Statement of Fitness for Work allows you to advise
one of two options:
Not fit for work:
Where your assessment of your patient is that they should
refrain from work for a stated period of time.
May be fit for work taking account of the following
advice:
Where your assessment is that your patient’s health condition
does not necessarily mean they cannot return to work;
however, they may not be able to complete all of their normal
duties or hours, or they may need some support to help them
undertake their normal duties.
If it is not possible for the employer to provide the support for

your patient to return to work, your patient and their employer
can use the Statement as if you had advised ‘not fit for work’.
Your patient does not need to return to you for a new
Statement to confirm this.
Why change? Improving your

patients’ health through work
Evidence shows that work has therapeutic value and is
generally good for physical and mental health.1 The longer a
patient is off work, the lower their chances of getting back to
work. There is strong evidence that long periods out of work
are associated with poor mental and physical health, increased
use of health services and poverty. In most cases an individual
does not need to be 100% fit to return to work. Evidence also
suggests that people with common health conditions could be
helped to return to work, as part of their recovery, following a
few basic principles of healthcare and workplace management.2
1 Waddell, G. and Burton, A.K. (2006), Is work good for your health and
well-being? TSO
2 Waddell, G., Burton, A.K. and Kendall, N.A.S. (2008), Vocational Rehabilitation,
what works, for whom and when? TSO
Further information
Further guidance on the new Statement of Fitness for Work can
be found at: www.dwp.gov.uk/fitnote
Ordering more forms

Hospitals or Trusts can order replacement stock of the revised
Med 3 forms direct from iON, the distributor. Further details on
this process can be found at:
http://www.dwp.gov.uk/publications/
catalogue-of-information/how-to-order¬products/
Statement of Fitness for Work

For social security or Statutory Sick Pay
Patient’s name Mr, Mrs, Miss, Ms
I assessed your case on: / /
and, because of the

following condition(s):
I advise you that: you are not fit for work.
you may be fit for work taking account

of the following advice:
If available, and with your employer’s agreement, you may benefit from:
a phased return to work amended duties
altered hours workplace adaptations
Comments, including functional effects of your condition(s):
M P L E
S A
This will be the case for
or from / / to / /
I will/will not need to assess your fitness for work again at the end of this period.
(Please delete as applicable)
Doctor’s signature
Date of statement / /
Doctor’s address
Med 3 04/10
For the patient – what to do now

Please read the notes below then fill in your details and sign and date the declaration.
If you cannot fill in your details yourself, ask someone else to do it for you.
What your doctor’s advice means

Not fit for work:
o doctor will advise this when they believe that your health condition means you should
Your
refrain from work for the stated period of time.
May be fit for work taking account of the following advice:
Your
o doctor will recommend this when they believe that you may be able to return to work
with some support from your employer. Sometimes it may not be possible for your employer
to act on the doctor’s advice and you will not be able to return to work until you have further
recovered. Yo ou do not need to get a further Statement from your doctor to confirm this.
If you are employed
If you are not fit for work, or your employer cannot support your return to work, your
employer should consider paying Statutory Sick Pay (SSP) based on the information provided.
If SSP cannot be paid, or your SSP is ending, your employer will give you form SSP1 to claim
social security benefits. If you are self-employed, you may be able to claim social security
benefits because of your health condition.
Social security benefit claimants
If you are claiming social security benefits because of your health condition, send this form to
your Jobcentre Plus office. If you are claiming social security benefits for any other reason,
you should contact a Personal Adviser to discuss the advice on the form. If you do any work
you must inform Jobcentre Plus of your change of circumstances.
If you want to make a new claim to social security benefits you can:
s download a claim form at www.direct.gov.uk/benefits, or
E
s phone 0800 055 6688 88 (8am to 6pm Monday to Fridayy).y) Textphone users call 0800 023 4888.
Te
e
extpho
P L
Yo
our details – Ple e use BLOCK CAPIT
ease TA
ALS
A M
Surname Mrr,, Mrs, Miss, Ms
Other names
Address
S Postcode
Date of birth / /
National Insurance (NI)

number
Declaration
I agree that my doctor may give the Department for Work and Pensions or a healthcare
professional acting on its behalf any information which is needed to deal with my claim
for benefit or any subsequent award.
Signature
Date / /
If you have signed this form for someone else, please tick here:
Important information about this leaflet
This leaflet is only a guide and does not cover every
circumstance. We have done our best to make sure that the
information in this leaflet is correct as of March 2010. It is
possible that some of the information is oversimplified, or may
become inaccurate over time, for example because of changes
to the law.
This report can be accessed online at:

www.dwp.gov.uk/fitnote
© Crown Copyright 2010
Published by the Department for Work and Pensions
30 March 2010
www.dwp.gov.uk

Fitnote Hospital Guide

Uploaded by

Copyright:

Available Formats

Fitnote Hospital Guide

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Fitnote Hospital Guide

Uploaded by

Copyright:

Available Formats

Statement of

Fitness for Work

Hospital doctors and sickness

The role of hospital doctors in

Examples where hospital doctors should

• when a patient is receiving treatment at a fracture clinic and

• when discharging a patient from hospital, as well as issuing

• patients who have mental health conditions and are under

Statement of Fitness for Work:

• including telephone consultations as an acceptable form of

• removing the option to say a patient is fit for work;

• introducing a new option: ‘May be fit for work taking

• increasing space for comments on the functional effects of

• changing the rules for issuing the Statement so that, during

• simplifying the current system by combining the Forms

What stays the same?

• the Statement remains advice from you to your patient;

• your patient can still use the Statement as evidence of

• the advice on the Statement is not binding on employers.

Not fit for work or may be fit for

If it is not possible for the employer to provide the support for

Why change? Improving your

Ordering more forms

Statement of Fitness for Work

I assessed your case on: / /

and, because of the

I advise you that: you are not fit for work.

you may be fit for work taking account

a phased return to work amended duties

altered hours workplace adaptations

Comments, including functional effects of your condition(s):

For the patient – what to do now

What your doctor’s advice means

National Insurance (NI)

This report can be accessed online at:

© Crown Copyright 2010

Published by the Department for Work and Pensions

You might also like