Skip to main content

Research Repository

Advanced Search

Recommendations to facilitate the ideal fit note: are they achievable in practice?

Coole, Carol; Nouri, Fiona; Potgieter, Iskra; Watson, Paul J.; Thomson, Louise; Hampton, Rob; Drummond, Avril


Carol Coole

Iskra Potgieter

Paul J. Watson

Rob Hampton

Professor of Healthcare Research


Background: Although the UK fit note has been broadly welcomed as a tool to facilitate return to work, difficulties and uncertainties have resulted in wide variation in its use. Agreement on what constitutes the ‘ideal’ fit note from the perspective of all stakeholders is needed to inform best practice. A recent Delphi study conducted by the authors reached consensus on 67 recommendations for best practice in fit note use for employed patients. However, such recommendations are not necessarily followed in practice. The purpose of this study was therefore to investigate the perceived achievability of implementing these Delphi recommendations with a further reference panel of stakeholders.
Methods: Potential participants were identified by the research team and study steering group. These included representatives of employers, government departments, trades unions, patient organisations, general and medical practitioners and occupational health organisations who were believed to have the knowledge and experience to comment on the recommendations. The consensus Delphi statements were presented to the participants on-line. Participants were invited to comment on whether the recommendations were achievable, and what might hinder or facilitate their use in practice. Free text comments were combined with comments made in the Delphi study that referred to issues of feasibility or practicality. These were synthesised and analysed thematically.
Results: Twelve individuals representing a range of stakeholder groups participated. Many of the recommendations were considered achievable, such as improved format and use of the electronic fit note, completion of all fields, better application and revision of guidance and education in fit note use. However a number of obstacles to implementation were identified. These included: legislation governing the fit note and GP contracts; the costs and complexity of IT systems and software; the limitations of the GP consultation; unclear roles and responsibilities for the funding and delivery of education, guidance and training for all stakeholders, and the evaluation of practice.
Conclusions: This study demonstrated that although many recommendations for the ideal fit note are considered achievable, there are considerable financial, legal, organisational and professional obstacles to be overcome in order for the recommendations to be implemented successfully.


Coole, C., Nouri, F., Potgieter, I., Watson, P. J., Thomson, L., Hampton, R., & Drummond, A. (2015). Recommendations to facilitate the ideal fit note: are they achievable in practice?. BMC Family Practice, 16(138),

Journal Article Type Article
Acceptance Date Oct 6, 2015
Publication Date Oct 13, 2015
Deposit Date Jul 22, 2016
Publicly Available Date Jul 22, 2016
Journal BMC Family Practice
Electronic ISSN 1471-2296
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 16
Issue 138
Article Number 138
Keywords Fit note, Sickness certification, Statement of fitness for work, Recommendations, Achievability, Implementation
Public URL
Publisher URL
Related Public URLs
Copyright Statement Copyright information regarding this work can be found at the following address:


Coole et a;.pdf (460 Kb)

Copyright Statement
Copyright information regarding this work can be found at the following address:

You might also like

Downloadable Citations