The Association of Occupational Health and Wellbeing Professionals​

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Position Statement: Enhancing Fit Notes for Improved Workforce Health and Productivity

By The iOH Board and Trustees

Published 22 April 2024


The Association of Occupational Health and Well-being Professionals (iOH) acknowledges Prime Minister Rishi Sunak’s proposal to review the fit note system. 

As multi-disciplinary and dedicated advocates for employee health and well-being, we recognize the importance of optimising fit notes to support individuals to remain at and return to ‘good’ work. In this position statement, we outline our evidence-based perspective on the matter.


Fit notes, also known as “sick notes,” play a crucial role in assessing an individual’s fitness for work. Currently, general practitioners (GPs) and regulated health professionals who have completed online training issue these notes based on their clinical judgment. However, the proposed shift toward involving unregistered work and health professionals warrants careful consideration.

Evidence-Based Perspectives

Collaboration and Referral:

  • We support the idea of involving multi-disciplinary qualified and registered health professionals in the fit note process. These specialists should receive appropriate training to address both physical and mental health aspects of functional impairment.

  • Collaboration between GPs, occupational health professionals, and employers is essential.

  • Fit notes should be part of a broader consultation, considering individual needs and workplace context.

GP Advice & Workload:

  • Doctors who complete Fit Notes are not currently expected to have specialist knowledge of workplaces or occupational health.

  • GPs face immense pressure, and fit notes constitute a significant part of their daily tasks. Delegating this responsibility to trained professionals could alleviate their workload.

  • GPs have insufficient time to assess the functional impact of their patient’s condition.

  • Primary care should remain engaged in the discussion, ensuring comprehensive health management for patients.

Dynamic Fit Notes:

  • Fit notes need to evolve into more dynamic tools. They should identify evidence-based adjustments and inform referrals to specialised support services and ensure collaboration and referral including being able to refer for early access to treatments such as physiotherapy, psychological therapies and vocational rehabilitation.

  • Occupational health professionals can provide tailored advice, accommodations, and return-to-work plans, promoting overall well-being.

Holistic Approach:

  • The reason for an individual’s absence from work often involves multifaceted factors. A personalised approach, considering health, work context, and employer collaboration, is crucial.

  • Fit notes should not be isolated documents but part of a holistic strategy to enhance workforce health and productivity.

Evidence on Work and Health:

  • Encouraging return to work, with appropriate adjustments, benefits both employees and employers

  • Research consistently shows that ‘good’ work positively impacts health.

  • It is essential that the workplace is integrated into rehabilitation.

  • Multi-modal medical rehabilitation decreases the risk of retirement on the grounds of ill-health.


iOH supports a consultation on evidence-based reforms to the fit note system. By involving trained specialists, fostering collaboration, and emphasising a holistic approach, we can enhance workforce health, reduce GP burden, and promote ‘good’ work & sustainable productivity.

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