New study finds GPs need more training to make better use of fit note

Press Releases

12 Jun 2013

Over a third of fit notes issued by doctors are for mild-to-moderate mental health disorders, the new research also found. Conditions such as depression, stress and anxiety appear to be a growing cause of sickness absence, according to a major study from the Institute for Employment Studies (IES) and the University of Liverpool conducted for the Department for Work and Pensions (DWP).

Patients living in more socially deprived areas were much more likely to be diagnosed with a mild-to-moderate mental health disorder, most likely depression, with 41 per cent of fit notes being issued for this reason. However, for those living in better off neighbourhoods, fewer than 31 per cent of fit notes were issued for this type of health problem and it was most likely to be for stress. The research also found that women were more likely than men and younger people were more likely than older people to receive a fit note for a mental health condition.

The research, examining the impact of the new fit notes, which replaced the traditional 'sick note' in 2010, found evidence that the new system is having a positive effect in reducing long-term sickness absence. However, the study also found considerable variation in how GPs use the new option, which, where appropriate, enables them to recommend that somebody 'may be fit for work' and to advise on changes that could help people return to work sooner.

Commenting on the results of the study, Jim Hillage, Director of Research at IES and one of the authors of the report, said:

‘Most people who need a fit note get one lasting four weeks or less. However, about one in five sickness absence episodes, last for over 12 weeks and four per cent last longer than 28 weeks. Older people, males and those living in areas of social deprivation are the most likely to have a long-term sickness episode.

‘Although the proportion of longer-term medical statements seems to be falling, long-term sickness absence is still a significant problem for individuals, their employers and the economy. While there is some evidence that the introduction of the fit note is starting to have a positive effect on long-term sickness absence, our study suggests that with further training and guidance for GPs, particularly in relation to mental health disorders and work, the effect could be even greater.’

Other key findings from the report include:

  • Fit notes issued to patients in the most socially deprived neighbourhoods were nearly five times more likely to be long term than those issued in the least socially deprived areas.
  • After mental health problems, the most cited reason for sickness absence was back problems, with 11 per cent of patients being issued a fit note for this reason, followed by ten per cent for respiratory conditions.
  • Male patients were 72 per cent more likely to receive a long-term fit note (over four weeks) than females.
  • Fit notes issued to older patients were significantly more likely to be long term.
  • Nearly 12 per cent of all patients received at least one fit note which advised that they 'may be fit for work'.


The full report is available from the Department for Work and Pensions website:

For interviews with the authors or further information, please contact: Lorna Hardy: 01273 763 414 or

Note to Editors

A new medical statement (the Statement of Fitness for Work - known as a 'fit note'), was introduced on 6 April 2010 across England, Wales and Scotland. Medical statements are issued by doctors as evidence of the advice they have given on an individual's fitness for work and are the normal method for employees to provide evidence of sickness to employers after the seventh day of absence. The new fit note has the option to record that an individual 'may be fit for work taking account of the following advice' and to indicate basic adjustments that could aid return to work.

The fit note was introduced with the aims of improving back to work advice for individuals on a period of sickness absence; improving communication between individuals, general practitioners (GPs), and employers on what a patient could do at work and thereby reducing the length of sickness absence and getting people back to work more quickly.

As part of the broader programme of evaluation, the Institute for Employment Studies (IES) and the University of Liverpool were commissioned by the Department for Work and Pensions (DWP) to conduct a quantitative assessment of the fit note to strengthen the evidence base on sickness certification and sickness absence. To achieve this 49 GP practices in five areas of Great Britain collected the data from 58,700 fit notes distributed to 25,000 patients over a 12-month period between October 2011 and January 2013.

The study replicated the method used in a previous study of practices in the Liverpool area (See Shiels, C., Gabbay, M.B. and Ford, F.M. (2004) 'Patient factors associated with the duration of certified sickness absence and transition to long-term incapacity' British Journal of General Practice, February 2004, 54, 86-91). Report reference: Shiels C, Hillage J, Pollard E and Gabbay M Evaluation of the Statement of Fitness for Work (fit note): quantitative survey of fit notes, DWP Research Report 841, 2013

About IES

The Institute for Employment Studies is the UK’s leading independent, not-for-profit centre for research and evidence-based consultancy on employment, the labour market, and HR policy and practice.

About Jim Hillage

Jim Hillage leads the Institute for Employment Studies’ work on UK public employment policy. He draws on over 30 years’ experience of researching into labour market and employment issues from an individual and an employer perspective, and evaluating the direct and indirect effect and impact of a range of policy interventions on employers, individuals and intermediaries.