Fit note certification by physiotherapists

Can all physiotherapists now certify fit notes?

The legislation covers all qualified physiotherapists in the UK from the point of registration with the Health and Care Professions Council (HCPC).

Access to the version of the fit note set out in regulations (Med 3 forms) is limited to those with access to general practice IT systems or those working in NHS settings where they will be able to order paper pads of fit notes directly from DWP.

Does this mean all physiotherapists should now certify fit notes?

No. This change recognises the valuable role physiotherapists have in providing health and work advice and supporting people to stay in work where possible. However, not every physiotherapist should issue fit notes. You should be working in a suitable environment and have the necessary education, training and capability to have work and health conversations with patients. As with all clinical tasks, this must fall into your personal scope of practice and be appropriate to your role. To support you to identify if this is the case, guidance and training has been developed for you and your employer. While non-statutory, the CSP expects its members to complete the training and follow the guidance.

How do I access online training?

The online training is hosted by elearning for healthcare (elfh).  It is available to all physiotherapists and other relevant healthcare professions across countries and sectors.  If you do not already have an elfh account, you will need to register for one.  You do not need an NHS email address to do this. Registration provides access to the open content available on the platform which includes 'The fit note' and allows you to download proof of completion of the module.  

What do these changes mean for the Allied Health Professionals Health and Work Report? 

It does not change anything about this tool which can still be used as before, whereby provided a patient’s employer agrees it can evidence eligibility for statutory sick pay (see SSP guidance). The AHP Health and Work Report and the fit note are similar in content. HCPs familiar with the AHP Health and Work report should easily transition to certifying fit notes

Is this only for physiotherapists (first contact physiotherapists and advanced practitioners) working in general practice?

The majority of fit notes are issued in primary care therefore this legislative change will naturally have most impact on physiotherapists working in these roles. It will simplify the process of issuing and receiving a fit note for patients who have seen an FCP or AP and reduce the burden on GPs.

However, it may be appropriate to issue a fit note in different healthcare settings. The acute and secondary care sectors are particularly being encouraged to provide more fit notes to ease pressure on primary care. It is up to you to determine if it is appropriate to issue fit notes within your setting and according to the specific context of your individual patient. Use the guidance to help you, paying particular attention to whether access to the medical record would be necessary in that specific situation.

How do I practically issue a fit note within the NHS?

You can complete either a digital or paper fit note. This change follows amendment of the legislation in April 2022 to allow the issue of digital fit notes that no longer need to be printed and signed. Currently only physiotherapists working in general practice will be able to issue fit notes digitally, although there are plans to extend this system to secondary care. Systems are currently being updated to change the fit note format to include the signature of physiotherapists. Until then, it is acceptable to put your name next to ‘Doctor’s name’ but ensure you clearly state your role and profession after your signature. 

Please be aware that IT upgrades may be required to allow you access to the digital fit note. This will take time and will differ between countries and regions. It is a local decision whether you use paper fit notes in the interim or wait for the upgrade of your IT system.

Working in other NHS settings, you will need to order paper pads of fit notes to physically sign. See the DWP guidance on how to do this .

I work in private practice. Is it appropriate for me to issue fit notes to my patients?

It is not envisaged that private practitioners will routinely issue fit notes as this is a service freely available from general practice. However, if you are considering issuing fit notes you should be aware of the following:

• You should consider the guidance around appropriate access to medical records and mentorship recommendations
• You will not have access to the paper or digital form of fit note. You will have to produce a report that includes the information set out in regulations and complies with ‘the Rules’, which can then be considered ‘a form to like effect’ as a fit note. 
• Completing an AHP Health and Work Report may be more appropriate as it can allow for more detail to be included than a fit note
• If you provide a fit note to support a benefit claim, you may be asked to provide further evidence in relation to the assessment carried out on behalf of DWP. Claimants are told that they should not pay to get any additional medical evidence so you won’t be able to claim the cost of this work from the Department for Work and Pensions
• Fit notes are classed as advice. It is for employers to determine whether or not to accept them

Also see the DWP guidance.

I work in a private hospital, seeing NHS and private patients. Who can I issue a fit note to?

You can issue the Med 3 version of a fit note to NHS-funded patients using a paper pads ordered from DWP. You should speak to your employer about your local policy relating to the issue of fit notes for private patients.