Health Assessment and Fit Notes
Occupational Health Clinicians are specialists in assessing health and fitness to work, understanding the inherent risks in the workplace, employment law and health and safety legislation.
Many small employers still rely heavily on Fit Notes and the opinion of the GP and treating specialist. Whilst OH will obtain information from treating medical practitioners where the clinical picture is unclear this is not required in most cases, and the opinion of the GP is not impartial.
Why an OH Health Assessment?
- The GP is the employees advocate -they owe allegiance to their patient, and can afford to take the patients word at face value. They are not contracted to advise the employer unlike Occupational Health.
- They are unlikely to have detailed knowledge of the workplace and how work can affect health and the employees’ health affects their work.
- GP’s have around seven minutes to assess a patient and can provide a repeat Fit Note without evaluation.
Impartial health assessment is the role of Occupational Health
Occupational Health Professionals use a range of skills and tools during a health assessment. We utilise listening skills, and verbal and visual observation. We compare the employee’s responses and history with the current medical evidence and what would be expected clinically. We check consistency, use validated assessment tools, and consider the evidence to ensure the assessment is robust and defendable. Most employees will have access to health assessment information from their GP or treating specialist in the form of consultation letters that provide information on diagnosis and treatment.
Some employers will ask for the GP to underpin or validate Occupational Health advice for example-does the GP agree with the phased return? They sometimes become concerned if they feel that the advice from Occupational Health diverges from a GP statement. On the other hand, many GP’s refer employers onto Occupational Health when a Fitness To work health assessment is needed.
Assessment of Fitness To Work- The Legal Aspects
Here is what Professor Diana Kloss, a barrister and expert in OH law has to say-
“May I point out that the GP or other health professional completing a fit note cannot state that a worker is fit to return to work, only that they are completely unfit or unfit unless adjustments are made. Advice that a worker is fit for work must be sought from an occupational health professional who is expert in such matters. Employers’ liability insurance companies are aware of this and accept an OH report on fitness, because they understand that the fit note cannot certify fitness for work.
OH must assess whether or not they are fit. If they decide they are fit that overrides the fit note so that the employer can allow them to return to work. Employers can rely on OH”s assessment that the employee is fit. OH are, or should be, experts on fitness for work, which most GPs are not because they aren’t trained in OH.”
Many employees will see their GP expecting an all or nothing ‘sick note’ which is effectively the Fit Note.
The reality is that many employees with be fit for some aspects of their job, they may be fit to return to work to reduced hours or duties for a timeframe that may not be always easy to predict at the point of health assessment. This situation will usually depend on the employer considering a range of adjustments that would support the employee to return considering the application of areas of employment law and the Equality Act, Disability Section (2010).
The role of Occupational Health will be to provide a rehabilitation plan and specific advice on adjustments that enables the employer to support the employee back into work earlier than might otherwise be expected.
