Exploration of GPs' views and use of the fit note: a qualitative study in primary care

Background: Sickness certification constitutes daily clinical practice for GPs. In April 2010, the UK sickness certification system changed to reflect the evidence that work is generally good for health and a new Statement of Fitness for Work - the 'fit note' - was introduced. Sickness certification is a contentious topic among GPs and the proposed fit note generated mixed reviews. Aim: To explore GPs' views and use of the fit note during its first year of operation. Design and setting: Qualitative interview study of GPs based in different geographical locations across the UK. Method: GPs (n = 15), who were recruited from a national sample, participated in semi-structured telephone interviews which were subject to constant comparative analysis. Results: Overall, the fit note was well received. GPs recognised that work is generally good for health and felt the fit note facilitated using an earlier return to work as a negotiation tool. GPs perceive employers as the major obstacle to early return to work. There were reports of scepticism towards the system that negatively impacted on some GPs' operation of sickness certification. Feedback over the fit note's impact on employer behaviour and the return of a mechanism that enables GPs to request early independent assessments would be welcomed. Conclusion: A revised approach is needed to address the scepticism towards the sickness certification system that persists among some GPs. New strategies need to be designed to engage employers in facilitating an early return to work and to enable the objectives of the medical statement reforms to be achieved.