A recent change to legislation has meant that it is no longer only doctors who can issue fit notes to patients. The fit note, which replaces the term sick note (also known as a med3 form) can now be certified by a range of healthcare professionals if they have been trained and are working within their scope of practice. Not all health professionals will be working in an environment where they will be needed or able to issue these forms and some discussion has suggested that this will be likely only to be done in general practice where the non-medic is the person who is autonomously seeing their patient, meaning this may likely be an addition to the non-medical prescriber's roles and responsibilities.
This has provoked reaction from many quarters. The Health and Care Professions Council (HCPC, 2022) points out that the legislation is permissive so it does not mean that every registrant in the named professions will automatically be required to issue fit notes and that those who do should ensure they are working within their scope of practice and in line with their professional responsibility at all times.
However, the Royal Pharmaceutical Society (RPS) have some concerns regarding this new role and the increase in clinical demand this may place on their members. These concerns are around access to medical records, additional workload burden and the information the public has and that they are not ‘misled’ into thinking all pharmacists can provide this service (RPS, 2022)
The Royal College of Nursing (RCN, 2022) welcomes the legislation change that they have been pushing and influencing at many stages. They state that these changes will allow nurses to serve the needs of their patients and reduce unnecessary appointments with GPs.
However, the government guidelines are quite clear and the extensive list of contributors to the consultation bears testament to the rigour with which the process was managed. With effect from 1 July, nurses, occupational therapists, pharmacists and physiotherapists can certify fit notes in addition to doctors. The position of the government is that individuals should consider their scope of practice and ensure they have the relevant skills, knowledge and experience before undertaking health and work conversations and making decisions around certifying fit notes (gov.uk, 2022).
There is training involved for the fit note programme and all professionals who intend to certify must complete this alongside other resources that have been developed. This is to ensure that all professionals can develop the confidence and skills required and enable them to use their professional judgment to assess and manage this role. This is not just about the technical skills but developing, planning and self-management strategies with the patients Most of the professional bodies welcome this progress towards greater autonomy for some practitioners, improving access for patients and freeing up medical staff for other necessary clinical work. But the proof of the pudding will be in the eating and there will be careful observation of this move and its impact in general terms.