For many years, the GP "fit note" has been viewed as a necessary but often frustrating formality. While it serves a clear medical purpose, it frequently lacks the practical detail required to help an employer and employee navigate a successful return to the workplace. Issued by overstretched GPs, the document tends to indicate what a person cannot do, rather than providing a constructive roadmap for what they can.
Sir Charlie Mayfield, the former chair of John Lewis, is leading a drive to establish national standards for "stay-in-work" and "return-to-work" plans, with the aim of creating a credible alternative to the traditional medical certification route. This initiative, backed by the government, seeks to address the staggering 2.8 million people in the UK currently economically inactive due to long-term health conditions.
Dismantling the "Firewall"
Sir Charlie has characterised the current system as a "firewall" that can inadvertently prevent open dialogue between managers and staff. With 93% of patients currently signed off sick by their GPs, the Work and Pensions Secretary, Pat McFadden, has suggested a shift towards assessments by non-medical practitioners, individuals who are trusted by the patient but who have a more direct focus on vocational reintegration.
A "vanguard" group of 60 major companies, including Tesco, Ford, JLR, and British Airways, are already trialling a new Workplace Health Provision (WHP) service, with costs estimated at £60 to £180 per employee annually. The end goal is a certified standard that could eventually involve tax breaks or sick pay rebates for participating employers.
Legal Friction Points
While the prospect of more practical guidance is welcome, the move towards non-medical assessors and standardised plans introduces several legal friction points:
- The Expertise of the Assessor: A move away from medical practitioners raises questions about the ability of assessors to correctly identify underlying health conditions that meet the "disability" threshold under the Equality Act 2010.
- Standardisation vs. Individualisation: The duty to make reasonable adjustments is inherently individualised. Employers must ensure that a "common standard" does not override the specific, unique needs of the employee.
- Support vs. Monitoring: There is a risk that "stay-in-work" plans could be perceived as a disguised form of performance management. For those with chronic ill health, a plan that feels too focused on monitoring rather than support could trigger claims under Section 15 of the Equality Act.
- Privacy and Trust: Shifting the assessment process requires a high degree of trust. Employees must feel safe disclosing health information without fear it will be used in future restructuring exercises.
The Cultural Component
As Lisa Sharman of St John Ambulance recently noted in the FT, management plans are often seen as top-down interventions. To bridge the gap for chronic ill health, a "bottom-up" layer of peer support, such as training colleagues in Mental Health First Aid (MHFA),is vital. Peer dialogue can catch emerging issues before they reach the stage of a formal "firewall" or absence.
Practical takeaways
- Treat the standardised plan as a starting point only: the individual's specific health needs stay the priority.
- Train managers to run these plans as support, never as Performance Improvement Plans.
- Document the consultation as it happens: a supportive plan built on genuine consultation is the employer's best defence to a failure-to-adjust claim.
The fit note was designed for a world of acute illness and short absences. The world it now serves is one of chronic conditions, fluctuating capacity, and employers who need more than a tick box. Whether Mayfield’s standards fill that gap depends on whether they can be individualised in practice, because the Equality Act will not forgive a template that ignores the person.