Work and Benefit

Question 1

What do you write for the ‘condition’ part of a Fit Note for a patient?

Answer 1

the problem that means the patient can’t go into work e.g. fractured ankle

give as accurate a diagnosis as possble, unless you think precise diagnosis will damage your patient’s wellbeing or position with their employer

Question 2

What are the 2 key options that you can choose from when filling out a fit note?

Answer 2

1. You are not fit for work
2. You may be fit for work taking into account of the following advice

Question 3

What are 4 possible recommendations for patients who are fit to work with advice?

Answer 3

1. Phased return to work
2. Altered hours
3. Amended duties
4. Workplace adaptations

Question 4

Can you back date a fit note, even if you didn’t assess the patient at the time?

Answer 4

yes: if the patient has been assessed by another clinician, you can back date the form - includes letters from A and E or hospital admissions e.g. surgery

need to put date assessed at date seen originally

Question 5

Do patients need notes to say they can work?

Answer 5

no - if after a shared decision patient wants to go back to work, they can as long as the fit note has run out

if employers insist for this note, and you have no concerns about person returning, they can request a private note

Question 6

What should determine how long you are writing a fit note for?

Answer 6

may be advisable to write for longer time e.g. 4 weeks- 8 weeks if patient wil have difficult in collecting and sending another form before current one ends

Question 7

If a patient in unemployed but needs a fit note e.g. for benefit reasons, where do they need to take the completed form?

Answer 7

Local Job Centre Plus - need to see advisor there to help look at benefits

Question 8

What are 5 types of benefits that someone not working due to illness may be entitled to (depending on the situation)?

Answer 8

1. Employment Support Allowance: if ill and unable to work (being phased out and replaced by universal credit)
2. Personal Independence Payments PIP - may be entitled if have chronic illness lasting longer than 3 months and expected to last longer than 9 months, affecting mobilities or activities of daily living. In addition to ESA/universal credit
3. Universal credit: can get ESA or universal credit
4. Statutory sick pay: only entitled if in employment
5. Income support: if not receiving any other benefits and doing <16h or no hours a week

Question 9

What are 4 benefits of the fit note?

Answer 9

1. Can help manage patient’s expectations about their capability for work
2. Give clear clinical assessment to patient about impact of their condition on their fitness for work
3. Improve likelihood of patient keeping job, by helping them discuss ways they could be supported at work with their employer
4. Support role work can play in patient’s health

Question 10

After what time period is a fit note issued?

Answer 10

don’t need to issue for first calendar days of sickness absence- can self-certify for this period

Question 11

What are 8 types of functional limitations of a patient’s health condition to consider writing in the note?

Answer 11

1. Stamina e.g. better in morning or afternoon
2. Mobility e.g. walking, bending, stooping
3. Agility e.g. dexterity, posture, co-ordination
4. Insight or stability e.g. mental state, mood
5. Treatment e.g. side-effects, duration of
6. Intellectual e.g. cognitive abilities
7. Sensory e.g. hearing, vision, touch

Question 12

When should you consider ticking the ‘may be fit for work taking account of the following advice’ box?

Answer 12

if patient could do some form of work (not specifically current job) - gives maximum flexibility to patient and employer to discus ways to accommodate condition e.g. changing duties, reducing hours

Question 13

Why is it important to discuss patient beliefs about health and work?

Answer 13

emphasise advanages to patient’s health of being at work; sometimes reluctance to consider work stems from belief it will exacerbate/delay recovery

can ease apprehension

could also be issues at work- you can refer them to other available support, including specialist occupational health services

Question 14

What is the maximum length of time for a fit note?

Answer 14

in first 6 months of condition, can cover maximum of 3 months

if condition lasts longer than 6 months, can be for any clinically appropriate period up to ‘an indefinite period’

Question 15

If you specify a particular start and end date for time of work (rather than period e.g. 2 weeks) how does this work in terms of dates included?

Answer 15

it is inclusive e.g. if up to 10 April, will no longer apply from 11 April onwards

Question 16

For the fit note, how does the date of the statement differ from the date in box 1 with the ‘date of assessment’?

Answer 16

you may have assessed patient on different date from filling in the note

Question 17

What is important to include in the free text section of the fit note?

Answer 17

advice about the functional effects of patient’s condition on their fitness for work

give advice as practical as possible

don’t need to refer to current job; only refer to it if you feel it may be affecting their health + why

don’t be too prescriptive

Question 18

How can the tick boxes on the fit note e.g. phased return, altered hours etc. by used by the ptient?

Answer 18

not binding to patient and employer but help give broad idea about changes to discuss

Question 19

How can patients use their fit notes? 6 ways

Answer 19

1. if employed and you’ve indicated not fit for work, they can use it to claim sick pay
2. can keep note in case they need it for benefit or other purposes
3. if patient employed and may be fit for work, they should discuss your advice with their employer to se if there are changes that could support them
4. if employer can’t make changes to accommodate your advice, fit note is treated as if it stated that your patient was not fit for work - don’t need a new fit note
5. if out of work, can use fit note to support a claim for health-related benefits or show they’ve been unable to fulfil certain benefit requirements
6. can use in discussion with prospetive employers about supporting health condition

Question 20

What are 6 types of benefits that universal credit is replacing?

Answer 20

1. Child Tax Credit
2. Housing Benefit
3. Income Support
4. income-based Jobseeker’s Allowance (JSA)
5. income-related Employment and Support Allowance (ESA)
6. Working Tax Credit