This is a ‘cumulative’ data collection. Weekly data will continue to be added to the existing database. The value of data items may change as data is added.
- Number of fit notes may increase as historical data is received
- Fit note episode duration may change if there is issue of new fit notes for a patient.
Where patients change GP practice their new fit notes will be extracted by the supplier from the new practice. If records have been transferred by GP2GP, the linking ID will allow linkage of these patients fit notes. Where records are manually transferred to the new practice, the linking ID is not expected to continue.
All data for all reporting periods is updated in each quarterly publication. From April 2019 all publications will contain data from practices who have TPP as their system supplier (which was not previously available) and accounts for one third of practices in England, consequently publications from this date may not be comparable to previous publications.
In April 2020 - 14 NHS England Regional Local Offices were replaced with 42 Sustainability and Transformation Partnerships (STPs) as the higher-level health authority, in addition of the 191 CCGs some merged to create 135 CCGs. Learn more about these geographical changes.
In April 2021 - a series of mergers took place across 38 CCGs resulting the the number of CCGS falling from 135 to 106. These mergers have a legal date of 1 April 2021 but an operational date of 1 October 2021 for this reason the Q3 2020-21 publication does not contain CCG mapping consistent with the new configurations as many are not yet operational. This has resulted in a slightly higher number of unallocated fit notes for 2020-21, but this is less than 0.02% of fit notes issued.
The expectation is there will be fewer fit notes issued during the coronavirus (COVID-19) outbreak from March 2020 due to several factors, e.g. shielding, self-isolation or furlough .
Table 1: The number of fit notes issued, Q3 2019-20 compared to Q3 2020-21
Fit notes are used as medical evidence for employers on a patient’s fitness for work or to support a claim for health-related benefits through the Department for Work and Pensions (DWP). During the COVID-19 outbreak the only instances where GP practices can issue fit notes are for patients who:
- have a pre-existing fit note that is not related to COVID-19 and need to be reviewed
- need a fit note for any reason not related to COVID-19
Isolation notes rather than fit notes provide employees with evidence for their employers that they have been advised to self-isolate due to coronavirus, either because they have symptoms or they live with someone who has symptoms, and so cannot work.
Data is not available for number of people shielding; in receipt of an isolation note or furloughed who were in employment or in receipt of benefits prior to the advent of COVID-19, consequently it is not possible to ascertain the impact on the number of fit notes issued. Patients who became unwell not due to COVID-19 whilst they were shielding in isolation or furloughed and would normally need a fit note may not need one.
Those in employment would not receive a fit note in the following cases:
- Shielding - clinically extremely vulnerable patients are advised to take extra precautions during the peak of the pandemic in England. This is known as ‘shielding’
- “People who are ‘Shielding’ can continue to work from home if they are able to do so. If not, the letter advising them to shield can be used as proof of their inability to work not a fit note.”
- Self-isolation is when do not leave home because they have or might have coronavirus (COVID-19) for example they
- have symptoms of coronavirus
- live with someone who has symptoms of coronavirus
- are in a support bubble with someone who has symptoms of coronavirus
- have been told to self-isolate by a test and trace service
- If an employee is well enough to work, and can work from home, they do not need an isolation note
- Will get an isolation note if needed, not a fit note
- Furloughed - If employer and employee agree, the employer might be able to keep the employee on the payroll even if they are unable to operate or have no work for you to do because of coronavirus. This is known as being ‘on furlough’
- Employers can claim for staff furloughed from 1 March 2020
- Will not be issued with a fit note
Similarly, those not in employment may be shielding or in self isolation in which case the letter advising them to shield, or the isolation note would be used as proof rather than a fit note. For people who need to claim benefits including Employment and Support Allowance (ESA) or Universal Credit (UC) due to COVID-19 no fit note is required.