The 18 - 65 year old patient population is used as a proxy for working age for calculations per 100,000 GP practice population.
Fit notes are issued to show to an employer for sick pay purposes or to claim sickness related benefits from DWP. The age of the patient is not part of the fit note data collection but a fit note is generally only required for a person who is of working age.
There are two gaps in the data.
- Data from patients who have made a prior objection to their data leaving the GP practice for purposes beyond their direct care are excluded. Data collection for any patient who registers an objection subsequently will be excluded from the point this is registered. We do not know how many patients have made an objection, nor any of their characteristics.
- Data for the period 29 January 2018 to 4 March 2018 for GP practices with Cegedim Healthcare Systems as a system supplier have been under-reported due to a technical issue, consequently no data submissions were received practices using Cegedim system supplier from during this period.
- Data for the period 01 April 2021 to 30 June 2021 for GP practices with Cegedim Healthcare Systems as a system supplier have been under-reported due to a technical issue, therefore suppression may have been applied to Sub Integrated Care Board Locations where only 1 practice does not have Cegedim Healthcare Systems as their system supplier. Cegedim accounted for less than 1.5% of practices during this period.
This will only impact on fit notes for this period, episodes may be impacted for longer. For this publication, an episode can consist of a single fit note (where there is more than seven days between the end of one fit note and the beginning of the next) or of many fit notes where there is more than one fit note and there are less than eight days between the end of one fit note and the beginning of the next.
Episode data may be impacted as:
- episodes consisting of one fit note will be under-reported
- episodes which started before this period and consist of more than one fit note may end early due to the lack of a continuation fit note
- episodes which started during this period and consist of more than one fit note where the starting fit note was not reported would result in the number of fit notes in the episode being under-reported.
Reasons fit notes have been excluded from the publication
Where data was received from a single practice in an Sub ICB, all fit notes from that practice have been excluded from the publication. This is to ensure individual practice information is not included.
Fit notes with a missing Linking ID (an anonymised identifier for an individual patient) have been removed due to failing basic data quality checks.
Fit notes which mapped to ICD-10 chapter XXII (Codes for Special Purposes) have been excluded from this publication.
Duplicated fit notes
There are number of fit notes that have the same content and were issued at the same time to the same person. Each fit note has a different unique ID consequently all of these are included in the count of fit notes, but they account for less than 1% of the total number of fit notes issued each month.
The underlying cause of this duplication is not known, and the investigation is ongoing, but it has been impacted by the advent of Coronavirus (COVID-19).
Profession of Issuer
Since 1 July 2022 healthcare professionals other than GPs can issue a fit note. These are nurses, occupational therapists, pharmacists and physiotherapists. Data relating to fit note 'issuer profession' will be collected from January 2023 and under go data quality checks before being published in due course. The timescale for publication being dependant on the quality and completeness of the data being supplied.
Whole professions are named in the legislation, as it was not possible to set out in the legislation any sub- sets of those involved. Any registered practicing doctor, nurse, occupational therapist, pharmacist or physiotherapist can legally certify a fit note.
Fit notes are not part of the NHS services which community pharmacies provide and community pharmacists will not/do not have access to the ‘Med3’ - which is the technical name for the fit note provided for free under NHS provision.
Fit notes should only be certified following a full assessment of a patient’s fitness for work, and therefore should be provided by a clinician with a holistic oversight of the individual’s condition. Pharmacists working in multidisciplinary teams within general practices or hospital settings who can assess patient’s fitness for work, will have access to the official Med3 form. Pharmacists intending to issue fit notes should make sure that they complete the appropriate training and meet the standards for pharmacy professionals set out by the regulator.
The intention is that ‘where’ the fit note is certified will remain the same but there will be a wider range of healthcare professionals ‘who’ are able to certify the notes.