Fit notes for patients

Legislation changed last year to allow all registered physiotherapists to certify fit notes. However, this does not mean all physiotherapists should.  You must consider several factors before incorporating this into your practice.

To work within HCPC regulations and CSP guidance, before increasing your scope of practice you should ensure any gaps in your knowledge, skills or experience are addressed with additional training or support as may be appropriate. Training needs will vary but as a minimum, the CSP expects all physiotherapists to have completed the Fit Note learning module. Additional training should be sourced if required.

The Department for Work and Pensions (DWP), working with the CSP and other professional bodies, have produced official guidance that explores areas such as governance.  Areas to consider include mentorship, work-based experience and access to patient records or relevant medical history. This guidance will help you to determine if your work setting and governance arrangements are appropriate for you to issue fit notes.

Med 3 forms (fit notes) can be issued electronically or via paper pads, which can be sourced by NHS providers only via the DWP website. Guidance for how private practitioners can issue an equivalent ‘form to like effect’ is available on our website.

Alternatively, the AHP health and work report continues to be available as evidence for eligibility for statutory sick pay (subject to agreement by the patient’s employer) but not health-related benefits. We would encourage members to continue to use these reports where appropriate as they allow for more detail than a fit note.

Through the delivery of personalised care, physiotherapists are ideally placed to discuss work and health. While being able to certify fit notes enables this, conversations that can give patients the confidence and strategies they need to stay in or return to work are of greater value.