What are the perceptions and experiences of nurses, occupational therapists, pharmacists, and physiotherapists certifying fit notes?

Problem

Legislation introduced in 2022 allows nurses, occupational therapists, pharmacists, and physiotherapists (NOPPs) to certify fit notes. The aim was to alleviate pressure on GPs and allow NOPPs to use their rehabilitation expertise to support patients to return-to-work (RTW). This is important because there are growing numbers of people who are economically inactive due to long-term sick absence. Research indicates that the longer someone is off work, the less likely they are to return. Furthermore, there are physical and mental benefits associated with working, as well as economic benefits for individuals and society.Aims: to explore the knowledge, experiences, and perspectives of NOPPs around certifying fit notes, identify barriers/facilitators that might affect fit note completion, and identify NOPPs’ training needs.

Approach

Qualitative methods enabled in-depth exploration of NOPPs’ experiences. Most participants volunteered to be interviewed after completing an associated survey; others were accessed through snowball sampling. Data were collected through semi-structured interviews/focus groups conducted online via Microsoft Teams and thematically analysed using framework approach, informed by the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Themes were discussed and agreed between the research team. PPI were involved in designing the interview schedule and associated documentation; they also contributed to analysis and dissemination of the findings.

Findings

One focus group and 18 interviews were conducted with nurses (n=3,12%), occupational therapists (n=12,48%), physiotherapists (n=9,36%) and pharmacists (n=1,4%). Two-thirds of participants (n=17, 68%) were experienced in certifying fit notes. Facilitators included NOPPs’ perceiving fit notes as tools for enabling patients to RTW and enthusiasm about the legislation change. They valued the opportunity to use their skills and enhance their professional role. Some participants accessed training through professional bodies, others independently sourced training. Some NOPPs were involved in creating guidelines for their healthcare organisations. Participants without fit note experience reported barriers including lack of policies/guidelines, poor communication about the legislation change and available training, being told it is not their role, concerns about legal implications, and lack of confidence.Other barriers included insufficient resources, e.g. time pressures when completing fitness-to-work assessments, and limited access to electronic forms. Online training was considered adequate, but participants suggested improvements e.g. topic-specific modules, interactive training sessions, and peer support.Interim conclusions:Despite the willingness of NOPPs to undertake fit note certification, the current lack of policy/guidelines is a barrier to implementing the legislation change. Further work is required to develop training courses/materials that provide NOPPs with relevant skills and knowledge to assess fitness-to-work and confidently certify fit notes.

Consequences

NOPPs’ enthusiasm for completing fit notes should be supported at organisation level. Organising training and implementing policies/guidelines would allow more NOPPs to certify fit notes, maximising potential benefits for general practice and patient care.