Statements of fitness for work and the advanced nurse practitioner

Published: 24 September 2012

In 2010, a new Med 3 (now often referred to as a ‘fit note’, and more correctly ‘statement of fitness for work’) is required after the seventh calendar day of absence. During the first six months of absence a GP can issue a Med 3 indicating the individual is unfit for a maximum of three months. After the first six months of incapacity, a statement can be issued for any clinically appropriate period up to an indefinite period.

The Med 3 can also be issued following a face-to-face consultation, a telephone consultation or on the basis of information obtained from another clinician (for example a specialist report). Only a registered medical practitioner can legally issue a Med 3. A fundamental principle of sickness certification in the United Kingdom is that GPs provide advice on fitness for work as an integral part of the clinical management of a patient’s condition (www.dwp.gov.uk).

Hayden Marriott urges his nurse practitioner colleagues, particularly those whose clinical responsibility encompasses the entire episode of patient care from admission to discharge, to consider the following:

Since 2006, independent and supplementary non-medical prescribers in the UK have been able to prescribe freely for any medical condition within their scope of practice and competence. Since May 2012 this right has been extended to include schedule 2-5 controlled drugs. These developments allow experienced and suitably qualified nurses to help patients effectively, using skills and experience to perform work that has traditionally been done by our doctor colleagues.

However there remains a further barrier to cost-effective care for our patients - it is still a legal requirement that only GPs sign Med 3 certificates.

This situation can be extremely frustrating for the patient who, having been assessed and managed by a suitably-qualified clinician, has then to see another member of the team should they need a period of formal absence from work.

For many years the RCN has lobbied for nurses to be able to sign the Med 3 certificate, but no positive outcome has yet been achieved.

From the nurse perspective, we are trained and trusted to manage a patient’s care, prescribe drugs, and (in secondary care) admit/discharge a patient to and from hospital, but we cannot yet legally sign a document which supports the patient to have adequate time to rest and recuperate from the same condition.

At a time when the whole issue of ‘fitness to work’ is under scrutiny it clearly makes sense to assist the patient and make cost-effective use of existing resources. I urge nurse practitioners to read and sign the online petition Nurses to sign fit notes, forward it to as many colleagues as you can, post it on social networks using the easy click buttons on the e-petition web site, and also write to your local politicians and media, or the Department for Work and Pensions and push the issue forward in any way you feel may help.

Hayden Marriot, Nurse Practitioner