Fit notes: nurses now among professionals able to issue

Registered nurses, pharmacists, occupational therapists and physiotherapists are now able to sign fit notes, along with doctors. The new legal powers apply in England, Wales and Scotland, and are being mirrored in Northern Ireland.

The UK government says the move, agreed with the professions involved, will ease pressure on GPs and help reduce bureaucracy. It will “support and empower” better conversations about work and health between employers and staff by making it easier to get advice from the most relevant health professional. Digital signatures on fit notes are now also allowed.

The RCN has been involved in discussions about the changes from the start. “We have been pushing and influencing for this to happen,” says Head of Nursing Practice Wendy Preston.

“Nursing staff are often the first people patients see, particularly in primary care and especially those living with a long-term condition who may need time off to manage their condition at times.”

She adds: “These changes will allow nurses to serve the needs of their patients and reduce unnecessary appointments with other health care professionals.”

All registered nurses will be eligible to issue fit notes once they have completed a learning programme. But Wendy says in reality it is likely to be only those in certain settings – such as general practice, occupational health and some specialist areas of secondary care – who will use the new powers. It will be as part of existing assessment, management planning and evaluation of care rather than a stand alone task.

“This is a good move but not everyone is going to need or be pressured to do it,” she says. 

New government guidance for health care professionals explains the central part that work can play in maintaining wellbeing. The guidance said: “There is also strong evidence that long periods out of work are associated with poor mental and physical health, increased use of health services and poverty.”

It adds that extending legal powers to issue fit notes is an acknowledgement of the key role other health professionals play in supporting patients to manage their own health and wellbeing.

An e-learning training programme has been developed, again with input from the RCN, to support all the professions involved, including doctors, in building their knowledge and skills in relation to issuing fit notes.

Any health professional who intends to certify and issue fit notes should complete the training modules and undergo a period of “structured mentorship and support”, says the government guidance.