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Fit to work with limitations: where do they fit in?

Date posted
29 April 2024
Dr Karen Michell
Estimated reading time
3 minute read

UK Prime Minister Rishi Sunak recently announced plans to reform the welfare system, drawing criticism from many organisations. Dr Karen Michell, Research Programme Lead (Occupational Health) at IOSH, gives her view.

The debate around the culture of signing workers as unfit for work when there is potential for them to return with modified duties and/or reduced hours is a complex and emotive issue. This is not a new debate as reform to the process was made in 2010 when the sick note terminology was changed to ‘fit note’ in an effort to prevent unnecessary sickness absence from work and support workers with phased return to full duties.

We need to address the culture of signing workers off on unnecessary prolonged sickness absence. The intention behind the fit note is not to force workers who clearly cannot work into the workplace but rather to allow those who could continue to work with accommodations, the opportunity to do so. We know these options are available and would form part of the rehabilitation process, but the problem comes with implementation.

For a GP who is already struggling with their regular patient load, a ten-minute consultation is hardly the opportunity to assess what workplace adjustments should be made or how the worker could be accommodated. GPs, who lack the insight of workers’ jobs, are not well positioned to make specific recommendations and, as a result, offer generic options. Added to this is the fact that even when health professionals do make recommendations the employer is often unsure how to implement these without exposing themselves to potential litigation if things go wrong.

This is where the occupational health (OH) and safety services within a company are invaluable. These specialists are a diverse group of professionals with a clear understanding of the job demands and who, in collaboration with the treating health professionals (e.g. GPs and orthopaedic surgeons) are not only able to assist the employer with the accommodations but also support the worker throughout the return to work. The OH professional then consults the employer representative to monitor a worker’s progress allowing for modifications to the health care plan as the worker progresses.

Currently, it is estimated that only 45 per cent of workers in Great Britain have access to OH services. In small and medium-sized companies, this representation may fall as low as 18 per cent1. Without the support of OH services the ability to safely support these workers with accommodated returns to work is challenging. It was reported that of the 11 million fit notes issued last year, 94 per cent were assessed as ‘not fit for work’2. It would be interesting to see how many of the 94 per cent have access to OH services in the workplace.

These statistics further support the need for policy change. GPs are an important link to the workplace, but they need to be given the skills and capacity to address occupational issues, especially the more complex ones. The capacity to provide OH services in the workplace needs to be expanded, especially for small and medium-sized companies. These changes require creative collaboration from all stakeholders to move away from unnecessary long term sickness absence while supporting workers to achieve optimum health and longevity in the workplace.


  1. UK Government. Occupational Health: Working better. 2023. Available from Accessed 19 April 2024.
  2. Mason, R and Butler, P. 2024. Sunak to cite Britain’s ‘sicknote culture’ in bid to overhaul fit note system Available from:,%E2%80%9Cnot%20fit%20for%20work%E2%80%9D. Accessed 19 April 2024

Last updated: 03 May 2024

Dr Karen Michell

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Research Programme Lead (Occupational Health)

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