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BMJ Open Qual. 2018 Jan 9;7(1):e000220. doi: 10.1136/bmjoq-2017-000220. eCollection 2018.

Sick Note to Fit Note: one trust's project to improve usage by hospital clinicians.

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Postgraduate Medical and Dental Education Department, King's College Hospital NHS Foundation Trust, London, UK.



In April 2010, the government introduced a new Statement of Fitness to Work or 'Fit Note' for patients requiring time off of work or adaptations to their work due to illness. Responsibility to issue these documents has shifted from primary to secondary care. Hospital clinicians are required to issue for inpatients and for outpatients where clinical responsibility has not been taken over by the general practitioner (GP). However, awareness of this change is lacking. Misdirecting patients to their GP for the sole purpose of receiving a 'Fit Note' is an unnecessary use of appointment time and negatively impacts on patients. King's College Hospital NHS Trust receives a number of quality alerts from primary care regarding this issue.


A trust-wide educational initiative was designed and implemented to increase staff awareness of Fit Notes and their correct usage in order to reduce the number of patients being misdirected to their GP to obtain one. Interventions included direct staff engagement, a trust-wide promotional campaign and creation of an electronic version of the document.


Uptake of the electronic version of the Fit Note has steadily increased and there has been a fall in the number of quality alerts received by the trust. However, staff awareness on the whole remains low.


Patients being misdirected to their general practice for Fit Notes is an important issue and one on which the baseline level of awareness among hospital clinicians is low. Challenges during this intervention have been in penetrating a trust of this size and getting the message across to staff. However, digitising the Fit Note can help to increase its use.


hospital medicine; medical education; patient-centred care; primary care; quality improvement

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