Fit For Work - What You Need To Know

By Kathryn Adderley
11 Oct 2022

According to the NHS, in the first month of 2022, 539,300 business days were lost due to mental health.

In 2016, a new scheme was rolled out to help improve increasing rates of sick leave. However, the “Fit for Work” scheme closed in 2018. This is no longer a viable option, and new processes are in place for assessing whether staff are fit for work.

While many organisations already invest in occupational health (OH) services, many don’t. The lack of a fit for work scheme, and no OH services, mean many employers struggle to return staff to work. Others are left struggling with heightened unnecessary time off for sick leave.

In this article, we’ll take a look at what replaced the Fit for Work scheme, provide advice on managing sick leave, and explore the new rules on fit notes.

What is fit for work?

Fit for Work scheme

The Fit for Work scheme helped employers cut back on problematic employee sick leave. The aim behind this was to increase the productivity and workload of the entire company. The Fit for Work scheme would refer certain employees for an Occupational Health Assessment. Any staff member who was, or was likely to be, off work for more than four weeks could be referred.

While the Fit for Work scheme is no longer applicable, the process remains almost the same. If someone is off sick for four weeks or more, you may refer them for an occupational health assessment.

While you can refer an employee to occupational health at any time, they must consent to the assessment.

Process for assessing fitness to work

Employees can self-certify their sick leave for the first week of their absence. Afterwards, they must obtain a fit note from a medical professional.

Here’s how sick notes should be used: 

Doctors Note

Fit note 

A fit note provides medical evidence that an employee is incapable of performing work. It should also detail the length of time the individual should be off work.

A fit note can cover a maximum of 3 months. However, a doctor will usually set a period of time shorter than that to either review their condition or specify a date they’ll return to work. The note can include health and work advice on how to support them once they return, but this is usually covered more in the OH assessment.

The rules on who can issue a fit note used to specify that only a doctor or general practitioner can issue a sick note. Now, a fit note can be issued by:

  • A doctor / GP
  • Nurses
  • Occupational therapists
  • Pharmacists

You can check whether employees’ sick notes are genuine. If you contact their doctor, they’ll be able to tell you whether they provided the note. However, they cannot reveal any medical evidence without employees’ consent.

While a fit note does make a person’s absence legitimate, it does not mean they can remain on leave indefinitely. The change to who issues a fit note applies across England and Wales, as well as Scotland, and is being mirrored in Northern Ireland. This is part of the reason why the Fit for Work scheme was introduced in the first place. However, now the scheme is unavailable, you should instead refer to occupational health..

man being treated by doctor

Occupational health assessment

Once you have done this, and the individual has given consent, they’ll undergo a series of tests. Depending on the situation, the tests they take will be different. Some professionals who provide fit notes can also conduct an occupational health assessment, such as a doctor. However, there are others who can conduct this, including:

The referred employee will be assigned to one, or more, of the above who will assess them. Following the assessment, they’ll produce a report. The employee must also consent to this being shared with you. The report will provide you with health and work advice, plus information relating to the employee’s wellbeing. From there, you must make a decision about their capability and any plans to return them to work.

If the health assessment deems that they’re capable of working, you can start putting together a return-to-work  plan. Take the recommendations by the doctor, or another professional who conducted the occupational health assessment, into account. Plus, some points to consider are:

  • A timeline for their return and anything
  • Adjustments to make returning easier
  • Ways you can support with recovery

Some larger organisations may have their own in-house occupational health service. If so, they can provide advice on returning to work. Most companies won’t have this option and will need to outsource to an external assessment service.

To get the best results, you should conduct a . This helps you manage absence effectively, as well as highlighting any concerns the person might have. Keep a record of the interview as well as any documents provided in the meeting, such as a fit note.

Not sure what questions to include in your interview? Download our free template and questionnaire being forklifted


What types of assessments are there?

As every workplace is different, and each job role has its own hazards. To ensure each employee is fit for work, every occupational health check will be different too. Some will be no more than a questionnaire, requiring employees to fill in a form. Others will require in-depth medical examinations.

When assessing fitness for work, there are many factors an OH specialist might take into consideration. The list is long, so we won’t name them all—here are some of the most common checks staff could undertake:

  • Musculoskeletal questionnaire/assessment
  • Skin health check
  • Respiratory health check
  • Audiometry health check
  • Blood pressure
  • Vision (Keystone test)
  • Vibration health check
  • Colour vision (Ishihara)
  • Urinalysis
  • Mental health/workplace stress assessment
  • General fit for work check

Communicate with the OH provided which type of assessment you need. For example, an employee having to perform heavy lifting as part of their role may need to undergo a musculoskeletal questionnaire. Once the assessment is fit for work assessment is complete, you’ll be provided with a report, including health and work advice to act upon.

You should use this in tandem with a report from a doctor, or any other medical advice you’ve received to assess their capability to return to work.

Mental health capability

One issue that we receive a lot of questions on is capability in relation to mental wellbeing and sick leave. Unfortunately, there is still some stigma in this area, and some employers believe that it does not constitute legitimate sick leave.

However, stress, depression, and anxiety are some of the leading causes of absence in the UK. Whatever your beliefs on the matter, it is a serious issue that needs handling with care. Failure to do so as an employer can lead to tribunal claims and damage to your company's reputation.

Your first step to solving this issue could be to implement an employee assistance programme (EAP). Some of these services offer OH assessments as part of the package. Find out more about our employee assistance programme here.

Other simple steps include drafting and publishing a mental health page somewhere you staff can easily access. Some employers include mental health pages on their company intranet or website.

Sad, Normal & Happy FacesSad, Normal & Happy Faces

Sad, Normal & Happy Faces


Who can I refer to the Fit for Work Scheme? 

Previously, you could refer the following to the Fit for Work scheme:

  • Employees only (not self-employed)
  • Employees who have been absent from work or are likely to be absent for at least four weeks
  • The employee should have a likelihood of being able to return to work within three months and have not used the service in the previous 12 months.

The same criteria applies when referring staff for a fit for work check via an OH assessment.

What are the benefits to employers?

It is not compulsory to use an assessment service. However, there are some benefits to doing so, including:

  • Improved health & safety performance
  • Improved staff relations and morale
  • Improved business efficiency
  • Improved public image and PR
  • Reduces costs associated with accidents and incidents at work
  • Lowers the cost of absences per person

Also, an OH assessment is often more enlightening than a regular medical report. It focuses on the specific job the employees are performing.

2 people in conversation at doctors2 people in conversation at doctors

2 people in conversation at doctors


What is the process if someone isn’t fit for work?

Once a doctor deems a person too sick to work, you need to start considering your next steps. Don’t jump straight to —this should be a last resort. Instead, consider whether there are any reasonable adjustments you can make to make returning to work easier.

If there are none, or the employee rejects the changes, then you could consider a capability dismissal, as they are no longer fit for work.

Stay in communication with the employee during the process. Ensure they are aware of the steps you are taking to accommodate them. If a return to work looks to be impossible, then you can invite employees to a formal medical capability hearing. Make this meeting as accessible as possible—using video call, for example—as they may be unable to attend in person.

If they fail to attend this meeting after multiple invites, you can hold the meeting in their absence. However, having them in attendance is better for both parties.

If the employee does attend, and you cannot come to an agreement about them returning to work, you may issue a letter informing them of dismissal due to them not being fit for work. We would not recommend making a decision in the room. Instead, come away from the meeting and consider the points raised.

In cases where the employee’s absence is related to a disability, you need to ensure you don’t discriminate during the dismissal process. For more employer advice on this issue, speak to one of our HR experts on 01455 858 132.

Practical suggestions on fitness for work

We recommend that employers consider whether to update their sickness absence policies and procedures. If your company wants to utilise occupational health, your documentation should reflect this. Also, if you have an effective absence policy in place, you can reduce your reliance on occupational health. If you have your own OH assessment service, this should also be reflected as a page in your staff handbook, contracts, and/or company website.

When staff undertake work that increases their risk of injury or becoming sick, such as heavy lifting or working with dangerous chemicals, keep OH assessments in mind. You may even use one at the beginning of employment to measure whether they are fit for work or not.

Remember that rules around who can write a fit note have changed. Don’t reject a fit note just because it hasn’t been issued by a doctor.

Finally, when seeking solutions on health and working on-site, remember to communicate with your staff. They should be your first stop when gathering data on the issues that affect their well-being and safety. You could put together a form or questionnaire that they fill in anonymously to gauge their major concerns.

Support with Occupational Health

Although the Fit for Work scheme is no longer viable, you still have options when an employee has health concerns. Using occupational health is a good way to assess fitness for work, but you must be sure to get the process right to avoid discrimination. 

To ensure you manage sickness absence properly, from the first sick note to a capability dismissal, speak to a Croner expert on 01455 858 132.

About the Author

Kathryn Adderley

Kathryn Adderley is Croner's Senior Content Executive, responsible for producing, sourcing, and organising content across the website. She has a background of working agency side as a copywriter in the marketing industry and is also responsible for Croner's social media channels, so keep your eyes peeled for fresh content!