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Fitness for work : Opening doors back to work

File 104971A new assessment tool means physios can play their part in getting people back to work at an early stage. Daloni Carlisle reports.

Physiotherapists have played an important role in assessing people’s fitness for work and how much help they might need to remain there when they fall ill.

So when physios lost the right to sign ‘sick notes’ in April 2010, many saw it as a backward step.

Now they could be set to reclaim that role and provide a valuable service to employees, employers and GPs through a new Assessment of Fitness for Work initiative that, pending an official launch date, goes live in the next few weeks.

Léonie Dawson, CSP professional adviser, explains the background.

‘Before 2010, many physiotherapists had local agreements that allowed them to sign the old Med 3 form,’ she says. ‘That’s the one most people would know as a “sick note”.

‘This meant physios were able to sign people off for statutory sick pay and it was very valuable for everyone involved. Physios could use their expertise efficiently and help to save GPs’ time.

In the dawn of the era of self referral, patients could see only one health professional rather than two.’

Then in 2010, the government introduced the new GP Statement of Fitness for Work.

It was developed following the publication of Dame Carol Black’s review of the health of Britain’s working age population in 2008.

Her report, Working for a healthier tomorrow, argued that routinely signing people off sick was counterproductive to the individual’s health and wealth as well as to the wider economy.

Dame Carol suggested that creating a ‘fit note’ could help to reduce sickness absence. It would involve assessing employees’ fitness for work, what they needed to do to stay at work and then providing this assessment to employers.

In theory it was a great idea. For example, it would allow GPs to advise employers on adjustments they could make that would allow people to stay in work while not 100 per cent fit. The new form put the emphasis very much on the GP. ‘It became a legal requirement that only a doctor could sign it,’ says Ms Dawson.

‘It was a big backward step for physios.’  Nor did it seem to deliver the outcomes Dame Carol wanted.

She reported in 2010 that 85 per cent of people being assessed were still being signed off sick.

The fit note was in danger of becoming a sick note, she warned.  So in stepped the CSP, College of Occupational Therapists and Society of Chiropodists and Podiatrists.

In consultation with the Department of Health and the Department for Work and Pensions they designed an Allied Health Professional Assessment of Fitness for Work.

It’s an A4 sheet on which AHPs can write detailed recommendations about return to work and aims to help employees, employers and GPs to focus on what a person can do while using work as part of their rehabilitation, rather than simply signing him or her off sick.

‘Ideal opportunity’ for physiotherapy

‘The introduction of the AHP assessment tool is an ideal opportunity for the profession to support people in using work as part of their rehabilitation,’ says Ms Dawson.

With expertise that spans mental and physical health and well-being, physiotherapists are ideally placed to stop people going off work, getting people back into work on full, normal duties or, if alternative or modified duties are required, facilitating a managed return to work.

The three professional bodies tested the new assessment in 2011. The CSP bought the software that would allow AHPs to create an electronic version.

With no external funding, an evaluation was carried out using the free, web-based tool SurveyMonkey.

‘We had very positive feedback,’ says Ms Dawson. ‘AHPs found it consistent and useful.

Employers said it was useful and provided clear recommendations on what they could judge whether to carry on employing someone. In addition, GPs were positive.’

The Assessment of Fitness for Work could be adopted widely. It will be available through the CSP’s and all the AHP websites, albeit behind membership walls.

Information about how to use the assessment is already appearing in educational courses, including those run by the Association of Chartered Physiotherapists in Occupational Health and Ergonomics.

So great is the interest in this area that the last two courses on assessing fitness for work and function – one held at the end of 2011 and one at the beginning of 2012 – sold out.

The association is planning more.

Course leader and association member Catherine Burke has used the assessment in her day job as chief physiotherapist at the Northern Ireland Police Service’s occupational health and wellbeing department.

As an acknowledged expert – both professionally and by her employer – Mrs Burke welcomes the assessment but feels it replicates what she would do anyway as a matter of routine.

‘As an extended practitioner, I am already integral to the organisation and have for many years been doing fitness for work assessments,’ she says.

‘So it was nothing new for us in terms of what we do with our patients, and was really a matter of filling out a form for the GP.’

This might not be the case for every user, though. ‘Our situation is very different from the outpatient physio who is not normally working in this area,’ she says.

‘I do think that physios are the best-placed professionals to undertake these assessments but, and this is a big but, it is different from normal clinical practice.

It does change the emphasis of the relationship with the patient.’

As an occupational health physio, patient care remains central to Mrs Burke’s role and her duty of care is to the patient.

‘But there is also a duty of care to the employer,’ she adds. Training needs Physios giving employment advice need to understand the workplace and be aware of the implications of any advice they give, Mrs Burke stresses.

‘The implications can be quite far reaching; this is about people’s livelihoods.

My concern about AHPs getting involved in these assessment notes is that they should have the appropriate training to have the competence and confidence to give advice on fitness for work.’

But not every workplace has such good occupational health services.

A 2010 CSP survey found that more than half of small and medium size enterprises accept the business case for investing in health and wellbeing initiatives.

But according to the CSP report Sickness costs, more than a third of these enterprises felt that only big companies could afford them for their staff.

In almost two thirds of cases, the respondents did not provide occupational health services such as physiotherapy.

The new assessment could provide a way of linking employers with the physiotherapy services – whether private or NHS – used by employees in these enterprises.

Ms Dawson says: ‘We want to see physios working alongside GPs for the benefit of employees and employers.

The CSP hopes that the successful adoption of the form by members will deliver evidence that the profession is ready to take on a greater role in reducing absence because of sickness.

Once the tool is out there, the profession has to engage with it to realise its potential’.  

She adds: ‘The tool is being launched as the Black Review (see below) has recommended the creation of an Independent Assessment Service to support people back into work.

The profession and the tool are ideal for the purpose.’ fl


How does the Assessment of Fitness for Work help GPs, employees and employers?

It has been created in A4 to provide space for the AHP’s detailed recommendations and can be used by:

  • AHPs to provide advice to employees on fitness for work and how a return to work could be facilitated employees to provide evidence to their employer for sick pay purposes
  • employers to agree appropriate modifications to an employee’s environment to enable him or her to work
  • employees to give to their employer as part of a return to work discussion
  • doctors as a report on which to base the provision of a Statement of Fitness for Work to the employee

For more information, visit: www.csp.org.uk/professional-union/practice/assessment-fitness-work

Last November, the Department of Work and Pensions published Health at Work: An independent review of sickness absence.   Co-written by Dame Carol Black (left), it calls on the government to fund a new Independent Assessment Service.   Delivered by AHPs and subject to quality control measures, the service would provide in-depth assessments of a person’s physical and/or mental function. It would also provide advice on how someone taking sickness absence could be supported to return to work. It says employers using it could save some £100 million annually in sick pay.


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