Medical Certificates: Autism and Mental Illness

Fit notes can be certified by five groups of healthcare professionals: doctors; nurses; occupational therapists; pharmacists; and physiotherapists.

Fit notes are based on the professional’s clinical assessment of a patient’s health condition, and their clinical assessment of the patient’s fitness for work. In carrying out suitable clinical assessments of a patient’s health condition, this should include reference to National Institute for Health and Care Excellence (NICE) guidelines, where relevant.

NICE guidelines are not mandatory, however professionals and practitioners are expected to take NICE guidelines fully into account, alongside the individual needs, preferences, and values of their patients and service users, when exercising their professional judgement.

The Government’s recently announced fit note pilots will test reforms to the fit note in four integrated care boards across England. These pilots will test replacing the traditional general practice (GP) led fit note process with newly designed plans, and new work and health teams, to better support people who fall ill at work.

Clear clinical oversight and escalation routes are built into the pilots, including to ensure GPs retain a meaningful role in complex cases. Any future rollout or reform will be informed by learning from the pilots.