Fit for work - will it be fit for purpose?

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The new government funded advisory and assessment scheme, Fit for Work, is currently being rolled out with the intention that the service will be operational across Great Britain from May.  

We take a look at what the Fit for Work scheme (‘FFW’) involves and how it might impact on your existing attendance management and sickness absence processes and, in particular, the obligation on employees to provide GP fit notes.

What does FFW comprise of?

There are two elements to FFW:

  • Advice - provision of free and impartial advice on sickness absence issues for employees, employers and GPs provided by specialist advisers and accessed via the internet and telephone. Click here to access the Fit for Work webpage http://fitforwork.org

  • Assessment - once an employee has been absent from the workplace for four weeks, or is assessed as likely to be off for more than four weeks, their GP can make a referral for a free assessment by an occupational health professional. If an employee’s GP fails to make a referral by the time an employee has been absent from work for four weeks, an employer can refer an employee directly.

FFW will not provide employees with any rehabilitation treatment/services, for example, physiotherapy or counselling.  Such treatment will need to be accessed independently of the scheme, even if it is recommended as a result of a FFW assessment.   

Why is FFW being introduced?

FFW is a result of recommendations made following a major sickness absence review commissioned by the government in 2011 and overseen by Dame Carol Black, the Government’s National Director for Health and Work.  The review highlighted the absence of easily accessible good quality occupation health advice and assistance as a significant hurdle in tackling employee sickness absence levels.  FFW is primarily aimed at SMEs, although any employer can access its services.

How will the assessment element of FFW operate?

There are effectively three stages to the FFW assessment process:

Referral  

Once an employee has reached, or their GP expects them to reach, a period of four weeks absence, (which will include any period of self-certified sickness), they can be referred for a free occupational health assessment.

Although a referral for assessment is intended to be the default position in respect of an employee’s absence from work on sick leave for a period of four weeks or more, a referral requires an employee’s express consent, which they are under no obligation to provide.

Referrals will also be subject to a GP’s clinical judgement.  A GP can make a referral earlier or later than the 4 week trigger point if they judge this appropriate. In some cases they may decide against making a referral at all, if, for example, an employee is in a particularly acute stage of an illness or they feel it unlikely that an employee will ever be able to return to work.  Employee guidance in relation to Fit for Work recommends that an employee should inform their employer that they have been the subject of a referral, but there is no obligation on them to do so.

Employers can also make direct referrals for assessment, if the employee’s GP has not done so by the time the employee has been absent for four or more weeks.  Again, such referrals will be subject to the employee giving express consent. An employer is not obliged to contact the employee’s GP to inform them they have made a referral. Any duplicate referrals to FFW will be combined.

Employees can only be referred for one assessment in any 12 month period, although there is no limit on the number of employees that can be referred by an employer.

Assessment  - usually by telephone

Once a referral has been made, a case manager with suitable occupational health skills will contact the referred employee directly to carry out a telephone assessment.   It is envisaged that only in the minority of cases a face to face assessment will be deemed necessary.

The assessment approach adopted will be ‘bio psychosocial’ – essentially  holistic, dealing not only with the employee’s medical condition and their job requirements, but also their general physical and mental health and any other social and domestic issues that might be impeding a return to work.

Return to Work Plan

Following an assessment, the case manager will generate a ‘Return to Work Plan’ containing advice and recommendations aimed at returning the employee to work.  If they feel it is appropriate, the case manager will seek the employee’s consent to contact their employer for any further work-related information required to prepare the plan.

Once prepared, and subject to the employee’s consent, the Return to Work plan will be shared with their employer as well as their GP.  It will specify the steps to be taken by the employee, the employer and the employee’s GP with specified time frames in order to achieve the employee’s return to work by a target date.  It is envisaged that the target return date for most cases will be within three months of referral, even if this is on the basis of an initial phased return.

There will be provision made for case managers to check in with employees at certain stages to ensure that everything is on course to meet the target return date.

The case manager will check in with an employee shortly after the anticipated return date. If a target return date is missed, there is scope for the case manager to extent the length of the plan.

Return to Work Plans acceptable ‘in place of’ fit notes

The official DWP employer guidance which accompanies the FFW scheme advises that if an employer is in receipt of a Return to Work plan, they should not insist on receiving a GP fit note as well in relation to any period covered by the plan. Similarly, the official GP guidance to the operation of FFW encourages GPs not to issues fit notes in relation to any period for which is covered by a Return to Work plan. This is an important change to the current operation of the GP fit note scheme, and may impact on the certification requirements of many employers’ attendance management/sicknesses absence policies.

How will FFW fit with employer’s existing occupation health provision?

When announcing its introduction, the government emphasised that FFW was intended to compliment rather than replace existing employer occupational health provision.  Inevitably, the FFW assessment service will be of most use to smaller and owner managed businesses which don’t have in-house occupational health provision or don’t have easy access to good quality external resources.

FFW case managers are actively encouraged to work along-side and in co-operation with employers with the common goal of an employee’s early return to work.  Many larger employers’ occupational health referral systems will be triggered in advance of the FFW four week assessment trigger.  In such circumstances, if there is already an internal occupational health assessment in existence at the point of contact, it is unlikely that a FFW case manager will take any further action.

What are the limitations of FFW?  

Concern has been expressed by a variety of stakeholders that there will be insufficient resources made available to ensure that the service is delivered by individuals with the right level of occupational health expertise. 

Similarly, given that the assessment service will be telephone based in the majority of cases it is questionable whether such assessments will be sufficiently rigorous.  The FFW scheme will be delivered by health professionals who may not be particularly well versed the requirements of specific workplaces or jobs and unlikely to have much capacity to make on-site visits.

The services target turnaround time-frames, such as two days post referral for a telephone assessment, or five days for a face-to-face assessments also seem somewhat ambitious, given the likely resources available and it is probably realistic to expect some slippage.   

Tax exemption for recommended medical treatment

From 1 January 2015 the Government also introduced a tax exemption removing the tax and NIC liability for the first £500 worth of medical treatment paid for by the employer per employee per year, where that treatment has been recommended by the employer’s own OHP, or as a result of a FFW assessment.    

What should employers do now in preparation for the FFW roll-out?

  • The government has published employer guidance on the operation of the new scheme. You can access this guidance here.

  • Ensure that those within your business who are involved with the management of sickness absence are aware of the operation of the FFW scheme and the possibility of being contacted by a FFW case manager in relation to a Return to Work Plan.  Such employees should be aware of what they should do in these circumstances. For example, channel all such contact centrally to HR or an internal occupational health department, as appropriate.     

  • Review attendance management/sickness absence policies to ensure that there is nothing which is inconsistent with the operation of FFW, in particular taking into account that a Return to Work Plan can replace a fit note as evidence of sickness absence.  Companies and members who subscribe to our HR and employment law support should note that we have updated our model Attendance Management Policy to reflect the availability and potential impact of the FFW scheme.

Companies and members who subscribe to our HR and employment law support can also view our online guidance to find more information on employers’ other legal obligations in relation to the management of sickness absence. 

Author

Principal Legal Adviser

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