Guidance

Annex B – Case studies

Updated 6 October 2023

1. Case study 1: Workplace changes based on healthcare professional’s advice – Working from home

A proof-reader in a publishing company receives a fit note from an employee stating they have a cold and cystic fibrosis. On the fit note, the healthcare professional has advised that they ‘may be fit’ for work and has ticked the workplace adaptation box. The fit note covers a period of 10 days, and the healthcare professional has indicated that they do not need to see the employee once the fit note expires.

The healthcare professional’s further advice in the comments box of the fit note reads: The employee cannot travel into the office because they are at high-risk of developing a chest infection whilst they have a cold. The increased risk is due to their pre-existing chest condition: cystic fibrosis. The employee is able work from home during this period.

During the health and work discussion, based on the fit note information, the employee is advised to work from home for the next 10 days to help with their recovery and their return to work. The employee is sent an e-mail of their work schedule during this sickness absence

After 10 days, the employee recovers from their cold, returns to work and continues with their current job without going back to see the healthcare professional.

2. Case study 2: An employer makes changes – a delivery driver who can’t drive

A delivery driver has just undergone laser eye surgery and has been advised by the healthcare professional to refrain from driving for the next 2 weeks.

The healthcare professional has issued them with a fit note stating they ‘may be fit’ for work. The healthcare professional ticks the ‘amended duties’ box and the advice in the comment box of the fit note reads: ‘Dry eyes, may experience temporary blurring of vision. Should not drive for 2 weeks. They can still perform other reasonable physical tasks. Mental function unaffected. If they use the computer, they should take regular short breaks as per standard guidance.’

The healthcare professional also indicates on the fit note that they do not need to see the employee once the fit note expires so the employee can return to work after the sickness absence.

The employee has a health and work meeting with the employer to discuss the fit note and both parties agree that the individual should not drive for the next 2 weeks, and the employee is assigned to general admin duties during their recovery period.

After 2 weeks the employee’s eyesight is back to normal, and they return to their normal driving job, without having to see the healthcare professional.

3. Case study 3: Short term illness due to long COVID

A patient has been on sickness absence for the last 2 months from their current education-based job due to long COVID. An appointment to see the occupational therapist has been booked for the patient following a repeat fit note request at their GP practice.

They present with symptoms of fatigue, breathlessness, and anxiety affecting activities of daily living, and quality of life. Following the assessment, the patient is issued a fit note from the occupational therapist indicating ‘not fit for work.’

After a number of consultations, the occupational therapist and the patient agree on actions to support the patient’s recovery that include energy conservation, routine building, and coping strategies.   A new fit note is then issued indicating the patient ‘maybe fit’ for work including recommendations of a return-to-work plan and reasonable adjustments. The advice reads “Patient is experiencing fatigue, advise a phased return to work starting at reduced hours at three days per week, suggest regular reviews before increasing.  Some supportive adjustments include a quieter space to work, a quiet space for relaxation, provide additional time for administration tasks, postpone additional projects until settled into compulsory tasks of role.”  The patient, their employer, and occupational therapist also meet to agree what would be reasonable.

After 6 consultations with occupational therapists, the patient returns to their education-based job.  The patient is then discharged after 3 months as they have achieved and sustained a phased return to support their recovery back to work.

4. Case study 4: History of lower back pain and return to employment

A building labourer has been unemployed and claiming benefit for the last 2 years due to low back pain. They have been receiving repeat fit notes indicating as ‘not fit for work’ for their benefit claim and have been booked an appointment with the occupational therapist.

At the appointment, the patient explains they are interested in working but have not been able to return to a construction job due to their back pain and they are concerned about their job prospects in other industries. The occupational therapist identifies that the back pain is well managed and that they cope well in activities of daily living. The occupational health therapist discusses potential job roles with the patient. The patient is advised about reasonable adjustments and how this can support a return to work.  The occupational therapist issues a fit note indicating ‘may be fit’ for work and the advice on fit note reads “Back pain is triggered by prolonged walking and standing, repeated bending, repeated use of stairs or ladders.  Alternative job roles to construction may be more suited.  May require adjustments that include seated breaks for standing tasks, reduce regular bending or use of stairs. Would require a workstation assessment if engaging in computer-based work.”

The patient is referred to a local vocational service to support work search activities. They are enrolled on a hospitality course and are successful in obtaining a part time job with supportive adjustments.

5. Case Study 5: Phased return following an acute short-term illness

A patient has a respiratory infection and is treated by the Practice Nurse. During the health and work discussion, the Practice nurse prescribes the patient antibiotics and advises the patient to rest for the week to recover from this infection. The Practice nurse also advises the patient they could self- certificate for 7days and agrees a treatment plan.

The practice nurse then issues a fit note stating the patient ‘may be fit’ for work and advises that the patient should refrain from work for 14 days and have a phased return to work after this period.

The patient is relieved that they could take the time to recover, and a phased return as is advised on the fit note is agreed by the employer. The nurse states on the fit note they do not need to see the patient again at the end of the period as they expect the patient to be back to normal after this time.

6. Case study 6: Mental health review for patient with low mood

A patient, that has been off work due to low mood has been booked a mental health review with a healthcare professional. This health condition has been affecting their sleep pattern and ability to focus during working hours. This has been impacting their work as concentration and safety is critical in their role.

The healthcare professional discusses and agrees a treatment plan and arranges to review the patient in one months’ time. By this time, the healthcare professional expects the treatment to have started to have some effect. The patient is issued a fit note for a month stating they are ‘not be fit’ for work.

The patient is advised by the healthcare professional to discuss a referral to Occupational health and work-related stress contributing to their mental health problems with their employer.

During the health and work discussion with the patient, a referral to the occupational health team which supports the patient’s return to work is done.